File - Opendoor Education

Opendoor After School is excited that you have chosen to spend the summer with us! Attached you will find the
2016 Summer Camp schedule that includes eleven weeks of non-stop fun. Our Summer Camp program is
$150.00 per week and offered to all rising 1st through 6th graders. This price includes a morning and afternoon
snack, lunch, and two field trips each week.
You can sign up for as many or as few weeks as you want as our camp is run on a week-to-week basis. When
you register, you are committing to the week(s) you select and there is a $5.00 per week registration fee. Our
program has a two-week notice policy for any change in registration. Notice must be given in writing via email
to rachelbissette@opendoorchurch.com.
You will be charged a one-time $15.00 t-shirt fee at registration (payable by cash or check) as it is required to
wear on every field trip.
After reading the weekly descriptions, please initial the box beside the week(s) you wish to register your
child(ren). Please note two separate weeks of camp are only four days.
Once your information has been turned in and processed, you will receive a confirmation email that includes
the weeks you have registered for. We have provided space on the back of this to note for your records the
week(s) you registered.
In the event of a delay or closing, we use a program called EZTexting to notify you of urgent announcements.
Upon enrollment, both parent cell phone numbers will be entered into our system. In the event of any last
minute delays or cancellations that may affect your drop off or pick up schedule, you will receive a text
message from that system. If you have any trouble viewing or receiving the text please message the word
OPENDOOR to 313131. We also post on our Instagram pages: odmcdc (for Child Development Center),
odmschool (for Opendoor School) and opendoor.afterschool (for After School). We strongly encourage you to
follow for updates on your child’s program and for any announcements that may apply to you and your child.
Students will be transported to and from field trips by bus or van. Transportation providers will be staff
members of Opendoor Church, Opendoor After School and the Opendoor Child Development Center.
Permission to transport is valid for June through August 2016.
Tuition will be drafted on a weekly basis ONLY in the summer to accommodate changes in schedules, but we
still require a two week notice to change weeks otherwise you will be charged for that week.
The attached forms need to be turned in at the Opendoor Education front desk (located in the 2nd building)
as quickly as possible to complete your registration for Summer Camp 2016 (this top sheet is for you to
keep). The weeks will fill up quickly and are available on a first come first serve basis. If a particular
week is full, your student will be put on a wait list and contacted as soon as the spot becomes available.
We are so excited about this summer and can’t wait to have you join us! If you need to contact us for any
reason, please feel free to call Opendoor Education at (252) 321-1163 or contact me by email at
rachelbissette@opendoorchurch.com. !
!
Summer Camp Schedule (for your records):
_____ Week 1 – June 13th – 17th – Going for Gold
This week campers will go head to head in competitions and learn how to fight for Jesus. We will be
going to Boyd Lee Park for fun and games. We will also find out who can win it all bowling at AMF
Carolina Lanes.
_____ Week 2 – June 20th – 24th – Mission Space
This week campers will be exploring and discovering things that are out of this world! The students will
battle it out in Laser tag at the Atomic Laser Dome. Campers will also head to Raleigh and launch into
more fun at Defy Gravity.
_____ Week 3 – June 27th – July 1st – Shark Week
Let’s dive into a week of adventure! This week we will travel to the NC Aquarium at Pine Knoll Shores to
discover the wonders of the sea. We will also be jumping into all kinds of fun at the Fitness Connection
pool here in Greenville.
_____ Week 4 – July 5th – 8th – Stars & Stripes
This four day week will be packed with excitement! We will reach for the stars at Air-U Trampoline Park in
Greenville. The campers will also enjoy a fun picnic near the lake located at River Park North.
_____ Week 5 – July 11th – 15th – Best of the West
Howdy partners, who’s ready to round up some fun? This week we will head to Three Bear Acres in
Raleigh. We will also saddle up and ride at the Equine Country USA in Jacksonville.
_____ Week 6 – July 18th – 22nd – Christmas in July
We hope your week will be merry and bright! We are going to spread the CHRISTmas cheer at Frankie’s
Fun Park in Raleigh. We will also be cooling things down at the Simply Natural Creamery in Ayden.
