New Life Harvest Church - Spring Camp Registration 2016 - Richmond, VA
New Life Harvest Church - "We are saving and strengthening families."

Spring Camp Registration 2016
 
New Life Harvest Church
Location:
133 E. Belt Blvd, Suite D
Richmond, VA 23224
(804) 426-5314
(804)230-5950
 
Hours:
Mon - Fri: 7AM - 5:30PM
 




Begins March 28 - April 1, 2016
 
For 1 Week of Fun for only $80 we accept ages 4 and up!
 
Spaces are limited!!!
Payment options available!
 
Call today! (804) 230-5950 or (804) 426-5314
 
 
 
Spring Camp 2016 Registration
1 Week of Spring Fun! Ages 4 & Up (good for 1 Child)
Price: $80.00
 
Fun Daily Activities!
 Caring Environment!
Life Lessons Learned!
Breakfast and Lunch Provided! 
 
 
 
Please Be Sure to Fill Out Our Online Application After Payment is Made or Call us at 804-230-5950
*An Application Must Be Completed for Each Child*
 
 
SPRING CAMP REGISTRATION 2014
LIST NAMES OF CHILDREN AND AGES
DATE OF BIRTH OF CHILD
NAME OF CHILD
ADDRESS
CITY
STATE
ZIPCODE
HOME PHONE
FATHER'S NAME
EMPLOYER
WORK PHONE
CELL PHONE
MOTHER'S NAME
EMPLOYER
WORK PHONE
CELL PHONE
EMAIL ADDRESS
MEDICAL PHYSICIAN'S NAME
PHONE
Is Your Child on Medication that We Need to Know About?
Yes or No
Yes
No
If yes, please explain:
In Case Of Emergency, Contact:
Relationship to Child:
Your Child will be released only to the parents/guardian or the following person(s):
Phone
Your Child will be released only to the parents/guardian or the following person(s):
Phone
Parent's/Guardian's Agreement and Consent
1. I understand that the tuition for Summer Camp Program is based on age and availability and is Non-Refundable once the program starts.
Yes
No
2. I understand that the Summer Camp Program will be open Monday - Friday 7am - 5:30pm, and will be closed for Holidays.
Yes
No
3. My child has permission to participate in field trips and swimming activities; and can be transported by Summer Camp Program Staff
Yes
No
4. In the event of an emergency, the staff of the Summer Camp Program can administer first aid to my child or obtain emergency treatment, if necessary. I also understand that the staff can only administer dated, labeled and prescribed medication. I realize that I must leave written permission before my child can be administered his/her medication.
Yes
No
Certification: I certify that I have read and undertand this application. Electronic Signature (Print Name)
Today's Date

 
 
 
 
 
 
 

 
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