Extended Hours Summer Camp Schedule & CCCAP Registration Info

Our CCCAP spots are currently full! Applications are now being accepted for Waitlist only.

We will notify families on our waitlist if additional spots become available in Extended Hours Summer Camps. *

I understand Extended Hours Summer Camps are currently FULL and this application is for the waitlist only.

Family must be currently registered with Extended Hours Program in order to enroll in Summer Camp.

*If you are adding a sibling to your account that is not currently enrolled with Extended Hours Program, our office will contact you for additional information.

Have you had an account with Extended Hours Program between 2021-2024? *

If NO - you must register an account with Extended Hours Program prior to filling out the Summer Camp Application & Calendar info.
To register your account:
Go to www.extendedhoursprogram.com.
Click on Summer Camp tab.
Scroll down to "How to Apply". Under Step 1 - look to the option that says "No?" There will be a link to Procare Online Registration.

Click on the blue link and you will then be prompted to complete the online application through Procare.

*After completing the online application - please return to and complete this form for your Summer Camp Application.

DO NOT FILL OUT THIS FORM UNLESS YOUR FAMILY IS CURRENTLY ENROLLED WITH EXTENDED HOURS PROGRAM THROUGH PROCARE.

CCCAP Information

Will your family be receiving CCCAP (Colorado Childcare Assistance Program) for summer camp? *

This application is intended for CCCAP accounts only.

Please complete the Summer Camp Application and Calendar.

Link is available on our website www.extendedhoursprogram.com under the Summer Camp tab.

This application is intended for famlies who are currently enrolled with and receiving CCCAP Assistance.

Case Worker Name: *

Case #

Details

Please complete the required form for your child's Summer Camp Registration.

Hours

-6:30 am - 6:00 pm

Dates Offered:

- May 29 - July 26

Closed:

- Closed Monday May 27th & Tuesday May 28th: Memorial Day

-Closed Wednesday July 3rd - Friday July 5th: Independence Day

Families will recieve an email confirming their child's spot in the Summer Camp program.

We cannnot guarantee a spot in summer camp prior to recieving and evaluating your child's schedule.

*Please allow up to 10 business days after your calendar has been submitted for our office to process your application and evaluate openings in our locations.

You will receive email notification when this process is complete.

Registration Info & Permissions

The information in this section is required to update your child's registration for Summer Camp.

Summer Camp Location Preference

*All locations FULL! Waitlist only. *

Summer Camp Location 2nd Preference:
Please select your 2nd preference in the event your 1st choice is not available.
*

Parent/Guardian First Name *

Parent/Guardian Last Name *

Contact email *

Primary Contact Phone #
Do not include any dashes or spaces in number *

2nd Phone Number
(Work phone or other emergency number)

Do not include any dashes or spaces in number *

Emergency Contacts

Two Additional Emergency Contacts are REQUIRED for each family.

*CANNOT list yourself or N/A

Emergency Contact 1
CANNOT LIST YOURSELF

Name (First and Last) *

Emergency Contact 1

Phone Number:
Do not include any dashes or spaces *

Emergency Contact 1

Relationship to Child *

Emergency Contact 2
CANNOT LIST YOURSELF

Name (First and Last) *

Emergency Contact 2

Phone Number
Do not include any dashes or spaces. *

Emergency Contact 2

Relationship to Child *

Child Information

How many children are you registering for our Summer Camp? *

Will your children all have the same schedule? *

If your children have separate schedules - you will need to fill out a separate application for each child. We are not able to distinguish separate schedules for multiple children on the application form. *

Child 1 First Name *

Child 1 Last Name *

Birthday * +

Grade Level:
Please select the grade the child will be entering Fall 2024. *

Child's last Dr. visit or Well Child Check Up
(list date within last 12 months) * +

Is this child currently enrolled in Extended Hours Program? *

Please list the school your child attends during the school year: *

Swim Level

*We swim at Lincoln Park Pool.