_____ Week 7 – July 25th – 29th – Pirate Nation
Ahoy, Mateys! Are you ready to set sail? We will head to the Battleship in Wilmington and learn what it
takes to be a real hero at sea! Let’s make a splash at the Fitness Connection Pool and Fantasy Lake
Water Park in Hope Mills.
_____ Week 8 – August 1st – 5th – Circus Under the Son
Come one, come all to the greatest week ever! These five days are jammed packed with excitement!
We will head to Raleigh for fun at Monkey Joe’s. We’re also driving to Cameron for a wild time at Aloha
Zoo.
_____ Week 9 – August 8th – 12th – Royals
Welcome all Kings and Queens! We will separate our boys and girls this week as they head to Tryon
Palace in New Bern. Our girls will shake a leg in dance class and our boys will get down and dirty at
Deadwood in Williamston. !
_____ Week 10 – August 15-19th – Hollywood
Lights, camera, action! Let’s dream big this week as we travel to the Marbles Museum in Raleigh. We will
also sit back and enjoy a movie on the big screen at Carmike 12 in Greenville!
_____ Week 11 – August 22nd – 25th – Blast from the Past
During this four day week we will have a blast wrapping up summer camp! We will jump into fun at Air-U
in Greenville. Campers will also have a great time on campus with inflatables and other surprises!
Insufficient Funds Policy
We understand things happen, but if any type of payment is returned for insufficient funds, our policy is as follows:
First Offense – a returned payment fee of $25.00 will be assessed to your account. We will notify you of the
returned payment and give you the option for us to re-run the draft or provide another form of payment within
forty-eight (48) hours. If you need to make additional arrangements, please discuss this with us immediately.
Second Offense (within a year from the first offense) – a returned payment fee of $25.00 will be assessed to your
account. We will notify you of the returned payment and will need to make a CASH ONLY payment to cover the
payment that was returned. Your account will be marked as CASH ONLY. After one (1) year from the date of the
returned check, if timely payments have been made, we will remove your account from cash only.
Third Offense – a returned payment fee of $25.00 will be assessed to your account. We will notify you of the
returned payment and you will need to make a CASH ONLY payment IMMEDIATELY to cover the payment that
was returned (or balance in full) along with the returned payment fee. We hold the right to remove your child from
our facility and in order for them to return, you will need to pay a month in advance.
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Opendoor After School
Summer Camp 2016 Registration & Schedule
Student Name: ____________________________________________________________________
Parent Name: _____________________________________________________________________
Parent Email: _____________________________________________________________________
Daytime Phone: ___________________________________________________________________
Grade (rising): _________________ Age: ______________ Child(s) Weight: __________________
(For transportation safety)
T-Shirt Size:
____ X-Small ____ Small ____ Medium ____ Large
____ X-Large ____ XX-Large ____ Adult Small
If you would like to purchase your child an additional t-shirt for $10.00, please check the box.
Schedule of Weeks
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June 13th – 17th
Who’s ready to go for gold? This week campers will go head to
head in competitions and learn how to fight for Jesus. We will be
going to Boyd Lee Park for fun and games. We will also find out
who can win it all bowling at AMF Carolina Lanes.!!
June 20th – 24th
This week campers will be exploring and discovering things that
are out of this world! The students will battle it out in Laser tag at
the Atomic Laser Dome. Campers will also head to Raleigh and
launch into more fun at Defy Gravity.
June 27th – July 1st
Let’s dive into a week of adventure! This week we will travel to
the NC Aquarium at Pine Knoll Shores to discover the wonders
of the sea. We will also be jumping into all kinds of fun at the
Fitness Connection pool here in Greenville.
July 5th – 8th
This four day week will be packed with excitement! We will
reach for the stars at Air-U Trampoline Park in Greenville. The
campers will also enjoy a fun picnic near the lake located at
River Park North.
July 11th – 15th
Howdy partners, who’s ready to round up some fun? This week
we will head to Three Bear Acres in Raleigh. We will also saddle
up and ride at the Equine Country USA in Jacksonville.
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July 18th – 22nd
We hope your week will be merry and bright! We are going to
spread the CHRISTmas cheer at Frankie’s Fun Park in Raleigh. We
will also be cooling things down at Simply Natural Creamery in
Ayden.
