VBS/Summer Camp Registration Packet

VBS Week 1 Only: (June 8 – 12) If you are only planning for VBS from 9:00-12:30 with
no extended care, only complete pages 1-2. Otherwise all pages of the registration
packet must be completed to secure the registration).

In section IV, select Camp Kilamanjaro VBS for the FREE program.

In section IV, select Week 1 if your child will participate in extended care, available
from 7:30am-6pm.
Cost is $60 for VBS week only.

Kidz Camp: (Weeks 2-11) Fill out the complete registration and Field Trip permission
form.
Flexible ways to turn in your forms:
Complete two-sided forms for each child attending
Drop off the completed form or packet to the church office M-F from 9am-5pm, OR
 Scan and /or e-mail to campwbc@waysidemiami.org, OR
 Snail mail to Wayside Kidz Camp, 7701 SW 98 St., Miami, FL 33156


Questions? Call 305.595.6550 x.120.
Registration will be available on site on June 8th. $60 Extended care is available
from 7:30am to 6pm on a space available basis so register in advance to guarantee a
spot.
Check-in for extended care opens from 7:30-8:30am at the Kidz Ministry Entrance.
Beginning at 8:30am all children will enter through the North Worship Entrance.
2015 Field Trips
Thursdays -‐ all trips include admission, lunch, and transportation
6/25 - Museum of Science
7/9 - TY Water Park Castaway Island (Broward)
7/30 - Miami Seaquarium
Wayside Kidz Camp is a full service camp program for children
4K completers – 13 years old.
7:30 AM - 6:00 PM
Lunch and snacks are included.
Camp Pricing 2015 Sheet
Registration Fee $25/camper*
Week 1
VBS Camp Kilamanjaro—FREE 9:00-12:30pm
$60 ($12/day) Extended care 7:30-8:30 & 12:30-6pm Lunch and snacks
included. No registration fee. Extended care MUST be paid upon registration to
guarantee space.
Early Registration Deals for Weeks 2-Week 11
Pay One Price
Registration fee
$110/week—
Field Trips
(POP) (BEST
($25), then pay
minimum 5 weeks included
(value $12/trip)
PRICE!)
one payment for 5 ($550)
or more weeks
Early Bird
Reserve space
$120/week
Field Trips
Registration
with registration
included
(value $12/trip)
Register by 5/19
fee ($25), the pay
first week of camp
in advance
Regular Camp Tuition
Walk in rate
Registration fee
$135/week
Field Trips
($25), then pay as
included
(value $12/trip)
you go
Financial Aid
Financial aid is given on an as need and space available basis. To receive
consideration for discounted tuition based on need, a financial aid application
must be filled out and discussed with Camp Director or Kidz Ministry Director.
Field trips are not included and must be paid the week of the trip--$12/person.
*All campers are required to have complete registration forms, field trip permission slips,
and recurring payment forms on file regardless of how many weeks they are attending.
Wayside Kidz Camp Registration
Pk-4 Completed – 13 years
Phone: (305) 595-6550 x.120
Email: campwbc@waysidemiami.org
Web: www.waysidemiami.org/camp
OFFICE USE ONLY
VBS Only: _________________
VBS w/Ext: ________________
QB Date:___________________
Early Reg (5/18/15)__________
POP (5/18/15): ______________
WIR: ______________________
BF ________________________
VBS/Summer Camp 2015 Registration Form
I. Camper Information:
Camper Name (Last)
(First) ___________________ (Middle) ____________________
School Name
Grade Just Completed
Age ______ DOB ________ Male/Female - T-shirt Size (Youth: XS, S, M, L) ____ (Adult S, M, L, XL)
II. Family Information:
Parent/Guardian #1 (First/Last/Middle) ________________________________________________________
Cell Phone ___________________ Work Phone _________________ E-mail __________________________
Home Address
City ___________ State _______ Zip __________
Parent/Guardian #2 (First/Last/Middle) ___________________________________________________
Cell Phone
Work Phone _________________ E-mail _________________________
Home Address (if different)___________________ City _____________ State ________ Zip ____________
III. Camper Pick Up Authorization:
1. Name
Relationship to Camper
Phone
2. Name
Relationship to Camper
Phone
3. Name
Relationship to Camper
Phone
Parent/Guardian Authorization Signature:
IV. Program and Date Selection (check all that apply):
1. “Camp Kilimanjaro” VBS ONLY (Free –– 9:00am -12:30pm Wk 1 only) ______
2. Wayside Kidz Camp
Wk 1_____June 8th – 12th
______
3. Benny Fragela Extended Care** _______
Wk 5_____ July 6th – 10th
(VBS extended care $60 by WKC*)
Wk 9_____Aug. 3rd - 7th
(George Camp Week—Surge!)
Wk 2 _____June 15th – 19th
Wk 6_____July 13th – 17th
Wk 10_____Aug 10th – 14th
Wk 3_____June 22nd – 26th
Wk 7_____ July 20th – 24th
Wk11_____Aug17th - 21st
Wk 4_____June 29th – July 3rd
Wk 8_____ July 27th – 31st
*VBS extended care is available for $60. Care from 7:30-9am and 12:30-6pm, June 8th -12th only. Space is limited.
**Benny Fragela Camp attendees are eligible for an extended care of $12 a day or $55/week, 7:30-9am and 4-6pm.
OVER
Revised 2/17/15
VII. Medical Information:
Child's Physician:
Insurance Company:
Phone:
Policy #
Phone:
Please provide us of any learning disabilities, emotional or physical conditions: _________________________