**For intermediate and advanced swim levels children MUST BE ABLE TO SWIM. They cannot move to the large pool based on provision of a life jacket. *

Please list any updates to your child's information that may have changed from your inital school-year registration with Extended Hours Program.

Examples: changes in health, allergies, behaviors, special notes

Child 2

**If children have the same schedule - please just use one form.

If children have DIFFERENT schedules, please submit a separate Summer Application and Schedule for each child.

	All Fields Require Answer for Additional Children
Name: First and Last	All Fields Require Answer for Additional Children
Date of Birth:	All Fields Require Answer for Additional Children
Grade Level Entering Fall '24 (K - 6)	All Fields Require Answer for Additional Children
Swim Level: (BEG, INT, or ADV)	All Fields Require Answer for Additional Children
Additional Notes (Allergies, Health Concerns, Etc.)	All Fields Require Answer for Additional Children
Last Dr. Visit or Well Child Check (date within last 12 months)	All Fields Require Answer for Additional Children
Is this child currently enrolled in Extended Hours Program? (If NO, our office will contact you for additional information.)	All Fields Require Answer for Additional Children

Child 3

**If children have the same schedule - please just use one form.

If children have DIFFERENT schedules, please submit a separate Summer Application and Schedule for each child.

	All Fields Require Answer for Additional Children
Name: First and Last	All Fields Require Answer for Additional Children
Date of Birth:	All Fields Require Answer for Additional Children
Grade Level Entering Fall '24 (K - 6)	All Fields Require Answer for Additional Children
Swim Level: (BEG, INT, or ADV)	All Fields Require Answer for Additional Children
Additional Notes (Allergies, Health Concerns, Etc.)	All Fields Require Answer for Additional Children
Last Dr. Visit or Well Child Check (date within last 12 months)	All Fields Require Answer for Additional Children
Is this child currently enrolled in Extended Hours Program? (If NO, our office will contact you for additional information.)	All Fields Require Answer for Additional Children

Child 4

**If children have the same schedule - please just use one form.

If children have DIFFERENT schedules, please submit a separate Summer Application and Schedule for each child.

	All Fields Require Answer for Additional Children
Name: First and Last	All Fields Require Answer for Additional Children
Date of Birth:	All Fields Require Answer for Additional Children
Grade Level Entering Fall '24 (K - 6)	All Fields Require Answer for Additional Children
Swim Level: (BEG, INT, or ADV)	All Fields Require Answer for Additional Children
Additional Notes (Allergies, Health Concerns, Etc.)	All Fields Require Answer for Additional Children
Last Dr. Visit or Well Child Check (date within last 12 months)	All Fields Require Answer for Additional Children
Is this child currently enrolled in Extended Hours Program? (If NO, our office will contact you for additional information.)	All Fields Require Answer for Additional Children

Child 5

**If children have the same schedule - please just use one form.

If children have DIFFERENT schedules, please submit a separate Summer Application and Schedule for each child.

	All Fields Require Answer for Additional Children
Name: First and Last	All Fields Require Answer for Additional Children
Date of Birth:	All Fields Require Answer for Additional Children
Grade Level Entering Fall '24 (K - 6)	All Fields Require Answer for Additional Children
Swim Level: (BEG, INT, or ADV)	All Fields Require Answer for Additional Children
Additional Notes (Allergies, Health Concerns, Etc.)	All Fields Require Answer for Additional Children
Last Dr. Visit or Well Child Check (date within last 12 months)	All Fields Require Answer for Additional Children
Is this child currently enrolled in Extended Hours Program? (If NO, our office will contact you for additional information.)	All Fields Require Answer for Additional Children

Permissions:

Please indicate below that you give permission for your child to engage in the following Summer Camp activities: *REQUIRED *

Sunscreen:

As a licensed childcare provider we are required to ensure all children have proper sun protection prior to outdoor activity.
Sunscreen may need to be re-applied throughout the day.
Typical application lasts 90 - 120 minutes.

We require all children are sent to camp with their own sunscreen labeled with child's first and last name.

