Culpeper UMC Preschool

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

Last Name

Child's T-Shirt Size

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 7 - 11

Nature Week

May 24

Child's Home Address/ Contact Information

Child's Complete Home Address

Phone

Email - Primary

Email - Secondary

Parent/Guardian Information

Mother's Name

Home Phone

Cell Phone

Address (if Different than above)

Employer

Work Phone

Father's Name

Home Phone

Cell Phone

Address (if Different than above)

Employer

Work Phone

Medical Information

Child's Physician

Child's Dentist

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

Relationship

Phone

Name

Address

Relationship

Phone

Name and Phone Numbers of persons authorized to pick up your child

(may be the same names as above)

Name

Relation

Other Preschools your child has attended

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 enrollment / 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

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

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 7 - 11

Nature Week

May 24

June 14 - 18

Get Your Game On

May 31

June 21 - 25

Sleuthing with Science

June 7

June 28 - July 2

Beach Week

June 14

July 12 - 16

How Great Thou ART

June 28

July 19 - 23

Let's Make a Meal

July 5

July 26 - 30

Water Works

July 12

Child's Home Address/ Contact Information

Parent/Guardian Information

Medical Information

Emergency Contacts (local contacts only, please) If parents/guardians can not be reached

Name and Phone Numbers of persons authorized to pick up your child

(may be the same names as above)

Important Information for Parents

Registration / Supply Fee There will be a non-refundable enrollment / 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.

Registration / Supply Fee
There will be a non-refundable enrollment / 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.