CEEP
Community Educational Enrichment Program

June 13-July 1, 2022
8:30 a.m. – 3:30 p.m.

 

CEEP is designed for children who…
• Are entering 3rd–6th grade.
• Do NOT have chronic behavior problems.
• Can adjust to and benefit from a fun and creative camp focused on “The Arts.”
• Can attend the full 3 weeks.
*If unable to make this commitment, please ask to be put on the waiting list. If we do not reach capacity,
we will consider your request the week prior to opening.)

Tuition/Registration Fee (Total cost of camp) – All Fees are non-refundable

Federal Lunch Program Status
(or equivalent)

 Per Child

 Per Family

  Fee Due
FREE

$40

$60

 With Application
REDUCED

$80

$100

 With Application
NON-ELIGIBLE WAITLIST

$200

$300

 Upon Acceptance

RECENT copies of the following items are REQUIRED WITH APPLICATION:
1. Proof of income (Free/Reduced Lunch Verification, check stub, income tax return)
2. Report card – recent
3. Individualized Education Plan (IEP), if applicable
4. Custody documentation, if applicable
5. Tuition/Registration fee (cash, check, or money order, payable to Christ Episcopal Church with CEEP in the memo line)
6. Student Application Form or, if you filled it out online, an Authorization Form.

If you do not wish to fill out the application forms online, you can download it here, print it, and bring it to the church office with all of the other required documents. Please note:  if you do fill out the form online, you will still have to turn in the required documents in person at the church as well as this authorization form.

STUDENT INFORMATION (using tab button takes you to the next field but use the cursor in order to enter the needed information)

Last Name
Last Name
Field is required!
Field is required!
First Name
First Name
Field is required!
Field is required!
Middle Name
Middle Name
Field is required!
Field is required!
Goes by
Goes by
Field is required!
Field is required!
Age
Age
Field is required!
Field is required!
Date of birth
Date of birth (mo/day/yr)
Field is required!
Field is required!
T-shirt size
T-shirt size
Field is required!
Field is required!
Gender
Field is required!
Field is required!
Ethnicity (scroll to correct one)
Field is required!
Field is required!
Mailing Address
Mailing Address
Field is required!
Field is required!
City, State, Zipcode
City, state, zipcode
Field is required!
Field is required!
Phone Number
Please include the dash (-) in the phone number
include area code
include area code
Does this chilid have a current Individualized Educataion Plan (IEP). If yes, please provide a copy.
Field is required!
Field is required!
Do you have other children who attend CEEP
Field is required!
Field is required!
If applicable, names of siblings attending CEEP
Names of siblings who are attending CEEP
Field is required!
Field is required!
School
School child is currently attending
Field is required!
Field is required!
Grade entering in August
Grade entering in August
Field is required!
Field is required!
Will this child ride the bus?
Field is required!
Field is required!
Physical address if applicable
Physical address
Field is required!
Field is required!
Does this child qualify for a free or reduced lunch at school?
Field is required!
Field is required!
Submit

HOUSEHOLD/PARENT/GUARDIAN INFORMATION (using tab button takes you to the next field but use the cursor in order to enter the needed information)

