Summer 2021 Enrollment Form
Jenkins Day School is now enrolling for Summer Camp 2021. Please submit form and remit a non-refundable $50 registration fee and $50 supply fee payable by cash or check to Jenkins Day School in order to secure your spot. If we are unable to place your child, your fees will be refunded. Applications are accepted on a first come, first serve basis and requires deposits to secure the spot. Please fill out one form per student. Daily tuition rates are $26 for the first child, $24 for each additional child.
Child's Name: *
Child's Date of Birth: *
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Age of Child on August 15th: *
Program Option: *
Name of Parents/Guardian: *
Name and Ages of Siblings: *
Home Address: *
Phone Number(s): *
Email Address: *
Father Occupation/Place of Employment: *
Mother Occupation/Place of Employment *
Emergency Contact(s) and Phone Number(s): *
To insure the safety of your child, please list other adults to whom your child may be released, including phone numbers: *
Child's Physician and Phone Number:
Immunizations Current? (Please provide proof) *
Do you have a church home? *
If yes, where?
Has your child ever attended a program before? *
If yes, where? *
Allergies, reactions, preferred treatment? *
How does your child like to be comforted? *
Is your child potty trained? *
Favorite Activities, Foods, etc. *
Child's normal disposition (ie. Quiet, Active, Outgoing, etc) *
How do you handle discipline at home? *
Additional Comments/Information about your child? *
By signing below, I give permission to Jenkins Day School to take whatever emergency (ex. First Aid, Disaster evacuation, etc) measures judged necessary to insure the care and protection of my child while under the supervision of the staff. In case of a medical emergency, I understand that my child may/will be transported to the nearest hospital by the local emergency unit for treatment if deemed necessary. I understand that payment for emergency medical treatment will be the responsibility of the parents/guardian’s medical, dental or accident insurance or in such instances where insurance is not available, the treatment will be the sole responsibility of the parent/guardian. I, hereby, understand that Jenkins Day School will not be held liable for accidents or injuries that might occur. I further relieve the church and its staff of any responsibility for any injury my child or I may incur while on property. By enrolling in Jenkins Day School, I understand that they are not a “drop-off” childcare and I will be responsible for paying the full month’s tuition, even when my child is not present. (Please sign your name) *
I have read the Jenkins Day School Handbook (revised Aug, 2020) and understand the Covid-19 and Illness Policies set forth. I understand that the staff can deny my child's admission for the day for heath concerns; and will call for immediate pick up should he/she become ill during the day. (Please sign your name) *
I understand that Jenkins Day School and Jenkins C.P. Church staff is taking necessary precautions, outlined by the CDC, to prevent the spread of COVID-19. I understand the risks of bringing my child to Jenkins Day School and hereby relieve the church and its staff of any responsibility for any illness my child or I may incur as a result. I vow to inform staff of any changes in the health of my child and/or family and if there has been contact with someone diagnosed with COVID-19. (Please sign your name) *
One of the most exciting promotional tools used in childcare is the use of photos showing your children in action. Please indicate if we may use pictures of your child for use in future publications, newsletters, brochures, multimedia presentations, JDS website and church website and store these photos on discs for purposes of archiving. *
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