_________________________________________________________________________________________
List any or all medications your child will bring with him/her to camp:
Medical Condition: _________________________________________________________________________
Medications: ______________________________________________________________________________________
To be given when/how: ______________________________________________________________________
VIII. Allergies:
Medication Allergies: _______________________________________________________________________
Describe reaction and management of the reaction: ________________________________________________
Food Allergies or Dietary Restrictions: __________________________________________________________
Other Allergies (Include insect stings, hay fever, animal dander, etc.): _________________________________
IX. Photos:
May we use photos of your child in advertising for Wayside Baptist Church? Photos may appear in print or on
our website.
Yes_______ No_______
Emergency Treatment Information - Please Read and Sign Below
Informed consent for Emergency Treatment: In case of an Emergency and if I can not be reached, I authorize
the staff of Wayside Baptist Church to obtain whatever medical treatment he/she deems necessary for the
welfare of my child. I further understand and agree that I will be responsible for all charges and fees incurred in
the rendering of said emergency treatment regardless of whether or not my medical insurance would cover such
charges or fees.
Print Name of Parent/Guardian:
Signature of Parent/Guardian:
Date:
Wayside Kidz Camp
7701 SW 98 Street, Miami, FL 33156
(305) 595-6550 x.120
Wayside Kidz Camp 2015
Payment Authorization Form
www.waysidemiami.org/camp
At Wayside Kidz Camp, our purpose is to assist working families by providing an affordable, caring, and Christ-centered environment
for their children to attend. We know it is always ideal for children to be with their families during school vacations and teacher work
days, but in today's world that is not always possible. We are here to provide a caring and safe environment for children while they
are making friends, playing, and learning. Our goal is to minister to the whole child through art, sports, fun, applicable Bible lessons,
and friendship. All lunch and snacks are included. No separate fees will be charged for the use of this service. The 2.5% processing
fee is included in the camp tuition payment.
Parent/Guardian Name(s) _____________________________________________________________________________
Address _______________________________City ___________________ State __________ Zip Code _____________
Telephone _________________________Email ___________________________________________________________
Child(ren) Name(s)__________________________________________________________________________________
VBS Aftercare Week 1 - $60
Registration Fee (per Child) Weeks 2-11- $25.00
Camp Fee (per Child) - $135/week
(In house events, field trips, lunch, snacks, and supplies included.)
Field Trip - $12
(Only for special circumstances i.e. adding a parent chaperone or F/A recipient.)
Other Amount_____________ Initials_______ WBC Approval________
(stated in the financial aid agreement )
I authorize Wayside Baptist Church to charge the credit card or checking account provided for the Camp Registration Fee.
I further authorize that each week my child(ren) attend camp, that Wayside Baptist Church may process the payment
amount from the payment method I provided. If I need to make a change in the payment arrangements agreed to, I must
provide sufficient notice to Wayside Baptist Church to act upon the change. All payments provided to Wayside Baptist
Church comply with U.S. Law.
Enclosed is a copy of a voided check OR credit card information for my payment.
 I plan to make camp payments in the form of ______Checking Account OR ______ Credit Card
Credit Card Number _________________________________
Expiration Date ____ /_____
Field Trip
Information Form
Summer 2015
Field Trips
Thursdays
6/25 - Museum of Science
7/09 – TY Castaway Island Water Park (Broward)
7/30 - Miami Seaquarium
COST
.
Included with full paid tuition. Financial Aid Cost: $12
Transportation, entrance fees, and lunch are included.
Transportation provided by Maranata Bus Service.
•
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•
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One permission form will cover any and all field trips listed that your child may be
eligible to attend.
Your child must be registered for the camp week in which the field trip is
scheduled.
Your child must wear their camp t-shirt and close-toed shoes.
Parents are welcome to attend, but must notify and pay the registrar in advance.
All Wayside Kidz Camp staff will attend each field trip. No Kidz Camp staff will
be on duty at Wayside Baptist Church during field trips.
Any specific information, i.e. wear a swimsuit, jacket, etc, will be provided on
Monday before the field trip.
Wayside Baptist Church and Kidz Camp
Field Trip Permission Slip & Release
Name of activities: Wayside Kidz Camp Field Trips 2015 Includes all dates on the Field Trip form.
