2017 SUMMER CAMP
LIMITED SPOTS ARE AVAILABLE FOR ALL OF OUR CAMPS - register early, first come first serve!
PLEASE SEE SUMMER CAMP SCHEDULE for specific dates, weekly themes, and more - provided ON OUR WEBSITE to download at www.eteachingme.com/camps.html

Monday - Thursday's (June through August dates) *closed Fridays
Daily Times: 9:30 am to 2:30 pm
Register as you need ~ just 1 day, 2, or 3 - or for the whole 4 day week!

$35.00 per child, per day (sibling discounts available)
SPECIAL: All 4 camp days, only $125 per child ($115 siblings)
Monthly discounts are available - contact eteachingme@gmail.com

Kids will enjoy weekly themed activities - games, craft projects, playtime, stories & movies, snack time daily, & interacting with friends! PARENTS ARE REQUIRED TO BRING A SACK LUNCH & A BOTTLED WATER FOR THEIR CHILD! Daily snacks will be provided & is included in camp fee.

We look forward to having you and your child(ren) join us for learning and fun at eTeachingMe!

Summer 2017 REGISTRATION FORM
FAMILY NAME
Please list the last name in which you want your family account to be identified by.
Your answer
Parents/Guardian First & Last Name
Your answer
Phone Number 1
Your answer
Email Address
Your answer
Home Address
Your answer
Child #1 Enrolling: Name
Your answer
DOB
Your answer
Current Age of Child #1
Allergies, Needs, or Medical Conditions (If none, type N/A)
Your answer
Child #2 Enrolling: Name
Your answer
DOB
Your answer
Current Age of Child #2
Allergies, Needs, or Medical Conditions (If none, type N/A)
Your answer
Additional Childr(en) Enrolling
If none - leave blank. Please list any additional child(ren) you are wanting to enroll in camps. List their NAME, DOB, Current AGE, and any ALLERGIES they may have.
Your answer
WEEK 4 - SENSORY EXPLORATION CAMP (June 26 - 29)
IF YOU WANT JUST 3 DAYS this week - please click on OTHER & specify which 2/3 days of the week. Please note: we do NOT have camp on Fridays, as we will be closed.
WEEK 5 - ANIMALS CAMP (July 3 - 6)
IF YOU WANT JUST 3 DAYS this week - please click on OTHER & specify which 2/3 days of the week. Please note: we do NOT have camp on Fridays, as we will be closed.
WEEK 6 - GLOW IN THE DARK FUN CAMP (July 11th & 13th only) *Ages 5 to 10 years only *6:00 to 8:00 pm - $50 total for both days
WEEK 7 - LITERACY CAMP (July 17 - 20)
IF YOU WANT JUST 3 DAYS this week - please click on OTHER & specify which 2/3 days of the week. Please note: we do NOT have camp on Fridays, as we will be closed.
WEEK 8 - SCIENCE CAMP (July 24 - 27)
IF YOU WANT JUST 3 DAYS this week - please click on OTHER & specify which 2/3 days of the week. Please note: we do NOT have camp on Fridays, as we will be closed.
WEEK 9 - WARS WEEK CAMP (July 31 - Aug 3)
IF YOU WANT JUST 3 DAYS this week - please click on OTHER & specify which 2/3 days of the week. Please note: we do NOT have camp on Fridays, as we will be closed.
Minute To Win It - DAY CAMP (Mon, August 14)
A full camp day full of hands-on, challenge activities - 930 am to 230 pm. Snack is provided and a full lunch. $40 per child for the day (siblings $35)
Emergency Contact
In case of an emergency situation, please list one local person that we can contact other than the parents/guardian listed above.
Your answer
Emergency Contact Phone #
Your answer
Emergency Contact Relationship to Child
Is this person also Authorized to Pick-up your child?
Note: All authorized to pick-up are required to show a valid photo ID at the time of pick-up, and must be 18 years or older.
Tell us How....
We love to know where our families come from. Please select how you heard or found out about us below!
Drop off & Pick up Policy
For all camps and day kid-events, parent or guardian is required to drop child off at beginning of camp time and efficiently pick up the child/person at the end of camp time. There will be a late charge of $10 for every 15 minutes that pick-up time is late. Due to our program needs, we enforce this policy to properly and efficiently manage our class’s schedules and the needs of all of our students.
Medical Emergency Consent
By signing your name below, you are agreeing and understand the following. I, the undersigned parent or guardian of the above named student, do hereby grant authority to the staff of eTeachingMe to render judgement concerning medical assistance in the event of an accident, injury, or illness during my absence.I give my consent for my family doctor to treat my child in case of emergency or if you are unable to contact him, please accept this form as your authority to use the doctor on call in the emergency room for any necessary emergency medical treatment.I also understand that in this instance, I will be notified by phone in regards to the situation, and I give permission for my child to be transported to the nearest medical center if treatment is needed.
Your answer
Payment Policy Consent
I understand that there is a $35.00 fee for each child (exception of sibling discount) that attends a day camp at eTeachingMe. I understand that payment must be paid in full in order to hold my child's spot in camp. If payment is not received, the student may not be able to attend the day camp, and their spot may be given to another student on the wait list. I understand that all fees are non-refundable.
Credit Card Policy
By submitting my credit card information through the secure online registration process using the PayPal payment processing system, I authorize eTeachingMe to automatically charge my card for the full camp fees posted, as a one-time charge.
Photo Release Statement
I grant/do not grant eTeachingMe the right to take photographs/videos of my child. I agree that eTeachingMe may use such photographs or videos for any lawful purpose; including such purpose as publicity, illustration, advertising, social media postings, or on our website for camp illustrations.
Release of Liability
By reading and signing this form, you are agreeing and aware that you are engaging in activities with Love N Learn At Home, LLC dba eTeachingMe that include but are not limited to physical exercise and use of equipment, facilities, training and learning instruction. Some of our activities could cause injury to you or others. You are voluntarily participating in these activities and assume all risks of injury and liability that might result. You agree to waive any claims or rights you might otherwise have to pursue, Legal or other action against Love N Learn At Home, LLC dba eTeachingMe, the facility's owners, officers, employees, or agents for any reason. You have carefully read this waiver and declare you are sufficiently physically fit for any of our activities in which may require physical abilities and exercise.
Signature of authorized parent/guardian
By signing below, you are agreeing to register the above named child/person for our enrichment learning classes. You have read and fully understand all class details, descriptions, and policies as stated above. This signature verifies understanding and acceptance of this registration.
Your answer
Signed this day
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Signed at this time
Time
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