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CUMC SUMMER CAMP APPLICATION FOR ADMISSION
You may register directly online by filling out the following form. When you click submit, you will be directed to our online bill pay where you can remit payment for the registration fee.
If you prefer, you may download a paper Application for Admission by clicking
here
. Please return this application with a non-refundable enrollment fee of $75.00. Make your check payable to Culpeper United Methodist Church and attach it to this form.
Culpeper UMC Preschool does not discriminate against any student on the basis of race, creed, or national origin.
Child Enrollment/ Information Record
First Name
Date of Birth
Child's Middle Name
Gender
Gender
Male
Female
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Last Name
Child's T-Shirt Size
Child's T-Shirt Size
X-Small (2-3)
Small (4-5)
Medium (6-8)
Large (10-12)
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Please check desired camp week (student must be age of desired class by June 1, of the current year, and fully potty trained.)
Camp Week
Camp Theme
Registration & Camp Fee Due
Days Attending
June 3 - 7
Get Your Game On
May 20
M 6/3
T 6/4
W 6/5
Th 6/6
F 6/7
June 10 -14
Sleuthing with Science
May 28
M 6/10
T 6/11
W 6/12
Th 6/13
F 6/14
June 17 - 21
AM - VBS
PM = Super Heros
June 3
M 6/17
T 6/18
W 6/19
Th 6/20
F 6/21
June 24 - 28
Nature Week
June 10
M 6/24
T 6/25
W 6/26
Th 6/27
F 6/28
July 8 - 12
How Great Thou Art
June 24
M 7/8
T 7/9
W 7/10
Th 7/11
F 7/12
July 15 - 19
Let's Make a Meal
July 1
M 7/15
T 7/16
W 7/17
Th 7/18
F 7/19
July 22 - 26
Water Works
July 8
M 7/22
T 7/23
W 7/24
Th 7/25
F 7/26
July 29 - Aug 2
Fun, Fun, Fun
July 15
M 7/29
T 7/30
W 7/31
Th 8/1
F 8/2
Child's Home Address/ Contact Information
Child's Home Address
Phone
Email
Parent/Guardian Information
Mother's Name
Home Phone
Cell Phone
Address (if Different than above)
Employer
Father's Name
Home Phone
Work Phone
Cell Phone
Address (if Different than above)
Employer
Medical Information
Child's Physician
Child's Dentist
Work Phone
Phone Number
Phone Number
List all allergies, including food and medical
Any chronic physical and/or emotional problems or conditions
Emergency Contacts
(local contacts only, please) If parents/guardians can not be reached
Name
Address
Name
Address
Relationship
Phone
Relationship
Phone
Name and Phone Numbers of persons authorized to pick up your child
(may be the same names as above)
Name
Name
Name
Name
Relation
Relation
Relation
Relation
Other Preschools your child has attended
Phone
Phone
Phone
Phone
Has your child ever been asked to leave a preschool?
Does your child have any special behavior issues?
Are you a member of CUMC?
How did you hear about CUMC Preschool?
Important Information for Parents
Enrollment Policy
Children who are enrolled but not toilet trained at the start of Summer Camp will not be accepted. ENROLLMENT FEES WILL NOT BE REFUNDED IF YOUR CHILD IS NOT TOILET TRAINED. At parents’ request, we can place the child on a waiting list at no cost. The only time a refund of the enrollment fee can be given is if the class is full. Your check will be returned to you.
Camp Fees Policy
The Summer Camp Fees are based on a weekly summer rate and is due in full at least two weeks prior to the Camp Week Date. There is a $25 returned check fee. There is no deduction for absences or holidays. Checks should be made payable to Culpeper United Methodist Church, or you may pay on our secure preschool webpage at
www.culpeperumc.org/preschool.
CUMC Summer Camp reserves the right to dismiss a child from our program due to behavioral issues (after parent conferences) with two weeks’ notice to the parents.
Registration / Supply Fee
There will be a non-refundable registration / supply fee of $75.00, due at time of registration at least two weeks prior to the first desired camp week date. This is a one time summer fee. This fee will include a school t-shirt.
Parent Signature
Today's Date
SUBMIT
