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Kids-AcademyRegistration

Day Camp Adventure
at
Walker World 
July 27-31 
$175.00 Includes:

Camp Adventure @ Walker World is an Outstanding Exclusive experience for your child. What makes Camp Adventure so unique is it's beautiful wildlife location on the waterfront and it's creative retreat center which your child will have exclusive access to for an entire week. This is our 7th Kids Camp! WOW! Your child will enjoy all the amazing foods we will be preparing together, Boating, Swimming, Arts, Ceramics, Volleyball, Sports, Bonfires, Mud Race, Singing, Dance Party, Hiking Trails, Scavenger Hunt, Obstacle Course, Talent Show, Scrapbooking, Wild Life, Capture the Flag, Rope Swing, Stand-up Paddle Boarding, Tie-Dying, Food Sculpting, Chocolate Fountain & More!
We would love to have your child join us @ Camp!
​ 
Learn more about this Amazing Walker World in this recent article: http://www.saltmagazinenc.com/?page_id=3629 
www.walkerworld.com Castle Hayne, NC














Registration Information

Registration payments should be sent to the Head Instructor Chef Gailyn Gagliardi,
104 Tealbriar St., Burgaw, NC 28425. or email us
If registering more than one child, each child needs to have their own form completed. Thank-you (We offer a 10.00 discount on each additional child.)

Day Camp schedule July 27th-31st
Monday-Friday 10am-4pm
(We do offer early drop off and late pick-up for your convenience.)
175.00 (Includes the 35.00 registration fee.) 

Payment may be paid by check, money order, cash or credit card. 

We are not able to give any refunds if the child is absent for any reason. 
Returned Checks: 
Please be aware that any returned checks will be assessed at $30 service fee per check. All returned check fees/amounts must be re-paid by certified check or money order. 
*All fees and dates of operation are subject to change 

 KCCA Kids Culinary Academy 
(Children’s Activities in a Responsible Environment) 
Welcome to KCCA Kids Culinary Academy. This is designed to acquaint you with our program and policies. 
KCCA is a program offering a variety of culinary & creative activities with a focus on nutrition, fitness & FUN under adult supervision, for children. 
The program was created to provide children who have a heart for the culinary world to be creative, learn amazing skills while having FUN! 
We reserve the right to cancel the program should enrollment fall below what is needed to maintain the program. 

KCCA offers students a variety of physical, recreational, and educational activities which will include experimenting with cooking and baking, visits from other resources to extend fun learning experiences to their day, students designing their own personal cookbook that will be completed at the end of the week as well as dedicated time for catching up. 
KCA Goals 
1. To provide students with a safe, relaxed environment in a educational culinary program. 
2. To provide a nurturing, supportive atmosphere. 
3. To offer a variety of activities and materials that promotes a child’s creativity, as well as social, emotional, physical and intellectual development. 
4. To provide positive guidance for each student in order to develop confidence and responsibility, as well as respect for each other. 
5. To offer visits from other resources to extend fun learning experiences. 
Daily Information 
Children often play outside; please send the appropriate clothing. Gym shoes are required for playing outside. 
Please let us know if your child has a special request or dietary needs.
We strongly discourage children from bringing toys (including electronic devices) from home. We cannot be responsible for lost, broken, or stolen items. 

Rules for Children 
In every situation in life we are guided by a certain set of rules. Likewise, in every educational setting we also have rules. A leader in an educational position is continually faced with decisions about rules and consequences that will insure a successful program. 
At KCCA we have chosen a plan for the children that emphasizes the positive aspects of the rules listed below. With such a system, the guidelines are clearly defined and a sense of ambiguity does not exist. When a child knows what is expected of them, they have the opportunity to make an appropriate choice of behaviors. It is our intention that this system will contribute to the growth of your child’s self-control and their ability to choose the correct behavior. 
Below are the rules of the Kids Culinary Academy. 
Students will: 
Listen to and follow the directions of the Instructor
Walk whenever inside the home 
Keep hands, feet and other objects to themselves 
Always ask permission to leave 
Be kind and considerate to instructor and other students. 

