Description

Full-day, state-licensed, faith-based camp for kids 5–12 years old! Enjoy swimming, crafts, games, and outdoor adventures while growing in a safe, Christ-centered environment.

Hours: Mon–Fri 8 AM–4 PM | Early: 7–8 AM* | Late: 4–5 PM*

*Additional fees apply

John 8:12 – "Jesus spoke to the people again. He said, 'I am the light of the world. Anyone who follows me will never walk in darkness. They will have that light. They will have life.'"

Our detailed registration form ensures state compliance. While all children are welcome, one-on-one supervision is not available. Families needing extra support should contact our Youth Development Supervisor.

If a certain age group does not appear under the camp week you're interested in, please contact the camp office to be added to the waitlist. Do not register under a different group. The same procedure for if you see a specialty camp marked "Sold Out." You can call (920) 544-4975 or email [email protected].

Camper Name

Date of Birth

Gender

Male
Female
Non-binary

What school does your child attend?

Does your child have an IEP?

Swimming Ability:

Can swim, no flotation device required
Can't swim, flotation device required
Swim ability unknown

I give permission for my child's image or likeness to be used through photography, videography, advertisement, social media, and other promotionals

Media Release - Yes
Media Release - No

I give permission for my child to participate in transported/walking field trips and other activities during operating hours

Yes, my child can participate
No, my child can not participate

Summer Camp Transportation

I give permission for my child to be transported to and from the Kroc Center through Lamers Bus Lines for field trips (all return times are approx.)
I DO NOT give permission for my child to be transported to and from the Kroc Center through Lamers Bus Lines for field trips

Do you plan to use Wisconsin Shares or CLTS funding for camp weekly fees?

Please choose all weeks and add-ons that will apply. Due upon registration is a $50 non-refundable deposit per camper to hold your campers spot. Regular billing, which includes extended care and specialty camp add-ons, will be processed each Monday during the camp season (June 15 - August 21). Please refer to the table below regarding the pricing structure.

Status	Member pricing	Non-Member Pricing
Regular	$215	$245

Week 1: June 15-19, Alphabet Exploratorium

Week 1: June 15-19, Alphabet Exploratorium Add-Ons

Week 2: June 22-26, Spirit Week

Week 2: June 22-26, Spirit Week Add-Ons

Week 3: June 29-July 3, Stars and Stripes

Week 3: June 29-July 3, Stars and Stripes Add-Ons

Week 4: July 6-10, Wet, Wild, & Messy

Week 4: July 6-10, Wet, Wild, & Messy Add-Ons

Week 5: July 13-17, Holiday Hoopla

Week 5: July 13-17 Holiday Hoopla Add-Ons

Week 6: July 20-24, Heroes in Training

Week 6: July 20-24 Heroes in Training Add-Ons

Week 7: July 27-31, Color Kaleidoscope

Week 7: July 27-31 Color Kaleidoscope Add-Ons

Week 8: Aug 3-7, Kingdom Quest

Week 8: Aug 3-7 Kingdom Quest Add-Ons

Week 9: Aug 10-14, Fizz, Pop & Sprinkle-Splosion

Week 9: Aug 10-14. Fizz, Pop, & Sprinkle-Splosion Add-Ons

Week 10: Aug 17-21, Directions Not Included

Week 10: Aug 17-21, Directions Not Included Add-Ons

Please answer the following questions or write N/A if it does not apply.

Child's Name

Check any special medical condition that your child may have

No specific medical condition
Any disorder, including Cognitively Disabled, learning disorder, ADD, ADHD, or Autism
Asthma
Cerebral palsy/motor disorder
Diabetes
Epilepsy/seizure disorder
Gastrointestinal or feeding concerns, including special diet or supplements

Please list any other medical conditions that your child has that are not specified above

Please list any food or non-food allergies

Physician Name

Medical Facility Address

Telephone Number

Triggers that may cause problems - specify

Signs or symptoms to watch for - specify

Action steps (in the event of a medical emergency the Kroc Center staff should follow

Identify any staff to whom you have given specialized training/instructions to help treat symptoms

When to call parents regarding symptoms or failure to respond to treatment

When to consider that the condition requires medical care or reassessment

Any additional information that may be helpful to staff (medical or behavioral)

Emergency Medical Treatment

I hereby give medical consent for emergency medical care or treatment to be used only if I cannot be reached immediately.
I hereby DO NOT give consent for emergency medical care or treatment to be used only if I cannot be reached immediately

Medication

My child will not require any medication while attending camp
I hereby give The Salvation Army Ray & Joan Kroc Community Center camp staff my permission to carry and give my child the medication that he/she needs

Immunization Record

I understand that I need to give an up to date Immunization Record to the Kroc Community Center before the first day of after school or camp

Sunscreen \Authorization

Yes, staff and my child can apply sunscreen
Yes, only my child can apply sunscreen
No, staff or my child cannot apply sunscreen

Insect Repellent Authorization

Yes, staff and my child can apply insect repellent
Yes, only my child can apply insect repellent
No, staff and my child cannot apply insect repellent

Please include contact information for two parents/caregivers. An additional contact may be included for another authorized pick-up.