July 25th – 29th
Ahoy, Mateys! Are you ready to set sail? We will head to the
Battleship in Wilmington and learn what it takes to be a real hero
at sea! Let’s make a splash at the Fitness Connection Pool and
Fantasy Lake Water Park in Hope Mills.
August 1st – 5th
Come one, come all to the greatest week ever! These five days
are jammed packed with excitement! We will head to Raleigh
for fun at Monkey Joe’s. We’re also driving to Cameron for a wild
time at Aloha Zoo.
August 8th – 12th
Welcome all Kings and Queens! We will separate our boys and
girls this week as they head to Tryon Palace in New Bern. Our girls
will shake a leg in dance class and our boys will get down and
dirty at Deadwood in Williamston. !
August 15th – 19th
Lights, camera, action! Let’s dream big this week as we travel to
the Marbles Museum in Raleigh. We will also sit back and enjoy a
movie on the big screen at Carmike 12 in Greenville!
August 22nd – 25th
During this four day week we will have a blast wrapping up
summer camp! We will jump into fun at Air-U in Greenville.
Campers will also have a great time on campus with inflatables
and other surprises!
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_________________________________________________________________________________________________________________________!
For your child’s safety and security Opendoor Education is a lockdown facility. We have door keypads outside
all main entrances. We ask that you choose a code that will be kept with ONLY mother and father of the child.
All Authorized Pick-ups are to come to the front desk to have their ID checked before going into classrooms.
They DO NOT need to be given this code. Please fill in what you would like for your family’s door code to be
and it will be programmed by the first day of Summer Camp. All codes must be a four-digit number.
YOUR FAMILY’S DOOR CODE: ________________________
(PLEASE NOTE: You must press the * key after your code to enter the building)
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Contact!Information!
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Name&of&Child&(First,&Middle,&Last):&&___________________________________________________________________________________________&
Grade&(rising):&&______________________________&Date&of&Birth:&&________________________________________________________&&&
Student’s&Address:&&_____________________________________________________________________________________________________________&
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&&&&&&&&&&&&&&&&&&&&&&&&&&&& &
(Street)&
_________________________________________________________________________________________&&&&&______________________&&&&&_______________&
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&&&&&(City)&
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&&&&(State)&
&&&&&&&&&&&&(Zip)&
Mother’s!Name/Guardian:!___________________________________________________________________________________________________!
Cell!#___________________________________!Home!#___________________________________!Work!#___________________________________!
Address:&&_________________________________________________________________________________________________________________________&
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&&&&&&&&&&&&&&&&&&&&&&&&&&&& &
(Street)&
_________________________________________________________________________________________&&&&&______________________&&&&&_______________&
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&&&&&(City)&
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&&&&(State)&
&&&&&&&&&&&&(Zip)&
Place&of&Employment:&&__________________________________________________________________________________________________________&
Father’s!Name/Guardian:!!!!__________________________________________________________________________________________________!
Cell!#___________________________________!Home!#___________________________________!Work!#___________________________________!
Address:&&_________________________________________________________________________________________________________________________&
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&&&&&&&&&&&&&&&&&&&&&&&&&&&& &
(Street)&
_________________________________________________________________________________________&&&&&______________________&&&&&_______________&
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&&&&&(City)&
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&&&&(State)&
&&&&&&&&&&&&(Zip)&
Place&of&Employment:&&__________________________________________________________________________________________________________&
Emergency!Contact:!!!_________________________________________________________!!Relationship!to!Child:!____________________!
Cell!#___________________________________!Home!#___________________________________!Work!#___________________________________!
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Address:&&_________________________________________________________________________________________________________________________&
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&&&&&&&&&&&&&&&&&&&&&&&&&&&(Street)&& &
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(City)& &
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(State)& &
&(Zip)&
Name&of&Child’s&Health&Clinic:&&_________________________________________________________________________________________________&
Name&of&Child’s&Physician:&_________________________________________________________&Phone&#&&_________________________________&
Name&of&Child’s&Dentist:&____________________________________________________________&Phone&#&&_________________________________&
Health&Insurance&Provider:&&&___________________________________________________________________________________________________&
Policy&Number:&__________________________________________________&Group&Number:&&____________________________________________&
Name&of&Policyholder:&__________________________________________________________________________________________________________&
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We!need!a!copy!of!your!insurance!card!to!keep!on!file.&
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Authorization!&!Release!
