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REGISTRATION FORM (COMPLETE ONE PER CHILD) Camper’s Name: ____________________________________________

Date of Birth: ____________________

Parent(s) Name(s): ______________________________________________________________________________ Camper Lives with (custodial parent): _________________________________________ Home #: _________________________ Work #: _________________________ Cell #: ________________________ Address: __________________________________________ City: _____________ State: ___________ Zip: ________ Parent Email: ________________________________________________ Camper’s School: ____________________________ T-Shirts:  Youth S  Youth M  Youth L  Adult S  Adult M  Adult L  Adult XL How did you hear about us?  Previous Camper  Friend  Camp Guide/Mailing  Internet  Camp Expo Week

Grade Group K-1: Kroc Tots, 2-3: Jr. Krocs, 4-5: Krocs

Field Trip

Latchkey Care***

 1 (June 14 – 18)

_________________________________

John Ball Zoo

 AM

 PM

 2 (June 21 – 25)

_________________________________

Circle Theater

 AM

 PM

 3 (June 28 – July 02)

_________________________________

Bowling

 AM

 PM

 4 (July 06 – July 09*)

_________________________________

White Caps Baseball

 AM

 PM

 5 (July 12 – July 16)

_________________________________

Roller skating

 AM

 PM

 6 (July 19 – July 23)

_________________________________

AJ’s Fun Park

 AM

 PM

 7 (July 26 – July 30)

_________________________________

Children’s Museum

 AM

 PM

 8 (August 02 – August 05)**

_________________________________

Bounce Party

 AM

 PM

* In observance of July 4th, we will not be holding camp on July 5th. ** A Michigan Adventure Field Trip will be held on August 06 for an additional fee of $30.00 per participant. Please note that we will not be holding camp this day or latchkey care. *** Latchkey care is available everyday from 7 – 9AM and 3 - 6PM for an additional $2.50 an hour or $20.00 for a full week of either morning care or evening care. Space is limited for our latchkey care and preregistration is recommended.

PAYMENT AND REFUND POLICY A $25 dollar non-refundable deposit is due upon pre-registration for each week reserved and $5 for each week of latchkey. The balance of fees for the week(s) and latchkey care reserved is due 1 (one) week prior to the reserved week. Failure to pay by this time will result in a forfeit of the deposit and registration. Enrollment may be re-instated based on space availability; however a $10 late fee will be added to the balance due. Space is limited; registrations will be accepted on a first-come, first served basis. Deposits may not be transferred to a future session. No refunds are given unless the program is cancelled by the Transitional Kroc Center. Please charge my:

 Visa  Mastercard  Dicover

Account# __________________________

 Charge entire balance  Charge non-refundable balance only

Signature: ________________________ Expiration Date: ____________

ACKNOWLEDGEMENT OF GRAND RAPIDS RJKCCC DAY CAMP BEHAVIORAL POLICIES/PHOTO RELEASE Camper safety is our top priority. Campers are expected to follow the peace contract by keeping hands and feet to themselves, listening to all instructions and staying with the group. I understand that if my child does not adhere to these expectations disciplinary consequences will occur. Repeat or more serious acts such as fighting, theft and possession of weapons/drugs will result in immediate suspension or expulsion, necessitating removal from the camp. I or an authorized adult is responsible for picking him/her up immediately. Signature: ______________________________________________

Date: ________________

Register by Mail, Walk-In or Fax. The Salvation Army Transitional Kroc Center | 1632 Linden SE, Grand Rapids, MI 49507 | 616.241.3723 Register by Fax (for credit card only): 616.241.5777


2010 DAY CAMP REGISTRATION FORM  

 5 (July 12 – July 16) _________________________________ Roller skating  AM  PM  6 (July 19 – July 23) _________________________________...

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