Discipline Procedures 
KCCA reserves the right to deny attendance to any child due to any continuous physical, emotional or behavioral problems. The methods the staff will use for conflict resolution are: setting clear limits, redirection and positive guidance. If a problem arises the following steps will be taken. 
The child’s parent will be notified of the problem. 

The parent(s) will be notified a second time in a written disciplinary note, if the behavior has not changed. At this time consequences of this behavior will be discussed. 

If negative behavior persists, the instructor will meet with the parent(s) to develop an appropriate behavior plan along with a proposed timeframe for implementation of the plan. The parent(s) will also be informed of the daily progress of the child. 

If all reasonable approaches are exhausted and the pattern of negative behavior continues and/or the child’s actions are a threat to the well being and safety of other children and staff, the child may be placed on suspension. Behaviors that warrant suspension including the following: physical violence, biting, persistent bullying and swearing, verbal harassment of peers or staff and unauthorized departure from the program grounds. 



Medications 
We do not administer prescription or non prescription medication without the proper district protocol. Children may not keep or administer any type of medication. Please contact KCA Instructor for procedure. 
Health Procedures 

Illness 
According to the Health Department, children must be kept home if they have any symptoms of illness. During the course of the day’s activities, caregivers will take note of any changes in the appearance or behavior of the children. The KCA Instructor will contact you about coming to pick up your child if any symptoms appear while he/she is in our care. 
Serious Accident or Injury 
The procedure for a serious accident or injury of a child while in our care is that the child receives immediate attention and the appropriate people are called. The order of contact for a serious injury is: 
1. Attend to the child 
2. Call 911 
3. Contact the parent 





KCA- Kids Culinary Camp Academy Information 
Instructor/ Director: Chef Gailyn Gagliardi
910-547-0669
Gailyn@cafeliardi.com
Bio: www.cafeliardi.net 
104 Tealbriar St. Burgaw, NC 28425 

KCCA Registration Form  
Please fill out completely. 
Program Admission Date: _______________________ 
Child’s First Name: _____________________________________ History of Allergies: yes_______ no_______ 
Child’s Last Name: _____________________________________ ___________________________________________________ 
Address: _____________________________________________ Medical information on file at school office: _______________ 
City: __________________________ Zip Code: ____________ Sibling Name: ___________________________Grade________ 
Child’s Current School: Sibling Name: __________________________Grade_________ 


Grade entering this fall: _____________________ 
Custody Information: 
Child lives with: 
Both parents (birth or adoptive) _____ 
Custody: Joint ___ Mother ___ Father ___ 
Other: ________________________ 
(Notarized court documents required) 
CHILD’S BIRTHDATE: _______________________________ 
MALE _________________ FEMALE _________________ 
Family Doctor:___________________ Phone # ____________ 
Address: _______________________________________________ 
Dentist: ________________________ Phone # ______________ 
Preferred Hospital: ______________________________________ Insurance Carrier:____________________ Date of Tetanus:_______ 
Parent Information: Policy #________________________________ 
Mother’s First Name: ___________________________________ Father’s First Name: ______________________________________ 
Last Name:_____________________________________________ Last Name:________________________________________________ 
Address: _______________________________________________ Address: ________________________________________________ 

City: _____________________ State: ______ Zip Code: _______ City: ______________________ State: ______ Zip Code: _______ 
Phone: Phone: 
Home: ( ) ________________________________________ Home: ( ) ___________________________________________ 
E mail: ( ) ________________________________________ E mail: ( ) ___________________________________________ 
Cell: ( ) ________________________________________ Cell: ( ) ___________________________________________ 
Work: ( ) ________________________________________ Work: ( ) ___________________________________________ 
Employer Name: ________________________________________ Employer Name: ____________________________________________ 
Employer Address: _______________________________________ Employer Address: _________________________________________ 
Work Hours: _____________________________________________ Work Hours: ______________________________________________ 
List the persons that should be contacted in an emergency and who are also authorized to transport the above child. 
Name Address Relationship Phone Number 
1.____________________________ _____________________________________ ___________________ ___________________ 
2.____________________________ _____________________________________ ___________________ ___________________ 
3.____________________________ _____________________________________ ___________________ ___________________ 
4.____________________________ _____________________________________ ____________________ ____________________ 
I give permission to Kids Culinary Camp Academy to secure emergency medical and/or emergency surgical treatment for the named minor while in KCCA. 
Parent Signature: ______________________________________________________ Date Signed: _______________________________  
Rev. 06/12 

