Extended Hours 2023 Summer Camp Application

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 may contact you for additional information.

Have you had an account with Extended Hours Program between 2021 - 2023? *

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.

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

This application is intended for Private Pay accounts only.

Please complete the CCCAP: Summer Camp Application and Calendar.

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

Details

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

Hours

-6:30 am - 6:00 pm

Dates Offered:

- May 30 - July 28.

Closed:

-Monday May 29th: Memorial Day

-Monday July 3rd - Wednesday July 5th: Independence Day

Pricing:

-Activity Fee: $55.00 per child

-Daily Rate: $43.00

-We do not offer discounts for 1/2 or partial days.

-Sibling Discount Available!

1st child: $43.00 per day

Additional child: 10% discount for each additional child

Payment for Activty Fee is due upon acceptance into Extended Hours Summer Camp.

Payment for 1st two weeks of camp is due by May 12th.

Remaining payments are due 2 weeks at a time following the payment/cancellation deadline schedule.

A late fee of $5.00 per day will be applied to payments received after the payment deadline.

We encourage families to take advantage of our auto-payment option to avoid late fee charges.

*If your family is receiving CCCAP assistance - please use the form for CCCAP Summer Reservations.

Our program will place priority on registrations for children who will be attending all 5 days per week.

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 5 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 are currently full.
Applications are for waitlist only. *

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

ALL locations are currently full.
Applications are for waitlist only.
*

Parent First Name *

Parent 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 included 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 in number *

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 in number *

Emergency Contact 2

Relationship to child: *

Child Information

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

Will your children 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 2023. *

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

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 important information or updates to your child's information.

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

Child 2 (If Applicable)

**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 '23 (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 Applicable)

**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 '23 (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 Applicable)

**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 '23 (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 Applicable)

**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 '23 (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

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 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 when attending camp.

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

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.

Any changes or cancellations must be communicated to the Extended Hours main office prior to the corresponding deadline date. Once the deadline has passed, parent is responsible for payment of all scheduled days. We are unable to "switch" or "credit" un-used days after the deadline.

Our office will send families a deadline reminder email prior to each 2 week cancellation deadline.

Week 1 & 2 (May 30 - June 9)

Summer Camp Week 1: May 30 - June 2
(CLOSED Monday, May 29 - Memorial Day)

THEME: Welcome Week!

Please mark days that your child will be attending. *

Summer Camp Week 2: June 5 - June 9

THEME: Dinosaurs!
Please mark days that your child will be attending. *

Total for May 30 - June 9
of Summer Camp:

Week 1 & 2 Total Per Child:

$0.00

Cancellation Deadline: May 11

Payment Deadline: May 12

*Daily rate: $43.00

Week 3 & 4 (June 12 - June 23)

Summer Camp Week 3: June 12 - June 16

THEME: Under the Sea

Please mark days that your child will be attending. *

Summer Camp Week 4: June 19 - June 23

THEME: Old West Colorado/Farm

Please mark days that your child will be attending. *

Total for June 12 - 23 of Summer Camp:

Week 3 & 4 Total Per Child:

$0.00

Cancellation Deadline: May 25

Payment Deadline: May 26

*Daily rate: $43.00

Week 5 & 6 (June 26 - July 7)

Summer Camp Week 5: June 26 - June 30

THEME: Planes. Trains. & Automobiles

Please mark days that your child will be attending. *

Summer Camp Week 6: July 6 - July7
CLOSED: July 3rd & 4th & July 5th for Independence Day

THEME: Red WHite and Blue

Please mark days that your child will be attending. *

Reserving Full Week (Thurs - Fri)

Thurs. July 6

Fri. July 7

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

Total for June 26 - July 7 of Summer Camp:

Week 5 & 6 Total Per Child:

$0.00

Cancellation Deadline: June 8

Payment Deadline: June 9

*Daily rate: $43.00

EXTENDED HOURS SUMMER CAMPS AND MAIN OFFICE WILL BE CLOSED THURSDAY, July 3 - July 5 FOR INDEPENDENCE DAY.

Week 7 & 8 (July 10 - July 21)

Summer Camp Week 7: July 10 - July 14

THEME: Heros Week

Please mark days that your child will be attending. *

Summer Camp Week 8: July 17 - July 21

THEME: Outer Space

Please mark days that your child will be attending. *

Total for July 10 - July 21 of Summer Camp:

Week 7 & 8 Total Per Child:

$0.00

Cancellation Deadline: June 22

Payment Deadline: June 23

*Daily rate: $43.00

Week 9 (July 24 - July 28)

Summer Camp Week 9: July 24 - July 28

THEME: Get Up and Go!

Please mark days that your child will be attending. *

Total for July 24 - August 2 of Summer Camp:

Week 9 & 10 Total Per Child:

$0.00

Cancellation Deadline: July 6

Payment Deadline: July 7

*Daily rate: $43.00

Additional Notes on Schedule Submitted:

Summer Total for Child 1:
**This total is for one child. If registering multiple children the sibling discount will apply.
Sibling discount: $43.00 per day for 1st child. 10% discount applied to each additional child.

0.00

Child 2 Total: (includes 10% discount)

0.00

Child 3 Total: (includes 10% discount)

0.00

Child 4 Total: (includes 10% discount)

0.00

Child 5 Total: (includes 10% discount)

0.00

Payment and Cancellation Info

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 are still charged 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

Payment Information

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

Payment Options:

-Auto Pay: Our office will automatically run the card saved on file for reservation totals on the due date for each 2 week schedule.

-Self Pay: Family is responsible for making payments for reserved care by each payment deadline. Payment methods include: cash, check, credit card, or online payment. Payments are due by the deadline for each 2 week period.

-Late Payments: Late payments are charged a $5.00 late fee for each day that payment is past due.

*** If payment is not received by Tuesday after the payment deadline for each calendar, the card on file will be charged for total of care reserved for that 2 week calendar including any late fees.

Name on Card *

Credit Card Number *

Expiration Date (mm/yy) *

3 Digit Security Code *

Payment Preference: *

Late Payment Agreement *

I understand that I will be charged a $5.00 late payment fee per day that my account is past due.

I understand that if payment is not made by the Tuesday after each payment deadline, Extended Hours Program will process payment using my card on file for the total due including any late fees.

Deadlines for Cancellations & Payments:

-Week 1 & 2: (May 30 - June 9)
Cancellations due by: May 11th
Payment due by: May 12th

-Week 3 & 4: (June 12 - June 23)
Cancellations due by: May 25th
Payment due by: May 26th

-Week 5 & 6: (June 26 - July 7)
Cancellations due by: June 8th
Payment due by: June 9th

-Week 7 & 8: (July 10 - July 21)
Cancellations due by: June 22nd
Payment due by: June 23rd

-Week 9 (July 24 - July 28)
Cancellations due by: July 6th
Payment due by: July 7th

I agree that payments will be made by the required due dates and understand that failure to make timely payments to Extended Hours Program may result in removal from Summer Camp Program.

*I understand that a $5.00 late payment fee will be applied for each day that payment is late after each payment deadline. *

Agree

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 5 business days if we will be able to offer your child a spot in one of our Summer Camps.

Payment of Activity Fee will then be due to complete the registration.

I understand that Extended Hours will notify me within 5 business days if they are able to offer my child a spot in Summer Camp. *

Agree