Summer Camp Registration | Crosspoint Preschool

Child Information

CHILDREN MUST BE FULLY IMMUNIZED PRIOR TO THE FIRST DAY OF CAMP!

Child's Name(Required)

First Last

Name you prefer your child be called at school:(Required)

Sex(Required)

Male

Female

Date of Birth(Required)

Age as of June 1, 2026(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Parent/Guardian Information

Father/Guardian’s Name

First Last

Cell Phone

Email Address

Mother/Guardian’s Name

First Last

Cell Phone

Email Address(Required)

Marital status of adults with whom child lives:

(Notify the Preschool administrators of legal custody arrangement and bring copies of any custody papers if applicable.)

Class Enrollment

Note: Camps are scheduled according to demand and may be closed in cases of low enrollment.

Summer Camps are FULL. Registration is CLOSED.

In case of emergency, please list two people who may be contacted if we are unable to reach parents/guardians.(Required)

Name

Phone

Health Insurance

Company

Identification Number

Family Physician

Name

Phone

General condition of child’s health:

Is your child under a physician’s care for any medical conditions (including speech, hearing, eyesight, cardiac or orthopedic)?

Yes

Please offer a brief explanation of medical condition.

Has your child received or is your child currently receiving any form of early intervention evaluation/services?

Yes

Please offer a brief explanation of intervention.

Does your child have any allergies (contact, inhaled, ingested) including food?

Yes

Please offer a brief explanation of allergies.

Are there any dietary restrictions (medical or religious) for your child?

Yes

Please offer a brief explanation of dietary restrictions.

Physical, mental, or emotional limitations:

Primary language spoken at home:

Has your child attended church, neighborhood, or other group activities?

By nature, is your child:

Friendly

Aggressive

Shy

Withdrawn

Other

How would you describe your child's nature?

Has your child had any unusual experiences such as an accident or trauma, or does your child have any strong fears? (For example: elevators, loud noises, fire trucks, etc.)

Yes

Explain unusual experience.

Please Note: Your child must be potty trained prior to the first day of school. If your child is not potty trained by the first day of school, they may be removed from his/her classroom assignment, and no refund will be issued.

Is there any additional information the teachers should know to help make CrossPoint summer camp a more enjoyable experience for your child?

How did you hear about CrossPoint Preschool's summer camps?

CrossPoint does not discriminate in providing services to children and their families based on race, color, national and ethnic origin, political beliefs, or marital status.

Payment

You will receive a confirmation email once your registration has been received and processed. Detailed instructions for payment will be in the email. Payments will be due on the first of the month in which the child is registered. For example, if you register for 2 camps in July, payment for both weeks will be due on July 1, 2026. You will receive a 10% discount off the second child's tuition when you register siblings during the same week of camp.

Signature of Parent/Legal Guardian(Required)

Date

Office Use Only

Payment received by: Cash_________ Date_________ Check_________ Date_________ ACH_________ Date_________