ETC 2023 Summer Camps Registration Form
Hello from your ETC Staff!  

We would like to welcome each of you to our summer registration form. We have many exciting events planned each week, as we will be providing different themes to focus our learning activities, field trips and curriculum!

IMPORTANT REGISTRATION INFORMATION:  
You may register for as many weeks as needed/wanted for your child(ren).
Upon registering for the camps below, you are required to pay a non-refundable $50.00 deposit per week per student.  This deposit will be applied to your total $200.00 tuition fee for the week(s) selected.  The remaining balance due of $150.00 will be required on Monday, one (1) week prior to attending the selected camp. The non-refundable deposit cannot be applied to other weeks. If your student(s) fails to attend the selected week(s) registered, your non-refundable deposit will be forfeited.

WHEN:
June 5 - June 30; July 10 - July 28   ***We will be closed from July 3 - July 7, 2023.
Open from 7:00am - 6:00pm; Monday - Friday (The exception to this will be June 19th, when we will be closed in observance of the Juneteenth holiday.)

WHERE:
Simmons Elementary (one location for all elementary schools)

WHO CAN ATTEND:
Any child who was in elementary school this year (all 5 year olds must have completed Kindergarten)

COST:
The cost is $200.00 per child per week ($50.00 non-refundable deposit + $150.00 remaining tuition), plus a $20.00 one-time Registration Fee.  If you are a current ETC family, your Registration Fee will be waived for the ETC 2023 Summer Program.  We do accept CCAP payments.

COST INCLUDES:
- Fresh Breakfast, Fresh Lunch and an afternoon Snack  ( Breakfast and Lunch are being provided by the Woodford County School District as part of the Free Summer Feeding Program and will be delivered fresh each day.)
- All special planned activities including weekly Kona Ice, weekly swim day at the Falling Springs pool, various field trips and any special guest presenters.

ACTIVITIES:
We are planning different "camp themes" for each week:
June 5-9:  "Get Connected" - Lots of engineering activities with Legos, building blocks, and K'Nex. We will be ending the week with an ice cream social for families to attend to GET CONNECTED!

June 12-16:  "Fear Factor" - Fear is often what keeps students from making the right choice and tempts them to do wrong.  Fear takes them places they don't want to go and holds them hostage when they want to leave.  Fear is something we need to talk about.  During this week, the students will be participating in different activities that will test their fears, such as: "Walking on Glass" (walking on crushed up potato chips with a blindfold on), "Baby Food Taste Test" and "Worm Eating Challenge" (gummy worms in a small pie pan with whipped cream on top to hide the worms).

June 20-23:  "Sports Extravaganza" - Each day of camp will be dedicated to a different sport or two, such as Football, Soccer, Badminton, Cornhole, Basketball, Ultimate Frisbee/Disc Golfing, Baseball and Track/Running.  The students will learn the sport's history, along with different country's rules for how to play the sport.  During the afternoons, we will actually attempt to learn how to play the sport, occasionally with assistance from local coaches or guest speakers.  ****This week will only be 4 days due to not being open on June 19 in observation of the Juneteenth holiday and because of this, we will only be charging $160.00 per child to attend for the week.****

June 26-30:  "Music Makers" - Music is everywhere, during this week the students will explore different music instruments. We hope to have one of the music teachers from the school district provide a special program, along with other musical activities throughout the week.  

*****We will be closed July 3-7, returning on July 10, 2023.

July 10-14:  "Edible Engineering" - Students will start the week off with a Simple Cooking and Kitchen Safety program presented by the local extension office.  The children will explore different ways to use math, science and reading with hands-on cooking activities throughout the week.  We will end the week with a field trip to Old Fort Harrod State Park in Harrodsburg to learn more about gardening, cooking minimally and then enjoying lunch with the "Picnic in the Park" event.

July 17-21:  "Blasting Off with ETC?" - We will attend virtual field trips provided by the Smithsonian Air and Space Museum to learn about our solar system and outer space, along with making our own solar system and other fun science activities.  We will also be going on a field trip to the Aviation Museum of Kentucky, located at the Bluegrass Airport for a tour.

July 24-28:  "ETC's Got Talent!" - This week is going to be based around different artistic abilities and learning about the different fine arts.  The students will be going on a field trip to the Woodford Theatre to experience the "behind the scenes" workings of the theatre world.  We will end the week with a Talent Show allowing the children to showcase their individual skills and abilities.  Parents are highly encouraged to attend the Talent Show!


