Rising Star Childcare Academy

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Rising Star Childcare AcademyEnrollment Application

Emergency Contacts - Please provide two - (In the event a parent/guardian cannot be reached)

Persons other than the parent/guradian permitted to pick up the child

Medical & Emergency Information and Release

Medical Information

Emergency Information

I give permission to RSCA to administer prescribed medication to my child if needed. I understand when medication is given according to instructions, I will not hold provider liable for any reactions or complications that may follow as a result of my child receiving medication. In case of any emergency where I am unable to retrieve my child I give permission for my child to be escorted by car or ambulance to the Hospital of choice until I am able to be present. RSCA is not liable for any ambulance services, co-payments or other medical expenses for any professional treatment.
Transportation and Field Trip Authorization

I give permission for my child to go on occasional field trips, escorted and chaperoned by RSCA staff. I give permission for my child to be transported by bus.
I hereby request that my child, be permitted to participate in field trips to the park, or any other activities that would involve taking the child outside of the summer camp for his/her benefit in attendance at this facility. In automobile, van, and/or bus, children will be secured with a safety belt as appropriate for their age.

I hereby expressly waive any claim for injury or damage to such child arising out of such field trips and expressly agree to hold RSCA innocent of any undue harm.

Picture Authorization

I/We hereby authorize this organization to publish photographs of my child taken during summer camp activities in the local news paper. LWFC's (WWW.LlVINGWATERFC.ORG) website and social media outlets.
Discipline Policy

Discipline is a learning process and not a punishment. Misbehavior will be handled in a firm, consistent and POSITIVE manner. No child will be handled roughly, shamed or humiliated. No corporal punishment will be used, even at the request of parents. Age appropriate time-out procedures work well. Our philosophy on
discipline is to help children gain respect for each other and to teach constructive and positive alternatives when conflicts arise. RSCA is required by law to report to Child Protective Services and/or police, any suspected cases of child abuse or neglect.
I understand and agree to the above discipline policy provided by RSCA.

All of the above information is true and accurate to the best of my knowledge. RSCA is not held responsible for anything that happens to my child which I failed to disclose.


Registration is $50 per household

Daycare fees are assessed during your face to face meeting with the Director.
Call the church office if you have more than one child attending camp and lives in the same household.


Please fill out this form and click submit.