2026 Wellspring Summer Day Camp
Summer Day Camp is offered to preschool through 8th grade students at no cost. Preschoolers must be 4 years old and potty-trained.

Please note completing this does NOT guarantee your child will be enrolled as space is limited. Our Youth Director will notify you by email if your child is enrolled or put on the wait-list for the camp. Please add youthdept@wellspringinterfaith.org to your contact list to avoid the message going to spam or junk. 

Submission Deadline: May 27, 2026.

Camp Dates: 6/1/2025 - 7/10/2025
*Closed for Juneteenth and Independence Day (observed on 7/3)

Campers must attend at least 3 days a week.

Program Time: 9:00am-3:00pm

Limited transportation is available. 

You MUST complete a separate form for each child!

  ⚠️ Summer Day Camp Registration Update: K–1 and 2–3 grade groups are full. All applications for these groups starting now will be placed on our waitlist.  Grade with the most available spots left is 8th grade.⚠️ 
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Child's Name Last Name
You must complete a separate form for each child.
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Child's Name First Name
You must complete a separate form for each child.
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Child's Date of Birth *
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Child's Age *
Child's Gender
Select one *
Address
Please Capitalize *
City
Please Capitalize *
State
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Zip Code *
Primary Phone Number
(XXX) XXX - XXXX *
Primary Email
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What is your child's current school? *
Select the grade your child is currently in (or will complete THIS school year 2025/2026).  *
Parent/Guardian Name *
Parent/Guardian Phone Number
(XXX) XXX - XXXX *
Parent/Guardian Name
Parent/Guardian Phone Number
(XXX) XXX - XXXX
1. Emergency Contact Name
Must be different than Parent/Guardian Name(s).
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1. Emergency Contact Number
(XXX) XXX - XXXX
Must be different than Parent/Guardian Name(s).
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2. Emergency Contact Name
Must be different than Parent/Guardian Name(s).
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2. Emergency Contact Number
(XXX) XXX - XXXX
Must be different than Parent/Guardian Name(s).
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Daycare Provider Name
Daycare Provider Phone Number
(XXX) XXX - XXXX
Health Information 

Medical Conditions/Medications/Allergies/Special Needs
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Health Information 

My child will need to take medications during camp hours.

Please be advised Wellspring Staff cannot administer medications.
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Health Information 

What accommodations does your child need? Do they have an IEP at school? If yes, please thoroughly explain. If no, please write none.
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Transportation Rules

Bus Transportation
Wellspring provides limited free transportation using Fort Wayne School buses. Wellspring Staff will be at each stop.Campers will need to be at one of our designated bus stops no later than 8:15am. 
Bus Pick-up is at 8:15am
Bus Drop-off is at 3:15-3:30pm

Pre-K and 1st grade campers won’t be allowed to walk home from the site or bus stop alone. They must be picked-up by a parent, guardian, emergency contact, or childcare provider. 

Bus Pick-up/Drop-off locations:
1. Bethlehem Lutheran, S. Anthony Blvd (back of church on Euclid St)
2. Bloomingdale Elementary, corner of Third St. and Orchard St.

FWCS Transportation Rules:
- All students must use seat belts
- No Food or Drinks on bus
- No cell phone use or use of other electronic devices allowed.
- All campers are quiet on the bus.
- Windows must be put up before exiting the bus. 

Wellspring staff reserves the right to refuse bus transportation to any camper due to behavioral issues or if parents/guardians are habitually late picking up campers from the stop. 

Car Rider:
Campers can be dropped off at their designated sites between 8:30am-9:00am. If enrolled, our Youth Directors will inform you of your child's location. 

Program staff will be at the doors to let children starting at 8:30am. Once camp begins at 9:00am, staff will no longer be at the doors. DO NOT send campers into the building alone. All buildings are locked. Therefore, campers must arrive when staff is present. If you are late, you must contact our Youth Directors.
Car Drop-off is from 8:30am-9:00am
Car Pick-up is at 3:00pm

If you fail to pick your child up:
Campers left at sites or bus stops after 3:30PM will be brought back to Wellspring Interfaith Social Services (1316 Broadway). We’ll try to reach you first to make other arrangements before transporting your camper to Wellspring.
If campers are left at Wellspring after 4:00PM and we haven’t been able to reach a parent, guardian, emergency contact, or daycare provider, then we will contact the FWPD.