If a child attends forgets his/her own sunscreen, we will provide generic brand sunscreen from Walmart for the day. Parents will be notified by staff when their child's sunscreen is running low.

**Please see Terms of Agreement for additional sunscreening information. *

I give permission for my child to receive sunscreen while attending Extended Hours Summer Camp.

I will provide sunscreen for my child.

If my child has a skin allergy or sensitivity, I will provide the appropriate sunscreen for use at Extended Hours prior to my child attending..

SCHEDULE

Please fill out your child's schedule of anticipated attendance for the entire summer.

We understand that some families may not have a complete work schedule through July at this point, but ask that you fill out the calendar to the best of your knowledge.

This allows our program to estimate overall attendance so that we can determine how many children we can accept in accordance with our licensing and staffing capacities.

Parents will have the ability to make schedule changes/cancellations throughout the summer following the cancellation deadline schedule.

Once the deadline has passed, parent is responsible for payment of all scheduled days. Absences will result in a Private Pay charge.

We are unable to "switch" or "credit" un-used days after the deadline.

Week 1 & 2 (May 29 - June 7)

Summer Camp Week 1: May 29 - May 31
(CLOSED Monday, May 27 & Tuesday, May 28 for Memorial Day)

THEME: Welcome to Camp!

Please mark days that your child will be attending. *

Summer Camp Week 2: June 3 - June 7

THEME: Animal Planet!

Please mark days that your child will be attending. *

Cancellation Deadline for Weeks 1 & 2: May 16

Week 3 & 4 (June 10 - June 21)

Summer Camp Week 3: June 10 - June 14

THEME: Out of this World!

Please mark days that your child will be attending. *

Summer Camp Week 4: June 17 - June 21

THEME: Wacky and Wonderful!

Please mark days that your child will be attending. *

Cancellation Deadline for Weeks 3 & 4: May 30

Week 5 & 6 (June 24 - July 2)

Summer Camp Week 5: June 24 - June 28

THEME: Pay it Forward!

Please mark days that your child will be attending. *

Summer Camp Week 6: July 1 - July 2
CLOSED: July 3rd, July 4th, & July 5th for Independence Day

THEME: Party in the USA

Please mark days that your child will be attending. *

Reserving Full Week (Mon-Tue)

Mon. July 1

Tue. July 2

*Not attending this week. *Not attending this week.

Cancellation Deadline for Weeks 5 & 6: June 13

EXTENDED HOURS SUMMER CAMPS AND MAIN OFFICE WILL BE CLOSED WEDNESDAY, JULY 3RD - FRIDAY, JULY 5 FOR INDEPENDENCE DAY.

Week 7 & 8 (July 8 - July 19)

Summer Camp Week 7: July 8 - July 12

THEME: GAME SHOW MANIA!

Please mark days that your child will be attending. *

Summer Camp Week 8: July 15 - July 19

THEME: Storyteller!

Please mark days that your child will be attending. *

Cancellation Deadline for Weeks 7 & 8: June 27

Week 9 (July 22 - July 26)

Summer Camp Week 9: July 22 - July 26

THEME: INVENTORS WORKSHOP!

Please mark days that your child will be attending. *

Cancellation Deadline for Week 9: July 11

Additional Notes on Schedule Submitted:

Cancellations & Schedule

Schedule: Schedules are required for the full Summer.

ALL schedule changes must be submitted to the Extended Hours main office via email or phone. Staff on-site are not able to accept cancellations or schedule changes.

Cancellation Policy: ALL cancellations and schedule changes must be made by the cancellation deadline. There will be NO REFUNDS after 5:00pm on the date of the deadline.

If your child does not attend for ANY reason, you will be charged private pay for the full day fee. We are not able to "switch" or "credit" charges to another day if the deadline has passed.

Availability of adding days to schedule will vary depending on open spots and staffing.

I understand that the calendar I am submitting for Summer Camp is the schedule that I will be held to and will be responsible for payment of all days reserved.

