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__________________________________________________