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Student&Name:&&___________________________________________________________________&
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Consent!to!Use!Photos:!
I& DO! give& our& consent& for& the& above& minor& child’s& name/photo/picture/video& to& be& used& in& church& picture&
boards/brochures/websites/Facebook/Twitter/social& media& or& any& materials& published& regarding& activities&
sponsored&by&or&participated&in&by&Opendoor&Education.&&
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In!Case!of!an!Emergency:!
If& an& Emergency& arises,& I& hereby& give& permission& to& Opendoor& Education& to& secure& emergency& medical,& dental,&
and/or& emergency& surgical& treatment& and& to& provide& emergency& transportation& for& my& child.& & NonSemergency&
medical&treatment&or&elective&surgery&is&not&included&in&this&authorization.&&&
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Travel:!
I&am&agreeing&to&waive,&release,&and&hold&harmless&Opendoor&Education&its&members,&agents,&and&employees&from&
any&and&all&claims&and&liability&arising&out&of&your&child’s&participation&in&the&program&whether&on&campus&or&off&
campus&and&transportation&thereto&and&from&the&destination.&
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Medication:!
I&do&give&Opendoor&Education&permission&to&administer&medication&during&Opendoor&Education&hours&of&operation.&&
A&licensed&physician&has&prescribed&this&medication&and&Opendoor&has&a&record&of&the&medical&condition,&medicine&
to&be&administered,&and&the&dosage.&&It&is&not&Opendoor’s&policy&to&administer&medicines—unless&it&is&necessary&to&
prevent&illness&such&as&allergic&reactions&or&asthma.&&I&hereby&release&Opendoor&Education’s&employees&from&any&
and&all&liability&that&may&result&from&my&child&taking&the&medication.&
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Security:!
For&your&child’s&safety&and&security&Opendoor&Education&is&a&lockdown&facility.&We&have&door&keypads&outside&all&
main& entrances.& We& ask& that& you& choose& a& code& that& will& be& kept& with& ONLY& mother& and& father& of& the& child.& All&
Authorized&PickSups&are&to&come&to&the&front&desk&to&have&their&ID&checked&before&going&into&classrooms.&&They&DO&
NOT&need&to&be&given&this&code.&Please&fill&in&what&you&would&like&for&your&family’s&door&code&to&be&and&it&will&be&
programmed&by&the&first&day&of&Summer&Camp.&All&codes&must&be&a&fourSdigit&number.&&
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YOUR!FAMILY’S!DOOR!CODE:!________________________!
(PLEASE!NOTE:!You!must!press!the!*!key!after!your!code!to!enter!the!building)&
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Authorized!Pick!Up:!
Other&than&the&parents&listed&in&the&contact&info,&the&following&are&allowed&to&pick&up&my&child:&
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1.&&________________________________________________________& 2.&&_________________________________________________________&
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3.&&________________________________________________________& 4.&&_________________________________________________________&
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Parent&Signature:&&_____________________________________________________________&&Date:&&______________________________&
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Medical!Report.!
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Student&Name&(First,&Middle,&Last):&______________________________________________________________&&DOB:&&______/______/______&
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Name&of&Parent&or&Guardian:&&__________________________________________________________________________________________________&
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Address&of&Parent&or&Guardian:&________________________________________________________________________________________________&
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MEDICAL!HISTORY&
1.&&Is&child&allergic&to&anything?&&_____&No&&&&&&&&&&_____&Yes&
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If&yes,&what?&_______________________________________________________________________________________________________________________________&
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_________________________________________________________________________________________________________________________________________________&
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2.&&Is&child&currently&under&a&doctor’s&care?&&_____&No&&&&&&&&&&_____&Yes&
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If&yes,&for&what&reason?&___________________________________________________________________________________________________________________&
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_________________________________________________________________________________________________________________________________________________&
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3.&&Is&the&child&on&any&continuous&medication?&&_____&No&&&&&&&&&&_____&Yes&
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If&yes,&what?&_________________________________________________________________________________________________________________________________&
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_________________________________________________________________________________________________________________________________________________&
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4.&&Have&there&been&any&previous&hospitalizations&or&operations?&_____&No&&&&&&&&&&_____&Yes&
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If&yes,&when&and&for&what&reason?&______________________________________________________________________________________________________&
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_________________________________________________________________________________________________________________________________________________&
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5.&&Any&history&of&significant&previous&diseases&or&recurrent&illness?&_____&No&&&&&&&&&&_____&Yes&
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Diabetes:&&&&&&&&&&&&&&
_____&No&&&&&&&&&&_____&Yes&
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Convulsions:&&&&&&
_____&No&&&&&&&&&&_____&Yes&
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Heart&Trouble:&&&
_____&No&&&&&&&&&&_____&Yes&
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Asthma:&
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_____&No&&&&&&&&&&_____&Yes&
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6.&&Does&your&child&have&any&physical&disabilities?&_____&No&&&&&&&&&&_____&Yes&
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If&yes,&please&describe.&____________________________________________________________________________________________________________________&
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_________________________________________________________________________________________________________________________________________________&
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Medication!Authorization!
