2020 Roxy Summer Camp Application

Join us for a fun-filled summer learning about Jesus, playing games, making crafts, learning new skills, and so much more!

Roxborough Church strives to provide affordable, Christian children’s programming to the Northwest section of Philadelphia. We do this by offering early childhood education through our preschool, education assistance through our afterschool program, and planned activities through our summer camp.

In order for your child to participate in these programs, you must complete this application. All information is required in order for your student to be registered and attend.

This application and the accompanying fee is the first step in registration. Once your application has been processed you will receive an invitation to join Brightwheel, our system for parent communication and billing, if do not yet have an account with us. Your spot in camp will not be secured until the application is submitted and after you have received a confirmation email from camp@roxboroughchurch.org.

DETAILS:

-June 15th-July 31st, 2020
-$100/week
-8:00 AM-3:00 PM
-Aftercare is available until 6:00PM for an additional $35/week (space is limited)
-Lunch and snack are provided, however you may choose to pack your child's lunch daily
-Summer camp is for children ages 3-entering 6th grade (all students must be potty-trained) and students will be divided into two main groups of age 3-entering Kindergarten and entering 1st-6th grade.

If you have any questions, please contact us at camp@roxboroughchurch.org. We are looking forward to a fun-filled summer with your camper!

Roxborough Church
8230 Ridge Ave
Philadelphia, PA 19128

Roxborough Church is an equal opportunity provider. We do not discriminate against on the basis of race, religion or gender.

Camper Information

 
 
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Parent/Guardian Information 1

 
 
 
 
 
 
 
 
Parent/Guardian Information 2

 
 
 
 
 
 
 
 
Emergency Contacts

Parents are the first emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. These individuals will also be approved pickups. Any person listed should be able to assist in contacting you, able to take responsibility for the child in case the parent/guardian cannot be contacted, and should be at least 18 years of age. 
 
 
 
 
 
 
 
 
 
Approved Pickups

Parent/Guardians and Emergency contacts are approved pickups. Please list additional pickups here if desired. Person MUST be over 18 years of age and have ID when arriving. 
 
 
 
Medical Information

 
 
 
 
 
 
 
 
 
First Aid & Emergency Medical Care Consent

My initials below authorize staff of Roxborough Church who are trained in the basics of first aid to give my child First Aid when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize Roxborough Church to transport my child to the nearest medical care facility and to secure necessary medical treatment for my child. I understand that I assume all financial responsibility for any treatment or injuries sustained by my child while he/she is in Roxborough Church care.
 
 
 
Administration of Medication Consent Form

1. All prescriptions and nonprescription medications shall be maintained with the child's name and shall be dated.
2. Prescriptions and nonprescription medications must be stored in the original bottle with unaltered label. Medications requiring refrigeration must be properly stored. 
3. Prescription and nonprescription medication shall be administered in accordance with the label directions.
4. Written consent must be provided from the parent, permitting Roxborough Church staff to administer medications to the child. Instructions shall not conflict with the prescription label or product label directions. 
 
 
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Photograph/Media release authorization on behalf of Roxborough Church:

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Parent/Guardian Agreement

General Policies:
1. I am enrolling my child in Roxborough Church's programs.
2. I understand there is an application fee of $25.
3. I understand there is a tuition fee which is due by the due date via brightwheel or by check. Failure to pay could result in my child losing their spot in the program.
4. I understand that Roxborough Church will be providing Summer camp from the hours of 8:00 am - 3:00 pm (plus aftercare until 6:00 pm if enrolled).
5. I understand that my child will not be dismissed from the program without being picked up by a parent or designated adult.
6. I understand there will be a $15 fee will be added every 15 minutes for late pick-ups.
7. I understand that disrespect, fighting, physical and verbal aggression will not be tolerated in this program. I understand that my child could lose their position in the program and may be discharged immediately for such actions.
8. I understand that if a medical emergency arises, program staff will attempt to contact parents or the emergency contact that I have indicated. It is the parent's resonsibility to notify the staff if this information changes. If immediate medical attention is necessary, an ambulance or emergency vehicle may take my child to the hospital.
9. In case of illness, I understand that my child may not be permitted to attend the program. If staff feels that a child has a contagious disease, he/she may not return to the program without a doctor's note. 
10. In order for my child to be considered for this program I understand that I must complete all enrollment paperwork and health assessments. 
11. I understand that Roxborough Church's programs are faith-based (Christian).
12. I have received complete program information (handbook) at the time of enrollment (PA Code 3270.121, 3280.121, 3290.121).
13. I agree to update the emergency contact and parental agreement when changes occur or every 6 months at a minimum (PA Code 3270.124, 3280.124, 3290.124).
 
