VOH Registration

Application For (Required) *

Summer Day Camp Afterschool Program

Application Steps

Household

Step 1 of 7

Please complete one form per family and add each child in the next section.

Parent / Guardian Information

Enter the primary parent or guardian's information.

First Name (Required) *

Last Name (Required) *

Cell Phone (Required) *

Alternate Phone (Optional)

Email Address (Required) *

Home Address

Street Address (Required) *

Apt # (Optional)

City (Required) *

State (Required) *

ZIP Code (Required) *

Employer (Optional)

Job Title (Optional)

Preferred Communication (Required) *

Phone Text Email Any

Custodial Parent? (Required) *

Yes No

Ethnicity (Optional)

Add another parent or guardian if applicable.

First Name

Last Name

Cell Phone

Alternate Phone

Email Address

Home Address (Optional)

Street Address

Apt # (Optional)

City

State

ZIP Code

Employer

Job Title

Children / Youth Information

Step 2 of 7

Add each child applying for the program.

Emergency Contacts / Authorized Pickup

Step 3 of 7

List all individuals authorized to pick up your child.

Release & Custody Rules

Allow release to authorized sibling under 18?

Family, Household, and Church Information

Step 4 of 7

Church Name

Pastor's Name

Church Address

Church Phone Number

Number in Household (Required) *

Free / Reduced Lunches (Required) *

Household Type (Required) *

Annual Household Income (Required) *

How did you hear about Voice of Hope Summer Camp? (Required) *

Eligibility Quick Check

Please check any that apply

Single parent working at least 25 hours/week Two parent household working at least 50 combined hours/week Household meets income guidelines

Medical & Health Information

Step 5 of 7

Complete this section for each child.

Please add children in Step 2 first.

Enrollment & Payment

Step 6 of 7

One agreement covers your whole household. Your details and children carry over from the earlier steps — you only need to choose a start date, a payment schedule, and sign.

Program and Site

Fees and dates follow the program selected at the top of this form.

Site (Required) *

Term

Your Household

Entered in Step 1. Go back if anything needs correcting.

Carried over from Step 1 — Household

Parent / Guardian: —
Cell Phone: —
Email Address: —
Home Address: —
Second Parent / Guardian: —
Cell Phone: —

Children and Monthly Fees

Every child added in Step 2 appears here. Fees are calculated for you — there is nothing to type.

Child	Grade	Rate	Monthly Fee
Monthly total for this household			—

Children Enrolled 0

Monthly Total —

Full Term Total —

Due at Enrollment — First month's payment

Start Date and Payment Schedule

Program Start Date (Required) * Must fall within the program term.

Payment Frequency (Required) *

MonthlyDue on the first of each month. The first month is due at enrollment. One TimePay the full term up front. A deposit is due at enrollment.

Additional Payers on Account (Optional)

Anyone besides you who may make payments — a grandparent, an employer, or an agency. List all by name.

Payment Agreement

Please read before signing.

Parent acknowledges payment is due by the first of every month beginning — and ending —.

Accounts over 5 days past due may result in suspension until the full balance is paid.

By signing this agreement, you acknowledge Voice of Hope holds a place for your child whether or not your child attends. You will be billed monthly fees until the end of the term or until you un-enroll your child.

One-Time Fee programs require a deposit of the total payment at enrollment. Monthly Fee programs require the first month's payment at enrollment.

I have read and agree to the payment terms above for all children listed, and I understand the amount due at enrollment is —.

Signature

This signature covers the payment agreement. You will sign the program consents in Step 7.

Parent/Guardian Full Name (Digital Signature) (Required) *

Signature Date (Required) *

Your typed name and the date are recorded with this agreement as proof of signature.

Your progress will be saved and you can return later.

VOH Registration