1st Student’s Name: _________________ Grade: _____ Age: _____ Birth date: ____/____/____
Address: __________________________ City: _________________ Zip: _________
Best Phone #: (____) ___-_____________ 2nd #: (____) ___-________
Emergency #: (____) ___-_____________
Parent’s/Guardian’s Name: _________________________________________
If “No”, list any medical information we should know about your child(ren): ___________________________
_________________________________________________________________________________________
Release
The undersigned is the parent and/or legal guardian of the minor child(ren) named above (hereinafter referred to
as “minor(s)”). The undersigned desires for said minor(s) to attend and/or participate in certain ministries,
events, programs, functions, and activities (hereinafter referred to as “activity”), sponsored by, connected with,
or related to Wayside Baptist Church (hereinafter referred to as “church”). I understand and acknowledge that
the church will allow the minor(s) to participate in summer 2015 field trips only with my express permission.
Likewise, the church will permit the minor(s) to participate based on my promise to hold the church harmless
from liability arising out of the minor(s) attendance and/or participation in the activity listed above. This
expressly includes the process of—and risks associated with—transporting minor(s) to and from the activity.
I hereby accept and acknowledge that the church may accept the assistance of certain companies and/or
individuals to provide transportation. Each company or person shall be covered by one or more policies of
insurance sufficient to cover the risks associated with such transportation. I affirm and acknowledge that, should
any accident or incident arise during such transportation, the church shall not be liable for any injuries that may
occur.
I have investigated—or will do so—all risks involved with the minor(s) attendance and/or participation in all
summer 2015 field trip activities. Furthermore, as the parent or legal guardian of said minor(s), I accept—on
behalf of myself and the minors listed above—any and all risks of personal or bodily injury to said minor(s) or
property damages associated with said activity.
By signing this document, on behalf of myself and the minor(s), I hereby release and forever discharge the
church, its pastors, officers, directors and employees, agents and any parties volunteering on behalf of the
church from all claims, damages, costs or expenses of any kind arising out of or related to the minor(s)
attendance or participation in church activities. I understand that this document is a full and complete release of
all claims for personal or bodily injury and property damage which the minor(s) might sustain as the results of
the minor(s) attendance and/or participation in any church activity, regardless of the specific cause thereof, and
I further understand and agree that in the event of such personal or bodily injury to the minor(s), or property
damage, that I (on behalf of myself or the minor(s)) will not seek any type of recovery from, or bring any type
of action whatsoever against, the church or its pastors, officers, directors, employees, or agents.
PARENT / LEGAL GUARDIAN
______________________________
_________________________
____________________
Printed Name
Signature
Date
*A list of all field trips are available on our website: www.waysidemiami.org/camp or in the camp office.
Wayside Kidz Camp and VBS programs use KidCheck as a secure process for checking
children into and out of our programs. You MUST set up a parent account to attend our
programs. If you already have an account, please be sure to update your records to the most
current information available.
Signing up for KidCheck is easy and free for parents. Once you've created your account, you
can add your children’s information and any pertinent medical/allergy alerts, and designate
authorized and unauthorized guardians. You can also upload photos of yourself, your children
and the guardians to help your childcare provider with identification.
Sign-up
1. Go to the website https://go.kidcheck.com
2. Select “Register Now”
3. Fill in the requested fields and create your password
4. Agree to the license agreement and then go to choose your account options
5. Select “Save Changes”
My Account Page
1. Click on “My Kids”. This is where you will input your child’s information and upload photos.
Select “Save Changes” when done.
2. Click on “My Guardians”. This is where you will input additional guardians and upload
photos. Remember to “Save Changes” when you are done adding guardians.
Your account is now complete! When you go to check in for the first time, type your 10 digit
home or cell phone number onto the check-in screen, and your account will appear. Only
facilities that you check-in to will be able to see your information, and only after you check-in
for the first time.
Remember to keep your information up-to-date. You can easily make changes to your
account at any time by signing into your account at https://go.kidcheck.com