Non-discrimination in Services

SUBJECT: Nondiscrimination in Services

TO: Parents/Guardians


FROM: Christina Gomez (Director) & Kimberly Levine (Assistant Director)


Admissions, the provisions of services and referrals of clients shall be made without regard to race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age or sex.
Program Services shall be made accessible to eligible persons with disabilities through the most practical and economically feasible methods available. These methods include, but are not limited to, equipment redesign, the provision of aides and the use of alternative service delivery locations. Structural modifications shall be considered only as a last resort among available methods.
Any individual/client/patient/student (and/or their guardian) who believes they have been discriminated against, may file a complaint of discrimination with:

Roxborough Church
8230 Ridge Ave.
Philadelphia, PA 19128



Commonwealth of Pennsylvania Department of Human Services Bureau of Equal Opportunity
Room 225, Health & Welfare Building P.O. Box 2675
Harrisburg, PA 17105


U.S. Department of Health and Human Services
Office for Civil Rights
Suite 372, Public Ledger Building 150 South Independence Mall West 
Philadelphia, PA 19106-9111

 
Dismissal, Discipline, and Discharge Policy


  1. Children are not permitted to arrive alone and must be signed in by an adult.

  2. Children are only permitted to be signed out by an approved pickup over the age of 18.

  3. The fee for late pick up is $15 per 15 minute interval. Excessive lateness will be reviewed.

  4. Children are not permitted to bring any toys from home.

  5. A child who displays chronically disruptive behavior may be suspended or discharged at the discretion of the camp supervisors.

  6. Unacceptable Behavior of the Participant:

    1. Spitting, biting, or hitting

    2. Inflicting physical harm on other children on staff

    3. Inappropriate language or drawings

    4. Using profanities or obscenities

    5. Ridiculing or bullying other children

    6. Taking other children’s belongings

    7. Destruction of school or personal property

    8. Ignoring or disobeying the rules during the program times


 
 
 
 
 
 
 
 

Description

Join us for a fun-filled summer learning about Jesus, playing games, making crafts, learning new skills, and so much more!

Roxborough Church strives to provide affordable, Christian children’s programming to the Northwest section of Philadelphia. We do this by offering early childhood education through our preschool, education assistance through our afterschool program, and planned activities through our summer camp.

In order for your child to participate in these programs, you must complete this application. All information is required in order for your student to be registered and attend.

This application and the accompanying fee is the first step in registration. Once your application has been processed you will receive an invitation to join Brightwheel, our system for parent communication and billing, if do not yet have an account with us. Your spot in camp will not be secured until the application is submitted and after you have received a confirmation email from camp@roxboroughchurch.org.

DETAILS:

-June 15th-July 31st, 2020
-$100/week
-8:00 AM-3:00 PM
-Aftercare is available until 6:00PM for an additional $35/week (space is limited)
-Lunch and snack are provided, however you may choose to pack your child's lunch daily
-Summer camp is for children ages 3-entering 6th grade (all students must be potty-trained) and students will be divided into two main groups of age 3-entering Kindergarten and entering 1st-6th grade.

If you have any questions, please contact us at camp@roxboroughchurch.org. We are looking forward to a fun-filled summer with your camper!

Roxborough Church
8230 Ridge Ave
Philadelphia, PA 19128

Roxborough Church is an equal opportunity provider. We do not discriminate against on the basis of race, religion or gender.