Name of 1st Contact

Address

Phone Number

Place of employment and work phone number

Date of Birth

Gender

Male
Female

Caregiver relationship to camper:

Please check all that applies for this additional contact:

Lives in the same household as registered child(ren)
Emergency contact
Authorized to pick-up child(ren)

Name of 2nd Contact

Is the home address of 2nd contact the same or different than the 1st contact?

Same
Different

Phone Number

Place of employment and work phone number

Date of Birth

Gender

Male
Female

Caregiver relationship to camper:

Please check all that applies for this additional contact:

Lives in the same household as registered child(ren)
Emergency contact
Authorized to pick-up child(ren)

Would you like to add another contact? (Grandparent, babysitter, other family member, etc.)

Relation to Camper

Grandparent
Babysitter
Extended Family Member
Other

Additional Contact 1

Additional Contact 1 Phone Number

Additional Contact 1 Email

Additional contact 1 place of employment and work phone number

Please check all that applies for this additional contact:

Lives in the same household as registered child(ren)
Emergency contact
Authorized to pick-up child(ren)

Camp Deposit

Non-Refundable Registration Processing Fee

1 Camper $51.75 ($50.00 + $1.75 fee)

**Processing fees apply

Coupon Code

Total

$0.00

Waiver

A copy of the complete Procedures and Policies Handbook will be sent to the email listed in registration by the Youth Development Supervisor. We require all families to read through the handbook to fully understand the expectations of camp. Below are a few key camp acknowledgments regarding our procedures and policies. By marking "I have read and agree to the terms above," you are acknowledging the few key camp points and responsibility of reading the handbook as a whole.

Terms

Summer Camp Procedures and Policies Acknowledgments

☐I understand that Kroc Summer Day Camp is an outdoor camp operating Monday–Friday from 8:00 a.m. to 4:00 p.m., unless otherwise noted.
☐ I understand that check-in and check-out take place at the North Entrance and that my camper may only be released to an authorized adult with photo ID if requested.
☐ I understand camp fees, registration deadlines, and pricing vary by registration date, membership status, and camp type, and that additional charges may apply.
☐ I understand a non-refundable $50 registration fee (*processing fees apply) is due at registration to secure my camper’s spot.
☐ I understand all camp fees and selected add-ons must be paid in full by 12:00 p.m. the Monday prior to each camp week or my camper may not attend.
☐ I understand an active family membership must be maintained through the end of summer to receive member pricing and that rates are not retroactively adjusted.
☐ I understand financial assistance may be available and I may contact the Youth Development Supervisor for details.
☐ I understand up-to-date immunization records must be submitted prior to my camper’s first day of camp.
☐ I understand that if I do not grant photo/media permission, my camper will be required to wear a daily wristband for identification purposes.
☐ I understand and have reviewed camper expectations with my child, including behavior standards and that personal items (toys, electronics, candy, etc.) must be left at home.
☐ I understand the camp may immediately remove a camper whose behavior poses a safety risk to others.
☐ I understand swimming is a camp activity but is subject to staffing availability and safety requirements.
☐ I understand campers showing signs of illness will not be permitted to attend and may be isolated and sent home if symptoms develop during camp.
☐ I understand any head injury will be treated as significant and caregivers will be notified.
☐ I understand snacks and lunch are provided, and I may send an alternative lunch to meet dietary or allergy needs.
☐ I understand the DCF 251 Policies Handbook and Kroc Center Day Camp Procedures and Policies Handbook are posted outside the camp office and available for review

I have read and agree to the terms above.

Enrolled steps:

Online registration questionnaire completed; including acknowledgement of Procedures and Policies
One time, non-refundable, $50.00 dollar processing fee paid per camper
Current immunization record submitted
Autopay set up through ProCare

*The Youth Development Supervisor, will send a confirmation email to families stating that their camper(s) are fully enrolled.

Kroc Summer Day Camp

Description

Camper Registration

Emergency Medical Care Plan

Caregiver Information

Camp Deposit

Waiver