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Jefferson Child Care and Education Center
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Summer Camp Registration

Complete the program required forms and return them to the Center.

Summer Camp Registration

  • Fee Agreement (Download Form)
    Complete both pages and return to the Center.
  • Universal Health Record (Download Form)
    Complete Section 1 before sending to child’s physician for his/her completion. Please have physician attach immunization records. Return to Center no later than May 1, 2007. Note:  Last physical must be after  July 1, 2006
  • Permission Slip (Download Form)
    Complete and return to Center.
  • Emergency Form (Download Form)
    Complete entire form.  The signatures of those individuals you are authorizing to pick up your child are not required at this time.  The first time they pick up your child, they will be required to show identification and their signature will be obtained. 
  • Medical Release (Download Form)
    Complete entire form and return to center.
  • Receipt of Information Statement (Donwload Form)
    Complete entire form and return to center.
  • Good Behavior Pledge
    Explain this form to your child, fill in child’s name, have your child sign and date.
  • Payment
    Send 2 weeks tuition that will be held as a deposit.  This payment will be applied to your last two weeks of camp. Deposit due with packet, first week of tuition due on the first day of camp. To register for camp you must have a zero balance in your current program.   All prior balances must be paid before your child can attend camp.