Name of child(ren) attending CEEP
Name of child(ren) attending CEEP
Field is required!
Field is required!
Household type
Field is required!
Field is required!
How many children live in your household?
-
+
Field is required!
Field is required!
How many adults live in your household?
-
+
Field is required!
Field is required!
Do you need before care? Check yes to receive more informatiaon.
Field is required!
Field is required!
Name of parent/guardian
Full Name
Field is required!
Field is required!
Relationship to child
Relationship to child
Field is required!
Field is required!
Employer
Employer
Field is required!
Field is required!
Work phone with area code
Please include the dash (-) in the phone number
Invalid phonenumber!
Invalid phonenumber!
Date of birth
Select a date
Field is required!
Field is required!
Cell Phone (nclude area code)
Cell Phone - Please include the dash (-) in the phone number
Invalid phonenumber!
Invalid phonenumber!
Primary Phone (nclude area code)
Primary Phone
Invalid phonenumber!
Invalid phonenumber!
Email address
Email address
Invalid phonenumber!
Invalid phonenumber!
Are you a member of the military?
Field is required!
Field is required!
Which branch of the military
If yes, which branch of the military?
Field is required!
Field is required!
Name of other parent/guardian
Full Name
Field is required!
Field is required!
Relationship to child
Relationship to child
Field is required!
Field is required!
Employer
Employer
Field is required!
Field is required!
Work phone with area code
Please include the dash (-) in the phone number
Invalid phonenumber!
Invalid phonenumber!
Date of birth
Select a date
Field is required!
Field is required!
Cell Phone (nclude area code)
Cell Phone - Please include the dash (-) in the phone number
Invalid phonenumber!
Invalid phonenumber!
Primary Phone (nclude area code)
Primary Phone
Invalid phonenumber!
Invalid phonenumber!
Email address
Email address
Invalid phonenumber!
Invalid phonenumber!
Are you a member of the military?
Field is required!
Field is required!
Which branch of the military
If yes, which branch of the military?
Field is required!
Field is required!
Who is the person we can thank for telling you about CEEP?
The name of the person we can thank for telling you about CEEP?
Field is required!
Field is required!
Emergency Contact
Name
Field is required!
Field is required!
Contact's primary number
Primary phone number
Invalid phonenumber!
Invalid phonenumber!
Secondary phone number
Emergency contact phone
Invalid phonenumber!
Invalid phonenumber!
Relationship to child
Relationship to child
Field is required!
Field is required!
Emergency Contact
Name
Field is required!
Field is required!
Contact's primary number
Primary phone number
Invalid phonenumber!
Invalid phonenumber!
Secondary phone number
Emergency contact phone
Invalid phonenumber!
Invalid phonenumber!
Relationship to child
Relationship to child
Field is required!
Field is required!
Submit

ADDITIONAL STUDENT FROM SAME HOUSEHOLD (if there is a sibling going to CEEP. we only need one household form)

Last Name
Last Name
Field is required!
Field is required!
First Name
First Name
Field is required!
Field is required!
Middle Name
Middle Name
Field is required!
Field is required!
Goes by
Goes by
Field is required!
Field is required!
Age
Age
Field is required!
Field is required!
Date of birth
Date of birth (mo/day/yr)
Field is required!
Field is required!
T-shirt size
T-shirt size
Field is required!
Field is required!
Gender
Field is required!
Field is required!
Ethnicity (scroll to correct one)
Field is required!
Field is required!
Mailing Address
Mailing Address
Field is required!
Field is required!
City, State, Zipcode
City, state, zipcode
Field is required!
Field is required!
Phone Number
Please include the dash (-) in the phone number
include area code
include area code
Does this chilid have a current Individualized Educataion Plan (IEP). If yes, please provide a copy.
Field is required!
Field is required!
Do you have other children who attend CEEP
Field is required!
Field is required!
If applicable, names of siblings attending CEEP
Names of siblings who are attending CEEP
Field is required!
Field is required!
School
School child is currently attending
Field is required!
Field is required!
Grade entering in August
Grade entering in August
Field is required!
Field is required!
Will this child ride the bus?
Field is required!
Field is required!
Physical address if applicable
Physical address
Field is required!
Field is required!
Does this child qualify for a free or reduced lunch at school?
Field is required!
Field is required!
Submit

ANOTHER ADDITIONAL STUDENT FROM SAME HOUSEHOLD

Last Name
Last Name
Field is required!
Field is required!
First Name
First Name
Field is required!
Field is required!
Middle Name
Middle Name
Field is required!
Field is required!
Goes by
Goes by
Field is required!
Field is required!
Age
Age
Field is required!
Field is required!
Date of birth
Date of birth (mo/day/yr)
Field is required!
Field is required!
T-shirt size
T-shirt size
Field is required!
Field is required!
Gender
Field is required!
Field is required!
Ethnicity (scroll to correct one)
Field is required!
Field is required!
Mailing Address
Mailing Address
Field is required!
Field is required!
City, State, Zipcode
City, state, zipcode
Field is required!
Field is required!
Phone Number
Please include the dash (-) in the phone number
include area code
include area code
Does this chilid have a current Individualized Educataion Plan (IEP). If yes, please provide a copy.
Field is required!
Field is required!
Do you have other children who attend CEEP
Field is required!
Field is required!
If applicable, names of siblings attending CEEP
Names of siblings who are attending CEEP
Field is required!
Field is required!
School
School child is currently attending
Field is required!
Field is required!
Grade entering in August
Grade entering in August
Field is required!
Field is required!
Will this child ride the bus?
Field is required!
Field is required!
Physical address if applicable
Physical address
Field is required!
Field is required!
Does this child qualify for a free or reduced lunch at school?
Field is required!
Field is required!
Submit