The Academy After School Program 2023 Summer Camp!
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
The Academy After School Program
2023 Summer Camp!
Summer camp hours of operation: 7:30 am to 5:30 pm at the main campus from May 30 to August 4, 2023.
We accept children who have completed Kindergarten through 6th grade.
The Activity Calendar will be completed and emailed to everyone in May. Our summer camp activities and field
trips are designed to complement our 5 day/10 week program and are not specific to any particular day of the week.
A Packed Lunch is needed daily unless specified “Lunch on us” on the calendar. This means we will provide
their lunch that day.
Registration Deadlines:
Families not currently enrolled in the 2022 – 2023 after school program will have an opportunity to enroll in the 2023
summer camp from February 13, 2023 until we reach capacity.
How To Register
The packet is a fillable PDF, and is posted on “The Academy After School” webpage under “Summer Camp”.
All fields of the registration form must be filled in and completed electronically to be accepted.
o Handwritten copies will not be accepted.
o Registrations that are missing information will not be accepted.
One child per packet. If you have more than one child, complete an entire packet and then for additional
children complete only the registration and child emergency forms.
Please return completed packets to this email address only: academy.afterschool@theacademyk12.org
Registration forms sent to any other email address will not be processed.
Once your child has been selected for a space, we will email you a deadline date to pay the non-refundable
activity fee by. This fee holds your child’s space and pays for all the summer activities and field trips.
o Failure to pay the non-refundable activity fee by the allotted deadline, will result in your child’s
registration being placed to the back of the pile. A space is not guaranteed.
Dates to take note of:
March 17, 2023: is the last day to try and make changes to your summer camp schedule. We will
accommodate your request if we are able to do so.
May 1 – 7, 2023: If you cancel summer camp for any reason, there will be a $150 penalty fee per family.
May 8, 2023 and onward: If you cancel camp for any reason, you will be charged the full amount that you
registered for unless we are able to fill your child’s space, this is not guaranteed.
May 29, 2023 we are closed for Memorial Day
July 4, 2023 we are closed for Independence Day
If you have any questions, you can reach me at: pat.johnson@theacademyk12.org or 303-289-8088 ext. 166.
Thank you, Pat Johnson
Program SupervisorThe Academy After School 2023 Summer Camp
Registration Agreement
Child’s Name: ______________________________________ Birth Date: _______________________________
Grade Entering: _______ Gender: _______
Allergies: ___________________________________________________________________________________
Illnesses: ___________________________________________________________________________________
Medications: _________________________________________________________________________________
Parent/Guardian’s name: ______________________________________________
Address: _____________________________________________ City: _____________________ Zip: ___________
Email Address: _____________________________________________ Phone Number____________________
Parent/Guardian’s name: ________________________________________________
Address: _____________________________________________ City: ____________________ Zip: ___________
Email Address: ______________________________________________ Phone Number: ____________________
Tuition per week, per child Activity fee per week, per child
5 days a week $220.00 a week $36.00
4 days a week $184.00 a week $29.00
3 days a week $141.00 a week $22.00
Please select the days of week needed
M T W TH F Please select the weeks of care needed
Must register for a minimum of 4 weeks
May 29 – June 2 July 3 – 7
Please select a Swimshirt Size: June 5 – 9 July 10 – 14
Kid Small June 12 – 16 July 17 – 21
Kid Medium June 19 – 23 July 24 – 28
Kid Large June 26 – 30 July 31 – August 4
Kid Extra Large
Adult Small We are closed on May 29 and July 4. These
weeks will be considered full weeks of care.
I understand that I am registering my child in The Academy After School summer camp program. I understand that I
am the person(s) responsible for all fees that my child accrues while in this summer camp. I am aware of the summer
camp policies for: changing my days, early withdrawal or cancellation, which can be found in the program handbook
on the after school webpage and the 2023 summer camp registration letter.
Both parents must sign if sharing responsibility for payment.
