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Frederick Summer Enrichment Camp

Events

South End Baptist Church: 506 Carrollton Dr. Frederick

For those who have completed Kindergarten through those who completed 5th grade

Cost: $70 per child for 5 weeks

Dates: (5 weeks of camp) June 30 – July 31

Monday – Thursday camp (no camp on the 4th of July)

Times: 9:30 am – 3:00


Summer Enrichment Camp Participation Criteria
The Summer Enrichment Camp is committed to providing a safe and supportive environment for all participants. However, due to specific program limitations, we are unable to adequately support children with certain behavioral, emotional, or sensory needs. Please note the following qualifications and considerations for camp participation:
   1.	Behavioral and Emotional Needs:

The camp is not equipped to manage behaviors that require physical restraints or continual redirection.
We are unable to provide alternative learning methods or individualized learning environments.
Distractions cannot be minimized for individual students, and all students will work at a single pace in group settings. We are unable to accommodate additional time for individual students.

   2.	Specific Needs that Cannot Be Supported:

Children requiring one-on-one assistance will not be supported unless the family provides a qualified personal assistant with a clean background check.
The camp cannot accommodate children exhibiting self-harm behaviors or those who pose a risk of harm to others.
Students who tend to run or bolt from the environment will not be supported.
Children with heightened sensitivity to loud noises may find the environment challenging, as we are unable to reduce noise levels.

Families who feel their child may require accommodations outside of what is listed are encouraged to provide the necessary support (e.g., personal assistant) at their own expense, ensuring the assistant has undergone a background check.

We strive to create a positive experience for all campers and thank you for your understanding of our program limitations.

Frederick Summer Enrichment Camp Registration

STUDENT INFORMATION

Student's Name(Required)

First Last

Date of Birth(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Child's School(Required)

Grade Completed This Year(Required)

Child's Age(Required)

Reading Level(Required)

Is there something specific you would like for us to know about your child?

HEALTH INFORMATION

My child has medical conditions(Required)

Yes

If your child takes daily medication for the above medical conditions, list them here:

Does your child have any behavior issues that we should know about?

Camper who currently resides within the United States, a United States territory, or the District of Columbia; does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication?(Required)

Yes

Electronic Parent Signature(Required)

EMERGENCY CONTACT INFORMATION

Parent/Guardian Name (1)(Required)

First Last

Relationship to Child(Required)

Cell Phone(Required)

Work Phone

Parent/Guardian Name (2)(Required)

First Last

Relationship to Child(Required)

Cell Phone(Required)

Work Phone

Additional Contact Name

First Last

Cell Phone

Work Phone

PHOTO/VIDEO RELEASE

I give permission for a photos or videos of my child to be shared for the Mission's promotional use (social media, website, newsletter).(Required)

Yes

Electronic Parent Signature(Required)

Date(Required)

OFFSITE ACTIVITY CONSENT

Electronic Parent Signature(Required)

Date(Required)

PARENT AGREEMENT

I understand that in order to hold my child’s spot, the non-refundable amount due ($70) must be paid in full and all paperwork must be signed and completed. This program operates on a ﬁrst come, ﬁrst serve basis. Make checks payable to Frederick Rescue Mission, and send your check, along with this application to: The Frederick Rescue Mission Attention: SEC/Teri Kwiatek P.O. Box 3389 Frederick, MD 21705

Electronic Parent Signature(Required)

Date(Required)

PAYMENT INFORMATION

If paying with a credit card, enter your billing information below. You will be redirected to PayPal to complete payment upon clicking the “Submit” button.

SEC Registration Price

Price: $60.00

Registration Total

Name on Credit Card(Required)

First Last

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Payment Method(Required)

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name