Emergency Form

    This is page 1 of camp registration, please fill all pages down to the submit button

    MARYLAND STATE DEPARTMENT OF EDUCATION - Office of Child Care

    EMERGENCY FORM

    The tuition is $230 weekly. The $75 deposit is credited toward weekly tuition. After the deposit is paid each week will have a balance of $155 that is due the day before each camp week starts. Payments can be made on the total deposit due. Deposits are due in full by 6/24/22. Please call with questions on the deposit.

    INSTRUCTIONS TO PARENTS:

    (1) Complete all items on this side of the form. Sign and date where indicated.

    (2) If your child has a medical condition which might require emergency medical care, complete the back side of the form. If necessary, have your child’s
    health practitioner review that information.

    NOTE: THIS ENTIRE FORM MUST BE UPDATED ANNUALLY.

    When parents cannot be reached, list at least one person who may be contacted to pick up the child in an emergency:

    (1)

    (2)

    (3)

    In EMERGENCIES requiring immediate medical attention, your child will be taken to the NEAREST HOSPITAL EMERGENCY ROOM. Your signature
    authorizes the responsible person at the child care facility to have your child transported to that hospital.


    ANNUAL UPDATES

    OCC 1214 (Revised 6/2020) - Side 1 of 2 - All previous editions are obsolete.


    INSTRUCTIONS TO PARENT:

    (1) Complete the following items, as appropriate, if your child has a condition(s) which might require emergency medical care.

    (2) If necessary, have your child’s health practitioner review the information you provide below and sign and date where
    indicated.

    EMERGENCY MEDICAL INSTRUCTIONS:


    Note to Health Practitioner:

    If you have reviewed the above information, please complete the following:

    OCC 1214 (Revised 6/2020) - Side 2 of 2 - All previous editions are obsolete.

    Kingdom Care Camp 2022 Enrollment Form (p.3)

    Please make additional copies for each camper

    Parental Consent - Parents must agree to all items and this signed form must be submitted to Kingdom Care before your camper can be enrolled in any camp. Please initial beside each statement as indicated by line.

    By applying to Kingdom Care Camps, I accept the following terms and conditions:

    **READ CAREFULLY**

    Kingdom Care Camp 2022 Enrollment Form (p.4)

    ******Families only pay for the weeks their camper is present**** Page 4 of enrollment

    Enrollment is available on a first come, first served basis. The tuition for camp is $230.Tuition includes a.m and pm. snack and supply fee for onsite art and science. Tuition does not include Hot Lunch on Wednesdays and Fridays. Before Care and After Care is FREE. Before care opens at 7am. Camp hours: 9-4:30. After care begins at 4:30, ends at 5:30.

    2022 Sessions and Dates (place an X beside the sessions your camper will be attending)

    COVID 19 STATEMENTS

    Please initial each of the following

    TEMPERATURES WILL BE CHECKED AT ARRIVAL. HANDS WILL BE SANITIZED HOURLY

    **Students may take masks breaks for eating and drinking and in the restroom. Masks must be on at all other times