MEETING CHALLENGES,
   FACING THE FUTURE,
        CHANGING LIVES.
1512 Florida Avenue  Lynchburg, VA  24501  434-845-0433

SUMMER CAMP APPLICATION FORM:

FILL OUT AN APPLICATION FOR EACH CHILD.  LIST THE NAME(S) OF ALL SIBLINGS ON EACH FORM. THIS CUTS DOWN MAILINGS AND PREVENTS DUPLICATE PHONE CALLS!  

 

DEPARTMENT OF SOCIAL SERVICES CHILD REGISTRATION FORM:

1.  Social Services wants NO BLANK SPACES on this form; instead, please write N/A if something does not apply.

2.  Where requested, please list who has Legal Custody of the child (i.e. parent, Court, etc.)

3.  Please list the doctor OR medical practice responsible for your child's care.

4.  In the EMERGENCY CONTACT section, there must be two (2) complete sets of names, addresses and phone numbers. 


      SUMMER CAMP
APPLICATION


PRINT AND RETURN
  • Application Form
  • Registration Form
along with copies of
  •   immunization record,
  • birth certificate and
  • up to date physical
 TO :

JUBILEE FAMILY CENTER
1512 FLORIDA AVE
LYNCHBURG, VA  24501
OR
FAX :  434-845-4740



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