Parent Signature: ________________________________________________________ Date: ___________________
Parent Signature: ________________________________________________________ Date: ___________________
Guardian Signature: _______________________________________________________ Date: ___________________The Academy After School Summer Camp 2023
Licensing Requirement - All Areas Must Be Filled In, If Not Applicable Write N/A
Child’s Name: ________________________________________ Gender:_______ Age: ______ Birth date:_______________
Address: ________________________________________________ City__________________________________ Zip______________
Mother/Guardian_________________________________________ Father/Guardian_________________________________________
Cell Phone:____________________________________________ Cell Phone: ___________________________________________
Email: ___________________________________________ Email: __________________________________________
Employer: _____________________________________________ Employer: ____________________________________________
Wk Phone: _____________________________________________ Wk Phone: ______________________________________________
Wk Address: ___________________________________________ Wk Address:____________________________________________
City: __________________________________ Zip:__________ City: ________________________________ Zip:_____________
Second Parent Home address if other than child’s:
Mother or Father / Address: ________________________________________________ City_____________________ Zip____________
Step-Parent info: Please complete this area if you want us to contact them in the event that we are unable to reach the parents
Step-Mother___________________________________________ Cell Phone:____________________________________________
Step-Father____________________________________________ Cell Phone: ___________________________________________
Emergency Contacts ( Must be persons who are local and other than parents )
Name: __________________________________________________ Phone # ____________________________________________
Address: ________________________________________________ City: _____________________________ Zip:__________________
Name: __________________________________________________ Phone # ___________________________________________
Address: ________________________________________________ City: _____________________________ Zip: __________________
Illnesses/Chronic Health Problems/Allergies: ______________________________________________________________________
________________________________________________________________________________________________________________
Prescribed medication(s): _______________________________________________________________________________________
Physicians Name:_______________________________________________ Phone:__________________________________
Address:_______________________________________________________ City_______________________ Zip:____________
Preferred Dentist Name:____________________________________________ Phone: _________________________________
Address: ___________________________________________________ City:_________________________ Zip:______________
Hospital Preferred for Emergency Treatment:____________________________________ Phone_______________________
Address:______________________________________________________ City_________________ Zip:___________
Consent for Emergency Medical Care and Sharing of Information:
I, the undersigned, a parent or guardian of the above named child herein authorizes all adult sponsors, or any responsible adult
person bearing this written authorization into whose care the above mentioned minor has been entrusted, to consent to any x-
ray examination, anesthetic, medical, surgical diagnosis or treatment and hospital care. Such care is to be rendered to said
minor under the general or special supervision and upon the advice of a physician, dentist, and/or surgeon licensed to practice
in the State of Colorado and to consent to any x-ray examination, anesthetic, dental or surgical diagnosis or treatment and
hospital care. In addition, I authorize all Academy Child Care staff / school staff to exchange relevant information about my
child. It is understood that this authorization is given The Academy childcare program and for all program-sponsored activities.
Every effort will be taken to locate a parent/guardian before any action is taken. All medical expenses will be accepted by the
parent/guardian.
AUTHORIZED SIGNATURE: _________________________________________________ Date: ______________________The Academy After School 2023 Summer Camp
Child pick-up authorization form
* ONE FORM PER FAMILY
If parents are separated, please complete one form to accommodate both parents.
1. Please fill out this form using legal names, as they would appear on a government issued photo ID,
if you wish to give permission for other people to pick your child up.
2. The people listed below may pick your child up without your prior approval. You may allow other people
not listed here to pick your child up provided you either tell us in person, over the phone, or send an email
prior to 2:00 pm during the school year.
PLEASE NOTE: The people you list on this child pick-up form, as well as your listed “Emergency” contact
person(s) will be allowed to pick your child up at any time. If you wish this to be different, please let us
know.
Child’s Name: ______________________________ 2nd Child’s Name: ____________________________
3rd Child’s Name: ___________________________
Person(s) Authorized to Pick-up
Parent/Guardian: ___________________________ Parent/Guardian: ____________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
Name: ___________________________________ Phone # ___________________________
__________________________________ Date:_______________
Parent/Guardian Signature
__________________________________ Date:_______________
Parent/Guardian SignatureThe Academy After School and Summer Camp Program
Parent Handbook – Policies, Procedures, Conduct Agreement
2023 Summer Camp
The Academy After School and Summer Camp program is dedicated to children and their families. Parents and staff
of The Academy are identified as potential role models for the children present. As role models we are ALL expected
to portray good citizenship and kindness towards each other.
USING APPROPRIATE LANGUAGE: inappropriate language or verbal abuse directed at staff, parents or children
will not be tolerated.
BEING RESPECTFUL OF EACH OTHER: Raising concerns regarding the program or staff shall be done in private
with the program supervisor or site coordinator present. Threatening tactics will not be tolerated. Adults are never
allowed to threaten, physically harm or frighten any child. Parents that have any concerns regarding child related
issues must address it only with the program supervisor or site leader.
PORTRAYING A POSITIVE IMAGE AND ACTING APPROPRIATELY: We are all directly responsible for ourselves
and the guests that we bring into the building. Smoking, drugs or alcohol use are never permitted. If suspected
abuse occurs, the person involved will be subject to immediate removal from school property and proper authorities
contacted. Keeping children safe is our number one priority. If a staff member suspects that a parent is impaired,
and they plan to drive their child from the program, staff will NOT release the child and proper authorities will be
contacted.
UNRESOLVED ISSUES: If there are serious issues or concerns regarding a child or their parents, a meeting may be
scheduled to discuss the concerns. In the event a solution cannot be agreed upon between parents and aftercare
administration a third party may intervene. A good faith effort will be made to come to an amicable solution.
In the event that the intervention is unsuccessful, the Academy after School and summer camp administration
reserves the right to suspended or expel students from the program without tuition compensation.
