Choices Leadership Academy18106 Marsh Lane

Dallas, Texas 75287

SUMMER CAMPSUCCESS

Choices Leadership Academy18106 Marsh Lane

Dallas, Texas 75287

SUMMER CAMPSUCCESS

READING* WRITING* MATH*COMPUTER*DRAMA*SPORTS  STUDY SKILLS * FIELD TRIPS*LEADERSHIP * ART * SPANISH 

JUNE 8 thru JULY 17 GRADES 3-6 972-662-0665www.choicesleadership.org

*Sign Up For One Week Or All Six

*New Academic & Enrichment Activities Each Week

*Grades 3rd-6th

*7:30a.m.- 6:00p.m.*CLASS TIME: 8:30am-3:30pm

*Before Camp Care: 7:30am-8:30am*After Camp Care: 3:30pm-6:00pm

*Bring A Sack Lunch & Snack*Tuition $100 Per WeekSUMMER SESSIONS

Session I June 8 - 12 Session II June 15 - 19 Session III June 22 - 26 Session IV June 29 - July 2 Session V July 6 - 10 Session VI July 13 - 17

Choices Leadership Academy

Summer CampSuccess

Choices Leadership Academy

Summer CampSuccess

CAMP SUCCESS T-SHIRT FOR EACH

CAMPER!!!

CAMP SUCCESS T-SHIRT FOR EACH

CAMPER!!!

FUN FRIDAY IN HOUSE FIELD

TRIPS WITH SPECIAL GUESTS!!!

FUN FRIDAY IN HOUSE FIELD

TRIPS WITH SPECIAL GUESTS!!!

TWO CINEMARK MOVIE FRIDAYS!!!

*Popcorn *Hot DogsFUN!!! FUN!!! FUN!!!

TWO CINEMARK MOVIE FRIDAYS!!!

*Popcorn *Hot DogsFUN!!! FUN!!! FUN!!!

ALL BOOKS AND LEARNING TOOLS

SUPPLIED BY CAMP SUCCESS

ALL BOOKS AND LEARNING TOOLS

SUPPLIED BY CAMP SUCCESS

WIN PRIZES FOR DOING CAMP

HOMEWORK!!!!LEARN FROM GREAT

TEACHERS!!!

WIN PRIZES FOR DOING CAMP

HOMEWORK!!!!LEARN FROM GREAT

TEACHERS!!!

MAKE COOL FRIENDSBE A STAR!!!

ENJOY SPORTS & FITNESS!!!

MAKE COOL FRIENDSBE A STAR!!!

ENJOY SPORTS & FITNESS!!!

Registration Release Form

MEDICAL INFORMATION

Physician_____________________________________ Phone( )_______________________ Any health concerns or activity restrictions__________________________________________ Does student take prescription medication? Yes__ No___ If yes, what medication__________________________________________________________ Medications must be supplied by the parents and brought to camp in the original container and properly labeled with the name of the student, name of the medication, dosage amount and time the medication is to be administered. All medications must be taken to the Camp Office. MEDICAL RELEASEI hereby certify that my child is in good health and may participate in all activities. In case of an emergency, I give my permission for my child to be given emergency treatment at any hospital reasonably accessible. Parent/Guardian Signature_______________________________________________________ Relationship__________________________________________ Date____________________

WAIVER OF CLAIM & PHOTOGRAPHY RELEASE I hereby permit my child, herein after referred to as Participant to participate in the Choices Leadership Academy Summer Programs and  related activities including field trips requiring transportation by bus or van, sponsored by Choices Leadership Incorporated. I hereby release Choices Leadership Academy and it’s staff members and other persons and entities associated from any and all liability and responsibility for accidents or injuries arising. I hereby permit Choices Leadership Academy Summer Programs to use in whole or in part, photographs, videos, written  extraction, and voice recordings of the Participant for the purpose of illustrations and publications, including the Choices Leadership Academy website or newsletter. No Participant’s name will be published without  parent permission. I have read and understood the foregoing Consent,  Release and Waiver and I waive any and all claims, suits and causes of   action related thereto. I further understand that except for my Consent,  Release and Waiver in these respects the Participant will not be permitted to participate in the Choices Leadership Academy Summer Programs and related activities. 

 Parent/Guardian Signature_______________________________________ Date___________ 

Registration FormDETACH AND COMPLETE FORM

Mail, Deliver or Fax Registration Form and Tuition To:

Choices Leadership Academy18106 Marsh Lane Dallas, Texas 75287972-662-0665 Fax 972-307-3440

Last Name__________________________First__________________________________

Grade___School____________________Age___Birthdate_________________________ Parent/Guardian___________________________________________________________

Address_____________________________City_________Zip_______________________

Phone( )______________________________Cell( )_____________________________

Work( )_______________________E-mail_____________________________________

Name of person to contact if parent cannot be reached: Name______________________________ Phone________________________________ NONREFUNDABLE REGISTRATION FEE $25 DUE FOR EACH CAMP *Fee Is Applied To Each Camp Tuition *Registration Deadline May 29

CAMP SESSION GRADE TUITION _________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________*Confirmation of Payment Mailed After Registration Received* Total Tuition Fees_______________ Registration Fees_______________

( Balance Due Week Before Each Camp ) Tuition Balance_________________

Make Payment To: Choices Leadership Academy

___ Check Drivers License Number ___________________________(Required for checks) ___MasterCard ___VISA Credit Card Number _____________________________Expiration Date______________

Authorized Signature for Credit Card:__________________________________________

Please Print Name On Card__________________________________________________