Changes to Transportation
Please contact our youth department before 1:00pm if you need to make any changes to your child's transportation. Likewise, if you need to change your child's transportation due to an emergency, please contact our youth department.

Youth Department - 260-422-6618 x109

By typing your name below, you agree to and understand the rules outlined above.
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Transportation

Select your child's transportation needs.
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Transportation

Please indicate how your child will be getting home from the bus stop. 

Pre-K and 1st grade campers won’t be allowed to walk home from the site or bus stop alone. They must be picked-up by a parent, guardian, emergency contact, or childcare provider. 

If and only if your child is a car rider being picked up from their site and not riding the bus, please select not applicable.
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My child lives with
This is needed for statistical purposes only.
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Your Child's Ethnic/Racial Background
This is needed for statistical purposes only.
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How many years has your child participated in Wellspring's Summer Day Camp? *
Family Size

How many total persons (including yourself) live in your household?
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Household Income

Based on the image below,  select your income level under the number of persons in your household.
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What is the primary language spoken at home? *
Does your child qualify for free/reduced lunch? *
Has your child received tutoring through the Indiana Learns Program? *
Summer Camp Rules

1. Campers will be grouped by grade and at different locations to accommodate for space. They will be assigned a group based on the grade they just finished this school year. 

2. Attendance 
Campers must attend at least three days a week.
You do NOT need to notify the office if your camper will not be in attendance unless they will be absent for 3 or more days in a row. 
Camp begins at 9:00am and ends at 3:00pm.
Camp will be closed on June 19th and July 3rd.

3. Arrival: Camp begins promptly at 9:00am.
Drop-off campers between 8:30AM and 9:00AM. 
DO NOT drop off campers before 8:30AM or after 9:00AM. 
DO NOT send campers into the building alone if no staff members are outside as doors are locked.

4. Dismissal: Program ends at 3:00pm
You can pick-up your child at the sames spot you dropped them off starting at 3pm.
Campers will be signed-out out by Wellspring staff before leaving the site.
Campers left at site or at bus stop after 3:30pm will be brought back to Wellspring. We'll reach out to you and other contacts listed to make pick-up arrangements. If no contact is by 4:00pm, we will call Fort Wayne Police. 
There is NO early pick-up from the camp due to logistical and safety purposes. If your child can not attend the entire day, then they cannot attend that day. 

5. 3-Strike Policy
Beginning June 8th, we'll have a 3-Strike Policy. Wellspring staff track attendance and tardiness. 
If you drop off your camper late or you are late picking them up, you will receive a strike. You will be informed at that point. 
If you are late dropping your camper off 3 times, then they won't be allowed to stay for camp that day. 
If you are late picking up your camper at the bus stop 3 times, then you'll need to transport your camper to and from the sites as bus transportation will no longer be available for your child. 
If you are late picking your camper up 3 times, then they will not be able to attend camp. 

6. Personal Items/Electronic Devices
Campers are NOT permitted to bring any personal items from home. This often increases the likelihood of them getting lost, stolen, or damaged.  
Campers are NOT permitted to borrow, lend, or trade items while at camp.  
The following items are NOT allowed at camp: money, poppers, fidget spinners, toys, or stuffed animals.  
Cell phones are NOT permitted for use at camp. Wellspring staff reserve the right to confiscate any, and all personal items as issues arise. Confiscated items will be returned to the parent or guardian at the end of the day.  
Wellspring Interfaith Social Services is NOT responsible for any personal items that may have been lost, stolen, damaged or gone missing during camp. 

7. Behavioral Issues
Wellspring staff reserves the right to send any camper home that has disruptive, unsafe, destructive, or abusive behavior.  
We do NOT have the capacity for one-on-one supervision, so if you have a camper requiring this kind of supervision, our camp may not be the best program for them. We have approximately a 1:6 adult-to-child ratio.
Your camper must participate in all camp activities. If your camper refuses to participate, then they may be given a day off or discharged from camp.  

