Groundlings Summer Day Camp 2019
We live grounded in God's love and "filled with Joy and the Holy Spirit." Acts 13:52

Groundlings Day Camp is a multi-generational summer ministry of the Los Altos UMC and St. Gregory's Episcopal Church. We strive to offer every Groundling camper a sense of deep belonging in a supportive community of their peers through a whole lot of of recreation and play, creativity, and fun. Paired in “family groups” throughout the day, Groundlings campers learn about themselves and one another, and our collective faith story.

Our hope is that every Groundling camper will leave us after a week or more of camp with a sense of community, belonging, and an understanding of their unique ability to impact our world.

Location: St. Gregory's Episcopal Church, 6201 E. Willow, Long Beach, CA
Camp Hours: 9:00am - 3:00pm (before and after care available for additional charge)
Ages: Kindergarten - 8th grade
(Must be 5 years old prior to September 1, 2019)

Camper Registration
Kindergarten - 8th Grade
(Must be 5 years old prior to September 1, 2019)
Child's last name *
Your answer
Child's first name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Date of birth *
Your answer
Grade entering Fall 2019 *
Parent/guardian name (Last, First) *
Your answer
Parent/guardian cell *
Your answer
Parent/guardian email *
Your answer
Each week of Groundlings Summer Day Camp offers our beloved super-fun recreation, crafts, music or yoga, free play and time with friends!  Plus, each week will have a special focus on caring for God’s Earth and its creatures with a themed service project. Which weeks will your child attend? Camp Hours: 9:00am - 3:00pm *
Required
Payment is due at time of registration. Registration for camp will not be complete until payment is received. Registration will be cancelled if full payment is not received by June 30, 2019. No exceptions. Payments not accepted at camp. *
Before and After Care Registration
Before and After care is provided for campers from 7:00am - 9:00am, 3:00pm - 5:00pm. A $1/minute charge will be applied for campers picked up after 5:00pm. Child Care must be paid for at time of registration.
Are you interested in extended care? 7:00am-9:00 & 3:00pm-5:00pm? *
$60 per week. $30 sibling rate. Drop-in rate no longer available.
I understand payment for child care is required at time of registration. Payment will not be accepted at camp. *
$60 per week, $30 per week sibling
Authorized Adults for Camper Drop-Off and Pick-Up
Camper safety is our #1 priority at Groundlings. Campers must be signed in and out by an authorized adult. Campers arriving after the start of camp (9:00am) must be signed in, by an adult, with the Camp Director. Parking lot/street-side drop-off is not permitted.
Family members and friends must present a valid photo ID when signing out your child. Please list anyone who has permission to pick up your child in the space below. *
Your answer
Anyone not authorized to pick-up your child? This information will be kept confidential.
Your answer
Media Release and Authorization to Treat a Minor
Media Release: I hearby give my permission for Los Altos United Methodist Church to use photos and videos of my child/children in church publications, including brochures, newsletters, the church website, and social media. For reasons of privacy, no personal information, including name, may be printed with any photos. I understand that there will be no remuneration for the use of these pictures. *
(Type your name to authorize. If not, please leave blank ).
Your answer
AUTHORIZATION AND CONSENT TO TREAT A MINOR Pursuant to California Civil Code Section 25.8 : The undersigned do hereby authorize LOS ALTOS UNITED METHODIST CHURCH, IT’S AGENTS, EMPLOYEES and VOLUNTEERS or such substitute as they may designate as agent for the undersigned to consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care for the above minor which is deemed advisable by and to be rendered under the general or special supervision of any physician and surgeon, licensed under the Provision of Medicine Practice Act or of any dentist licensed under the dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, camp, or elsewhere. Further, we give permission for the above minor to participate in all regular activities or programs of LOS ALTOS UNITED METHODIST CHURCH, ITS AGENTS, EMPLOYEES and VOLUNTEERS. Said LOS ALTOS UNITED METHODIST CHURCH, ITS AGENTS, EMPLOYEES and VOLUNTEERS are hereby released and relieved from all liability for accident or injury arising from any and all activities. This authorization will remain effective while the above minor is en route directly to or from or involved or participating in any program or activity of the LOS ALTOS UNITED METHODIST CHURCH GROUNDLINGS SUMMER DAY CAMP 2019, unless revoked in writing by the undersigned, and delivered to Los Altos United Methodist Church. *
Electronic signature of parent/guardian
Your answer
Date *
Your answer
Please list allergies and food restrictions below *
Your answer
Groundlings provides one mid-morning snack. All snack items are donated by Los Altos UMC and St. Gregory's Episcopal Church. While we try to accommodate everyone, if your child has specific dietary needs or restrictions we recommend packing an extra snack in the event that your child cannot eat the snack provided by Groundlings.
Name of family physician *
Your answer
Physician phone number *
Your answer
Medical insurance plan *
Your answer
Medical insurance policy number *
Your answer
During camp, I can be reached at this number *
Your answer
Contact person if I cannot be reached *
Name (Last, First),
Your answer
Contact's phone number *
Your answer
Contact's relationship to child *
Your answer
Camper Cell Phone Policy Promise
I understand Groundlings has a No Cell Phone policy during camp hours. I will adhere to this policy during camp hours. I understand failure to do so may result in being sent home for the day. *
PAYMENT: $119/ per camper/week (K - 8th) until May 31, 2019 *** Please Note: Daily Rate No Longer Available for Camp Registration ***
PAYPAL/CREDIT/DEBIT:
See PayPal link below
PayPal does not auto calculate amount due. You will need to enter amount due.

CHECK:
Make checks payable to: LAUMC
Please put Groundlings/Campers Name in memo line of check
Mail to Los Altos UMC, 5950 E. Willow Street, Long Beach, CA 90815 Attn: Groundlings

Partial camperships are available. Please contact Rev. Melinda T. Dodge for more information: mdodge@losaltosumc.org

PayPal/Credit/Debit Card Payment
http://www.losaltosumc.org/activities-events/

paypal@losaltosumc.org
Specify GROUNDLINGS and name of camper in notes section

Refund Policy
Groundlings Summer Day camp will offer full refund of registration up to May 25, 2019.
A $20 administrative fee will apply for all refunds May 26, 2019 - first day of camp.
Please allow 2 - 3 weeks to process refund.
Additional information you would like to share about your camper?
Your answer
Reminder: Payment is due at time of registration. Registration for camp will not be complete until payment is received. Your registration will be cancelled if full payment in not received by June 30, 2019. No exceptions. Payments not accepted at camp. *
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