I understand that any changes to my calendar must be made by the cancellation deadline and that any late changes/cancellations will still be charged by Extended Hours Program. *

Agree

Cancellation Deadline Schedule

Deadlines for Cancellations:

-Week 1 & 2: (May 29 - June 7)
Cancellations due by: May 16

-Week 3 & 4: (June 10 - June 21)
Cancellations due by: May 30

-Week 5 & 6: (June 24 - July 2)
Cancellations due by: June 13

-Week 7 & 8: (July 8 - July 19)
Cancellations due by: June 27

-Week 9: (July 22 - July 26)
Cancellations due by: July 11

I agree that any cancellations will be made by the required due dates and understand that failure to make timely cancellations wth Extended Hours Program may result in private pay charges and possible removal from Summer Camp Program. *

Agree

Extended Hours Policies for Families Receiving CCCAP

I understand that my parent fee payment (if applicable) is due to Extended Hours Program on the 1st day of each month.

I acknowledge that if I do not pay my parent fee by the 5th day of the month Extended Hours Program will process payment on my account using the credit card on file. If payment cannot be processed care will be discontinued and my child may lose their spot in Summer Camp. *

Agree

I understand that all schedule changes to my reserved days are due by the cancellation deadlines for each 2 weeks of care.

The deadline schedule for each 2 weeks is listed above. (Cancellation deadline dates are listed on the Extended Hours Program website). Cancellations received after the deadline will result in a private pay charge and a "No Show" for the day. *

Agree

I understand that if my child has more than 2 absences on scheduled days, our Summer Camp Registration may be canceled and my child may lose their spot in Summer Camp.

Extended Hours may not accept future Summer Camp or Full Day reservations. *

Agree

I agree that if my child(ren) does not attend a day that was scheduled, I will be responsible for private payment of the absence.

The rate is $26.78 per day. *

Agree

I understand that if my child is sick, I must notify the main office by 8:00 AM of the day of care and provide a doctor's note within 24 hours to excuse the absence.

If doctor's note is NOT provided, I may be responsible for private payment for the absence. *

Agree

I understand that CCCAP does not pay Extended Hours Program the full rate of care if my child attends less than 5.01 hours.

I agree that if my child's attendance on any given day is less than 5.01 hours I will be responsible to pay the difference of $12.05 to Extended Hours Program. This payment will be due immediately to continue care. *

Agree

Families receiving CCCAP are required to check in on the ATS system as well as the manual check out sheet at drop off and pick up DAILY. Care may be suspended if parent/guardian fails to properly check child in and out on a consistent basis. *

Agree

Parent/guardian will authorize schedule and care through CCCAP caseworker prior to child attending. Any unauthorized care will result in a private pay charge due to the parent/guardian. *

Agree

This application is for Summer Camp 2024 only. I understand that I will have to re-register my child(ren) to attend in the school year program for the 2024 - 2025 school year.

(Registration for Extended Hours 2024 - 2025 School Year Programs will open in July 2024). *

Agree

Payment Information

Extended Hours Program will require a credit/debit card to be stored on file for each family.

*Your card will ONLY be charged in the event that there are charges on your account that are not covered by CCCAP.

Examples include:

-Your account has private pay charges

-Your parent fee payment (if applicable) is not received by the 5th of each month

-Child is picked up after 6:00 pm and a Late Pick Up Fee is applied to your account

Name on Card *

Credit Card Number *

Expiration Date (mm/yy) *

Security Code *

Terms of Agreement & Parent Handbook

Please indicate that you have read and agree to the following:

Extended Hours Program Terms of Agreement 2023

Extended Hours Program Parent Handbook

I have read the Terms of Agreement and Parent Handbook for Extended Hours Program. I have addressed any questions or concerns and agree to the terms listed. *

Agree

Confirmation

Once this form is submitted, our office will work on processing your application.

We will notify you within 10 business days if we will be able to offer your child a spot in one of our Summer Camps.

I understand that Extended Hours will notify me within 10 business days if they are able to offer my child a spot in Summer Camp. *

Agree