8. Illness
If your camper has a medical condition that is contagious, then we may require a doctor’s note before they’re allowed to return to camp.  
If your camper has a fever, they cannot return to camp unless they have been fever-free for at least 24- hours without the use of fever reducing medication.  
Your child must be potty-trained.  
Wellspring staff cannot administer any medications to campers.  
Wellspring staff can provide first aid.

9. Surveys, Questionnaires, Tests, etc. 
You and your camper must fill out all surveys, questionnaires, tests, etc. for the program. The information gathered from these tools is an invaluable way for us to measure our success in reaching goals and for reporting to our funders. 

10. Lunch
Lunch is provided by FWCS and served at each site. Wellspring has no ability to change or adapt the menu. You may access the menu at foodservice.fwcs.k12in.us. 
If your camper has dietary restrictions, please make sure that is included in the 'Health Information" section of this application
Through this lunch program, we are unable to provide special lunches. 
Your camper may bring lunch, however, we do not have refrigeration to store them. 

11. Dress Code
Campers should wear comfortable clothing allowing them a free range of motion to participate in recreational and athletics activities. 
Due to the nature of some activities, clothing may get soiled with dirt, grass, paint, glue, etc.
Unacceptable attire includes revealing clothing and apparel that displays/promotes drugs, alcohol, tobacco, or gang references, and excessively loose or baggy pants. If your camper comes to camp in “unacceptable attire,” then you’ll be responsible for providing them a change of clothing or picking them up from program.

12. Change in Personal Information
Please notify our office at 260-422-6618 x109 if your have changes in any information listed on this registration (phone numbers, email, emergency contacts, health information, etc).

13. Communication
Campers are not permitted to use cell phones at camp.
ALL COMMUNICATION is coordinated through the Youth Department office.
If you need to contact your camper or a Wellspring staff member, please call 260-422-6618 x109.
Note that any transportation changes must be made before 1:00pm each day. 
Transportation changes are for emergencies only. 

14. Overnight Camp
Overnight Camp is from July 20th-July 24th.
We attend Camp Lutherwald in Howe, IN.
All camp fees and transportation are provided by Wellspring.
This camp will be open to campers in grades 2nd-8th.
Campers will be chosen based on behavior and attendance.
Camp forms will be distributed during the 4th week of camp.
Limited spots are open for this camp. 


The Wellspring Summer Day Camp reserves the right to discharge your camper from camp if they or you are not adhering to any of these policies.



By typing your name below, you agree to and understand the rules outlined above.
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Camp Goals

The Wellspring Summer Day Camp is committed to providing children with life enriching experiences and exposure to educational, recreational, social and cultural growth activities.

Campers participate in approximately 15 hours of summer learning activities each week. 

Campers are supported by caring staff. 

Wellspring staff build healthy, positive relationships with campers by using the Search Institute’s Developmental Relationships Framework.  

Campers learn about and begin to develop a Growth Mindset.  

Camp provides a safe environment for all activities. 

Wellspring staff act as positive role models encouraging children to follow their example and maintain good behavior. 

Campers participate in weekly art, dance, and yoga activities. 

Wellspring staff encourage children to do well in all activities. 

The diversity of campers helps youth to become comfortable being with people of different racial, ethnic, abilities, and cultural backgrounds.              

Campers are encouraged to solve problems without hitting, throwing a tantrum, or using hurtful language.

Campers are encouraged to like themselves and feel that other people value them.  


By typing your name below, you understand and acknowledge these goals. 
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Photography/Video Wavier

I permit Wellspring Interfaith Social Services and its affiliated organizations to use and publish photographs and/or video of me and/or my child on social media outlets, websites, reports, or marketing materials for purposes of promoting Summer Day Camp and the agency.

By typing your name below, you agree to and understand the .
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RELEASE AND INDEMNITY AGREEMENT/ACKNOWLEDGEMENT OF RISK

By typing my name below, I understand that I am agreeing to “Release and Indemnity Agreement/Acknowledgement of Risk”, giving consent to treat my child in case of emergency, agreeing to/acknowledgment of the WISS SDC Policies and Goals.

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Captionless Image
By typing your name below:

1. I understand this is not a guarantee my child will be 
enrolled in Summer Day Camp and will wait for Wellspring staff to contact me about my child's enrollment. 

2. I affirm that all the information is correct on this registration form. 
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