Kids in College Summer Camp Registration

Thank you for your interest in College of Coastal Georgia’s Kids in College summer camp program. To register your child for our upcoming STEM and Fine Arts camps, please fill out all of the information below.

2014 Kids in College Summer Camp Registration
Camper Information
* Camper first name:
* Camper last name:
* Grade entering fall 2014:
* School enrolled for fall 2014:
* Camper gender:
* Camper age on 6/1/2014:

Parent Information
* Parent first name:
* Parent last name:
* Parent address line 1:
Parent address line 2:
* Parent City:
* Parent State:
* Parent Zip:
* Parent primary phone:
* Parent cell phone:
Parent work phone:
* Parent email:

Emergency Contact Information
Must be different than parent or guardian listed above
* Emergency contact first name:
* Emergency contact last name:
* Emergency contact cell phone:
Emergency contact
relationship to camper:

Pick Up Authorization
In addition to the guardian listed above, only persons listed below will be able to pick up the camper identified in this registration form from the designated drop-off/pick-up location. Persons picking up the camper may be asked to show proof of identification until the staff becomes familiar with these individuals.
First name:
Last name:
Relationship to camper:
First name:
Last name:
Relationship to camper:
First name:
Last name:
Relationship to camper:

Choose Your Camp and Dates
Kids in College will host two identical offerings of STEM, Fine Arts and Leadership camps in June and July. Please be sure to pick one of each type of camp.
STEM
July STEM Camp 2 – Monday July 7 - Friday July 11
July STEM Camp 2 – Monday July 7 - Friday July 11
Fine Arts
June Fine Arts Camp 1 – Monday June 9 - Friday June 13
July Fine Arts Camp 2 – Monday July 14 - Friday July 18
Leadership (Ages 10-13)
July Leadership Camp 2 – Monday July 21 - Friday July 25
July Leadership Camp 2 – Monday July 21 - Friday July 25

Additional Requests
Allergies:
Do you have any known allergies
(foods, medications or environmental)?
ADA requests:
Do you have any requests for accomodation relative to the
Americans with Disabilities Act?
Dietary requests:
Do you have any special
dietary needs?

Medication Authorization
I authorize Kids in College Staff to dispense medication to my child. I understand that my child’s medication must be picked up by an adult when the child leaves. Under no circumstances can medication be left in the child’s possession or overnight in on campus storage.
* Kids in College Staff to dispense medication to your child?
Medication(s):
Name of medication(s), dosage and time(s) medication is to be given?

Disciplinary Policy
You must agree to this policy in order to enroll a child in Kids in College.
* Good behavior is required of all children in this program. If a child has a conduct problem, the parent will receive one verbal notification unless the infraction requires immediate action. If the misconduct continues, the child will be removed from the program. I have read, understand and agree to this policy.

Refund Policy
You must agree to this policy in order to enroll a child in Kids in College.
* Kids in College (College of Coastal Georgia) will refund as follows: 95 percent before program begins; 75 percent before second class, 0 percent thereafter. I have read, understand and agree to this policy.

Photography Permission
You may choose to allow the College of Coastal Georgia to photograph your child while he or she participates in Kids in College. This is strictly voluntary and is not required.
* I hereby give permission for my child’s photograph to be taken by Kids in College and/or College of Coastal Georgia staff. I understand that photographs may be used to market Kids in College programs through various media.
Yes!  No I do not want my child’s photograph to be used to market Kids in College

Camp Fees
Early Registration Fee (before May 2, 2014) $160 per session
Standard Registration Fee (after May 2, 2014) $175 per session
Late Afternoon Pick-up Option
(Pick-up between 4:00 – 5:30 p.m.)
$50 per session
Note: Camp will assess a $10 daily fee if an unregistered student is picked up late.
Yes, I plan to use the late pick-up option
No, I do not plan to use the late pick-up option

Payment Method
Please mail signed waiver and check made payable to College of Coastal Georgia.

Bursar’s Office
College of Coastal Georgia
One College Drive
Brunswick, GA 31520

Credit / Debit
If you would like to pay with credit or debit card, please visit the Bursar’s Office located in the Andrews Center on the Brunswick Campus; open M-F, 8 a.m. – 4 p.m. Waivers may be dropped off the Office of Student Life, 2nd Floor of the Campus Center on the Brunswick Campus; open M-F, 8 a.m. – 5 p.m.

Legal Guardian
You must confirm your status as a parent or legal guardian in order to enroll a child in Kids in College.
* I hereby swear and confirm that I, the parent or legal guardia listed above in this form, am in fact the parent or legal guardian of the camper listed above in this same form. Furthermore, I do hereby swear that all information provided in this form is true and accurate to the best of my knowledge.