The form below will be print-formatted to look like our regular registration form. Your signature at the bottom of this document will serve as the official signature and you will not have to sign anything in person, outside of occasional field trip permission slips throughout the summer.  

After you have completed this form and it is reviewed by our office staff (allow 2-3 business days for this process), you will receive a confirmation email.  The confirmation email will include instructions regarding payment of the required non-refundable $50.00 deposit for each registered week, and the $20 registration fee (only to be paid if you did not participate in our regular ETC Afterschool Program during the 2022-23 school year). Students may not attend until the required deposit(s) and fee are paid.

When you submit this form, you will get an automatic email of your answers to keep for your records.

Follow our Facebook page at "WCPS Explorer Time Company - ETC" for reminders and announcements.
The Facebook feed is also available on our ETC web page under "Departments" on the school district web site and does not require you to have a Facebook account to view it.

Thank you for taking the time to complete this form completely and we are looking forward to seeing your child(ren) soon for some summer fun!
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Email *
Has your family participated in the ETC program previously? *
1st Parent/Guardian's First Name *
1st Parent/Guardian's Last Name *
1st Parent/Guardian's Email (if different from email submitted above)
1st Parent/Guardian's Phone Number *
1st Parent/Guardian's Address: Street *
1st Parent/Guardian's Address: City *
1st Parent/Guardian's Address: State *
1st Parent/Guardian's Address: Zip Code *
1st Parent/Guardian's Employment *
1st Parent/Guardian's Work Phone Number *
2nd Parent/Guardian's First Name (type NA to second guardian questions if none) *
2nd Parent/Guardian's Last Name *
2nd Parent/Guardian's Email
2nd Parent/Guardian's Phone Number *
2nd Parent/Guardian's Address: Street *
2nd Parent/Guardian's Address: City *
2nd Parent/Guardian's Address: State *
2nd Parent/Guardian's Address: Zip Code *
2nd Parent/Guardian's Employment *
2nd Parent/Guardian's Work Phone Number *
How many children are you enrolling in the ETC Summer Camps Program? *
Where did 1st Child last attend school? *
1st Child's First Name *
1st Child's Last Name *
1st Child's Date of Birth *
MM
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DD
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YYYY
How old is the 1st child as of June 1, 2023? *
What grade did the 1st Child just complete? *
Who does the 1st Child reside with? *
Does the 1st child have any of the following plans? *
Required
1st Child's Doctor's Name (First and Last) *
1st Child's Doctor's Phone Number *
1st Child Preferred Hospital Name *
1st Child's Insurance Carrier (cannot be left blank) *
1st Child's Insurance Policy Number (cannot be left blank) *
1st Child's Daily Medications? *
1st Child's Allergies? *
My electronic signature and check mark signifies the following assurances for medical assistance:   As the lawful parent or guardian of the above child, a minor child of whom I have custody and control, do hereby authorize the agents and employees of the Woodford County Board of Education to procure such emergency medical treatment as may be reasonably necessary to provide for the health and well-being of said minor child at any time that such minor is in the custody of said Woodford County Board of Education employee while in attendance at school, in attendance at the Explorer Time Company enrichment program, or while in route to or from a school.  I further authorize the said agents or employees of the Woodford County Board of Education to sign any and all consents required by physicians or hospitals in connection with said emergency treatment, including but not limited to the administration of anesthesia, disposal of tissue, the taking of photographs, moving pictures, television pictures, etc., the drawing of blood samples, and the performance of such additional operations or procedures as are considered necessary or desirable in the judgment of the attending physician or hospital authorities. In connection herewith, the Woodford County Board of Education agrees that it will direct its agents and employees to make a reasonable attempt to contact the parent or guardian of the child if emergency medical care or treatment is necessary and that the above authorization and consent is for the purpose of providing emergency care and treatment for the child when the parent or guardian cannot be located. *
Required
1st Child MAY be photographed. *
1st Child MAY have supervised internet access. *
1st Child MAY watch PG rated movies or shows. *
1st Child MAY participate in interactive Virtual field trips, where the field trip host is not an ETC staff member and will be able to interact virtually by speaking to and seeing the child. *
1st Child MAY attend trips to Falling Springs to use the water/pool facilities. *
1st Child MAY use waterslide at Falling Springs water/pool facilities. *
Please select all week(s) 1st Child plans to attend: *
Required
Do you have more children to register? *
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