Please initial and sign
_______ I have read, understand and agree to abide by all the program’s policies, procedures and code of conduct
agreement.
_______ I understand that I am able to view the Parent Handbook at any time on the programs web page at
www.theacademyk12.org, under child care. I understand that I will be notified via email of any changes to this
document.
_______ I understand that the Parent Handbook policies and procedures is a Colorado state licensing requirement. I
also understand that this program may administer additional policies and procedures that are not listed in the
handbook.
_______ I understand that I am to apply sunscreen to my child prior to coming to school or summer camp. The
program will provide “Coppertone Sensitive Skin SPF 50” and supervise the self-application by my child. This may
occur anytime during the program’s hours of operation when the children will be in the sun for extended periods of
time. I understand that if I do not wish my child to use the aforementioned brand of sunscreen, that I will complete the
sunscreen release form, and provide one source of sunscreen for my child. (i.e. Bottle or Stick). Staff will inform me
when a refill is needed. ATTENTION: Aerosol sprays are not permitted in our program.
_______ I understand that I am registering my child for the full school year or summer camp program, and that I am
liable for all tuition fees including any early withdrawal fees, non-school day fees, extra drop-in days etc.
______________________________ __________ ______________________________ __________
Mother / Guardian Signature Date Father / Guardian Signature Date
Child’s Name: __________________________________ Child’s Name:__________________________________
Child’s Name: __________________________________SUMMER CAMP 2023
PARENT CONSENT FOR: FIELD TRIPS AND ACTIVITIES
Camp Field Trip And Activity Agreement:
I understand that all the summer camp field trips that are listed on the summer camp calendar will take place away from
school, and that some activities listed on the summer calendar will remain at camp. Field trips may be by certified School Bus or
walking. I am aware that The Academy summer camp staff from both licensed facilities, North and Main campuses, may
combine their staff in order to care for my child. This combining of staff will occur during the summer camp for scheduled field
trips or other summer camp activities.
I exempt The Academy board, its employees, authorized sponsors and volunteers from all claims arising from the
student’s participation in the identified activity and trips unless caused by actions for which The Academy would otherwise be
liable under Colorado Law.
I understand, and give full authority for The Academy summer camp program staff to take whatever action it deems
necessary to safeguard the health and wellbeing of my child including, but not limited to, consenting to emergency medical care.
I understand that The Academy does not purchase, or have, any insurance to cover medical, dental or hospitalization or
cover injuries to or loss of life of a child, damage to or loss of personal property or to indemnify parents/guardians for any
expenses in connection therewith, and if any insurance is desired, it must be purchased by the parent/guardian.
Children participating in and representing The Academy summer camp program, have the responsibility to maintain the
same behavior standards expected of them when in school. Any student participating in the summer camp program will be
subject to consequences for breaches of such standards set forth in the programs “Parent Handbook”.
As parent/guardian of the child(ren) named below, I have read this agreement and do hereby grant permission for my
child to participate in all the identified field trips and/or activities listed on the summer camp calendar. I also understand that if
there are any changes to any scheduled field trips, that I will be notified in advance. I also give permission for my child to view
any of the ‘PG’ movies listed below while at summer camp.
“PG” MOVIE VIEWING PERMISSION
During our Summer Camp we like to expand our movie viewing options by asking your permission to be able to show these
“Select” “PG” movies. Only these PG movies listed here will be our current viewing options this year. If you have any problems
or questions regarding any of these movies, please contact me.
Thank you
Pat Johnson / Program Supervisor
( POSTED AS OF FEBRUARY 2022 ) PG MOVIES
HONEY I SHRUNK THE KIDS LEGO MOVIE BIG HERO 6
HOW TO TRAIN YOUR DRAGON (1 &2) SHERMAN & PEABODY THE CROODS
HUGO THE SMURFS 1 & 2 INSIDE OUT
PADDINGTON 1 WRECK IT RALPH ALL MUPPET MOVIES
IGOR TREASURE ISLAND FROZEN 1 & 2
MONSTER HOUSE SHARK TALE THE LITTLE RASCALS
HOTEL TRANSYLVANIA 1+2 SHREK 1, 2 & 3 EPIC
NANNY MCPHEE 1 & 2 GOOD DINOSAUR ADVENTURES OF TINTIN
NIGHT AT THE MUSEUM 1 KUNG FU PANDA 1 ,2 & 3 THE LORAX
NIM’S ISLAND PLANET 51 STUART LITTLE 2
CLOUDY WITH A CHANCE OF MEATBALLS 1 & 2 DESPICABLE ME 1 & 2 SCOOBY & SHAGGY –Get a Clue
MONSTER UNIVERSITY MOANA
Child’s Name:__________________________________ 2nd Child Name _______________________________
3rd Child Name___________________________________
Parent / Guardian Signature: _____________________________________ Date: ____________________You can also read
