Camp Application SummerEnrichment Camp 2023 June 26 – August 4 Applicant(Required) Sex(Required) DOB(Required) MM slash DD slash YYYY Grade(Required) Home Address(Required) Zip Code(Required) Parent Daytime Telephone Numbers(Required)Email(Required) Applicant’s Current School Placement/Address/Telephone(Required) Does the applicant have allergies or allergic reactions or conditions that require medical care?(Required) Yes No Explain(Required)Does the applicant have a history of behavior problems, school expulsions, and/or academic limitations?(Required) Yes No If yes, please explain, in detail, on a separate sheet and attach to this applicationCustodial Parent/Guardian(s)(Required) Father/Guardian Occupation(Required) Mother/Guardian Occupation(Required) Church Affiliation/Pastor(Required) Primary Emergency Contact(Required)Relationship(Required) ** NON-MPCS applicants must submit a current immunization record, negative COVID 19 test results, and the current report card with the application and initial payment My signature indicates willingness to abide by the rules and regulations of Mt. Pleasant Christian School, Inc. Summer Enrichment Camp and the Mount Pleasant Church and Ministries. _____ We/I understand that all camp fees are nonrefundable. _____ We/I further understand that field trips and other off-site events will require additional funds for lunch and specialty purchases. ______Weeks, if less than six(Required) Dates requested: MM slash DD slash YYYY Dates requested: MM slash DD slash YYYY Dates requested: MM slash DD slash YYYY Parent or Guardian Signature(Required)Date MM slash DD slash YYYY Registration Payment Amount and Receipt #(Required) MPCS admits students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. MPCS does not discriminate on the basis of race, color, national or ethnic origin in the administration of its educational policies, and other school-administered programs. Δ If you would like to print and mail in form Click Here To Download PDF
