Genesis

k-8

Children & Youth Programs(919) 832-1649 ext. 319 ccici@raleighfirstbaptist.org

Conveniently located in Downtown RaleighGenesis offers age-appropriate educational, cultural, social

and physical activities in a safe, Christian environment.

First Baptist Church Family Life Center - 109 S Wilmington Street, Raleigh, NC 27601Mailing Address: CCICI - 101 S Wilmington Street, Raleigh, NC 27601

Program Includes:Tutoring

Physical FitnessComputer Education

Homework AssistanceHealthy SnacksArts and Crafts

Field Trips

Teacher Workday CareLunch (Summer Camp)

After School Transportation(selected schools only)

APPLICATIONS and REGISTRATION FORMS AVAILABLE ONLINE @ WWW.CCICI.NET and WWW.RALEIGHFIRSTBAPTIST.ORG

YEAR ROUND TRACK OUT - Tracks 2, 3, 4

CAMP GENESIS - Summer Day Camp June 11, 2012 - August 3, 2012

GENESIS AFTER SCHOOL CAREAND TUTORING

Monday - Friday 2:00 - 6:00 p.m.

Sponsored by Capital City Intergenerational Care, Inc. (CCICI) - a nonprofit corporation ofFirst Baptist Church - 101 S. Wilmington St - Raleigh, 27601

GENESIS CHILDREN AND YOUTH PROGRAMS

First Baptist Church Family Life Center 109 South Wilmington Street

Raleigh, North Carolina

2012 – 2013 REGISTRATION FORM

Please complete a separate form for each child. Child ___________________________________ Date of Birth __________________ Age _______________________ Male __________ Female __________ Grade ______ School ______________________________________________ Address ____________________________ City ___________________________ Zip Code ____________________ Home Telephone ____________________ Name of Sibling in Program ______________________________________ Parent/Guardian _____________________________________ Relationship ___________________________________ Father’s Place of Employment __________________________ Work # ________________ Cell # _________________ Mother’s Place of Employment _________________________ Work # ________________ Cell # _________________ Allergies, handicaps, other disabilities __________________________________ Medication ______________________

________ 2012 GENESIS SUMMER DAY CAMP

June 11 – August 3, 2012

7:30 AM – 6:00 PM Monday – Friday

(Closed Wednesday, July 4) Cost: $80 per week for one child; $70 per week each for two or more children living in the same household. Mark All That Apply ___ Week 1: June 11 – 15 ___ Week 2: June 18 – 22 ___ Week 3: June 25 – June 29 ___ Week 4: July 2 – 6 ___ Week 5: July 9 – 13 ___ Week 6: July 16 – 20 ___ Week 7: July 23 – 27 ___ Week 8: July 30 – August 3 ________________________________________________________________________________________________

________ 2012 – 2013 GENESIS YEAR ROUND TRACKOUT

Cost: $80 per week for one child; $70 per week for two or more children living in the same household. Track 2 __________ Track 3 ___________ Track 4 ___________ ________________________________________________________________________________________________

_______ 2012-2013 GENESIS AFTER SCHOOL CARE AND TUTORING Cost: $140 per month for one child; $100 per month for each additional child living in the same household (Teacher workday care not included). Transportation Cost: $15 per week per family where children live in the same household. Parent Signature __________________________________________ Date ___________________________________ Sponsored by Capital City Intergenerational Care, Inc., a nonprofit corporation of First Baptist Church, 101 South Wilmington Street, Raleigh NC 27601 Telephone: 919- 832-1649 Ext. 319 Fax: 919-832-1670 Email: ccici@raleighfirstbaptist.org Website: www.ccici.net

Check each program in which you are interested. A $15.00 nonrefundable registration fee is required when enrolling in one or more programs. Make checks payable to Capital City Intergenerational Care, Inc. (CCICI).