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TO!BE!COMPLETED!BY!PHYSICIAN/MEDICAL!PROVIDER!!
Only!if!needing!medication!for!emergency!situations!
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Name&of&Student&(First,&Middle,&Last):&_______________________________________________________________________________&
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DOB:&_________________________________& Name&of&Parent/Guardian:&_________________________________________________&
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It&is&necessary&that&medication&be&given&during&Opendoor&Education&hours&in&order&to&keep&this&student&in&
optimum&health&and&to&help&maintain&performance.&
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Medication____________________________________________&&Dosage/mg_____________________&&Route____________________&
&&&&&&
Time(s)&medication&is&to&be&given&at&Opendoor&Education:&______________________________________________________&
!
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If& medication& is& ordered& as& needed,& please& indicate& specific& circumstances& when& medication& should& be&
given&(Opendoor&Staff,&nonSlicensed&medical&or&nursing&personnel,&will&be&administering&medication):&
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_________________________________________________________________________________________________________________________!!
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_________________________________________________________________________________________________________________________!!
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_________________________________________________________________________________________________________________________!
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&&&& May&selfSmedicate&(student&has&demonstrated&proficient&use&of&medication).&
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&&&&&&&&&&&&&&&&&&&&May&not&selfSmedicate.&&
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Physician’s&Signature:&&__________________________________________________&&Date:&&____________________________________&
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Name&of&Clinic/Office:&_______________________________________________________________________________________________&
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Opendoor After School Summer Camp 2016
ACH Debit Authorization Agreement
☐
Summer Camp
Child(ren)’s Name: _________________________________________
_________________________________________
_________________________________________
I hereby authorize Opendoor After School to initiate charges to my account and the bank named below
is authorized to debit that account.
Bank Name _______________________________________ Checking
Bank Routing #_______________________
[
]
Savings
[
]
Account # _____________________________________
PLEASE CLEARLY WRITE YOUR BANK ACCOUNT INFORMATION
(EVEN IF IT IS THE SAME AS BEFORE)
OR
ATTACH A VOIDED CHECK HERE
This authority is to remain in effect until the bank has received written notice of termination and has been provided a
reasonable opportunity to take action. The bank customer has the right to stop payment of debit entry by notifying the
bank prior to charging the account. If the organization initiates an incorrect debit entry to the customer’s account, the
customer shall have the right to ask the bank to credit the amount from that entry to the account. To obtain proper credit
to the account the customer shall have fulfilled the following conditions: notify the bank in writing of the incorrect entry
within fifteen calendar days following the date the customer received the statement of account or a written notification of
that entry or 60 calendar days after posting, whichever comes first.
BANK DRAFT AUTHORIZATION CONTRACT FOR TUITION FEE
I authorize Select Bank as agent for Opendoor After School, to initiate debits to my checking/savings account for 2016
Summer Camp from June – August 2016. Returned drafts will be charged a fee of $25. PLEASE REFER TO THE
INSUFFICIENT FUNDS POLICY AS STATED ON THE SUMMER CAMP INFORMATION SHEET.
By signing this authorization contract, I agree to the terms set forth herein.
Please print your name(s):
Signed:
Date:
Email Address**:
**You will receive an email from Joy Kimbril to confirm your draft information. Please respond upon receipt.**