Author: Susan

Yakima Adventist Christian School
2019 Registration 1200 City Reservoir Rd ● Yakima, WA, 98908 509.966.1933 ● www.yacsschool.org
A non-refundable reservation fee of $20 will hold your
KidZone spot. Reservation fee will apply to overall camp fee.

Child’s Name:_____________________________________
Address:__________________________________________
City:_______________ State: _______ Zip: _____________
Age: ________________ Date of Birth: _______________
School Attending: __________________________________

Family Information
Name of Parent/Guardian: _____________________________________ Home Phone:___________ Cell Phone:_____________
Email: _____________________________________________________ Lives in Home: Yes No Work Phone:____________
Name of Parent/Guardian: _____________________________________ Home Phone:___________ Cell Phone: _____________
Email: _____________________________________________________ Lives in Home: Yes No Work Phone: ___________
Emergency Care Information
Name of Child’s Doctor __________________________________________________ Phone ____________________________
Name of Child’s Dentist __________________________________________________ Phone ____________________________
Hospital Preference ______________________________________________________ Phone ____________________________
In case of emergency, if neither guardian can be contacted, please contact:
Name _____________________________ Relationship ________________________ Phone _____________________________
Name _____________________________ Relationship ________________________ Phone _____________________________
Persons with whom the child may be released (other than guardians):
Name _____________________________ Relationship ________________________ Phone _____________________________
Name _____________________________ Relationship ________________________ Phone _____________________________

Session Dates	Weekly Theme	Full Day / 8:30 to 3:30	Extended / 7:30 to 5:30	Half Day / 8:30 to 12:30	Drop-In / 8:30-3:30	Dates
June 17-21	Let’s Grow: Gardening Class	□	□	□	□
June 24-28	Spice It Up: Cooking Class	□	□	□	□
July 1-5	Closed
July 8-12	Hit It Again: Sports Class	□	□	□	□
July 15-19	Art Attack: Art Class	□	□	□	□
July 22-26	Nailed It: Woodworking Class	□	□	□	□
July 29-August 2	Miss Mash: A mix of this and that!	□	□	□	□

Customize Your Camp Experience

Cost:
Half-day: $85/week
Full-day: $160/week
Extended: Add’l $27/week
Drop in (full-day): $37/day
Drop In (half-day): $20/day
Multiple Week Discount:
Full-day campers: take advantage of the 10% discount when attending multiple weeks!

Please list any disabilities, fears, or allergies: ______________
___________________________________________________
___________________________________________________
Grade entering for 2019-20 school year: __________________
Gender: Male Female

2019 KidZone Summer Day Camp Notices and Permissions

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I acknowledge that I received the KidZone Summer Day Camp Guide containing policies and procedures relating to the KidZone Summer Day Camp Program. Furthermore, I understand the policies and if I have questions I will ask a staff member for clarification.
I have read and understand the Payment and Refund Policy found in the KidZone Summer Camp Guide.
There is a $20 non-refundable reservation fee required to reserve your child’s spot. This fee will apply to your overall camp fee.
Program payment must be paid in full by the Monday of the first day of camp.
Returned checks will incur a $30 fee each time the bank refuses payment.
My child, __________________________ has permission to fully participate in the Yakima Adventist Christian School KidZone Summer Day Camp. I, as the parent/legal guardian, do grant the YACS staff and designated adults the right to authorize emergency medical treatment for my child in the event that I or my emergency contacts cannot be reached. I agree to hold YACS and its agents harmless from liability resulting from an accident. I grant permission for staff to take whatever steps may be necessary to obtain emergency treatment for my child. These steps may include but are not limited to the following:
Calling 911 before making any attempt to contact parents in a life-threatening emergency or urgent situation.
Attempting to call the parent/guardian first in the case of a non-life threatening emergency, and proceeding to contact the parent-provided emergency contact as needed.
Calling the paramedics or sending the student to the sick room if no one can be contacted (depending on the seriousness of the situation).
My child, _________________________, has a serious medical condition. I have completed a Medical Information Form with adequate instructions on how to treat my child’s condition, and have provided necessary medication for his/her care at camp.
□ Yes □ No
My child has the following food, medication, or other allergies:
□ None
□ Please list________________________________________________________________________________
I have read and understand the Sunscreen Policy of the KidZone Summer Day Camp Guide.
□ I will send sunscreen (labeled with my child’s name) to school for my child and instruct him/her on how to
use it.
□ I will encourage my child to wear a hat to protect his/her face.
My child and I have read and discussed the Code of Conduct and No Tolerance Policy found in the KidZone Summer Day Camp Guide.
My child has permission to go on the various field trips planned during KidZone Summer Day Camp. I understand I will also be given a list of field trips each week.
I understand my student may be using web-based activities on the YACS computers at some time during KidZone Summer Camp.
Yakima Adventist Christian School would like to use pictures of your child in a group to promote the school and the KidZone Program. No names will be used.
□ Yes, I give permission for the school to use pictures of my child in a group.
□ No, I do not give permission for the school to use pictures of my child in a group.
I understand that the enrollment of my child in the YACS KidZone Summer Day Camp Program constitutes my agreement to the above.
______________________________________________________ ________________
Parent or Guardian Signature Date
______________________________________________________
Print Name