Health Care Questions 
Is your child in good health? ______________ 
List any activities that should be restricted______________________________ 
_____________________________________ 
Are your child’s immunizations up to date? 
Yes_________ No_______ 
The immunization record or appropriate waiver is on file with the child’s school? 
Yes ________ No________ 
 Photos 
During the course of the school year, we will from time to time take pictures of the children participating in various activities. We are respectfully requesting your permission to use these photographs in our bi-annual brochures, flyers or possibly on our web site. 
____ I agree to supply my child with 
appropriate sunscreen. 
____ KCCA has my permission to 
use photos of my child for brochures/ flyers/ web-site. 
____ Please do not use my child’s photo on any publication. 
____ My child may watch movies rated G___ and or PG___. 
*I have read and understand the scheduling and late fee policy. Please check: ______ 


Child Name: ________________________________ 

I have read and checked the appropriate questions regarding Health Care and Photos 
________ _ _____________________ 
Parent Signature Date 


Health Care Plan 
Hand Washing 
Hand washing Procedures 
The following procedures will be used for hand washing: 
Have a single service towel available. 
Turn on the water to a comfortable temperature between 60 degrees and 120 degrees. 
Moisten hands with water and apply soap. 
Rub hands together vigorously until a soapy lather appears and continue for at least 10 seconds. 
Rub areas between finder, around nail beds, under fingernails, and jewelry, and back of hand. 
Rinse hands under running water until free of soap and dirt. Leave water running while drying hands. 
Dry hands with a clean, disposable paper or single use cloth. Turn off tab with disposable paper or single service towel. 

Hands shall be washed with soap under running water. The following are not approved substitutes for soap and running water: 
Hand sanitizers 
Water basins 
Pre-moistened cleansing wipes 

Handling Bodily Fluids 
KCCA will use precautions when handling bodily fluids as instructed in the blood borne pathogen training. Steps used will include: 
Instructor will put on gloves. 
Clean up bodily fluid/diaper. 
Wash area with soap and water, rinse, and sanitize area. 
Wash hands of child. 
Take off gloves and wash hands. 

Cleaning and Sanitizing 
The following steps are to be followed for cleaning and sanitizing: 
Wash area/surface with warm water and soap/detergent. 
Rinse area/surface with clean water. 
Submerge, wipe, or spray the article or surface with a sanitizing solution. 
Let area/surface air dry. 



Sanitizing Solution 
Water and non-scented chlorine bleach solution with a concentrate of 1 tablespoon of bleach to one gallon of water. 
Commercial sanitizers specified on the label to be safe for food contact surface and used according to the manufacturer’s directions. 

Controlling Infections 
See universal precautions above. 
Toys and equipment will be washed immediately if dirty, or on a daily basis or when dirty. 
Children who have any type of communicable disease/condition will be removed from care and may return to care only with a doctor’s note. 
Children who become ill will be moved away from the children until they are picked up. 

Rev.6/12 
KCCA- Kids Culinary Camp Academy Receipt 
Payment may be made by check, money order or cash. 

Please Print: 
Student Name: __________________________ School: ______________________ Grade: _______ 
Parent Name: _____________________________ 
Total amount due: $______________________ 
Check: #___________ 
Money Order: #______________
Cash_____________
---------------------------------------------------------------------------------------------------------------------------- 
Please complete bottom portion and keep for your records. 
Student Name: ______________________________ 
Amount paid: _____________ 
Check or Money Order:#______________  


Packing for the Kids Culinary Camp made Fun and Easy!
Packing for camp can be a very stressful process. There are so many things you need to remember! What if you forget a shoe or a tube of toothpaste? What if you pack all the wrong kinds of clothes? Fortunately, we here at the Culinary Camp are ready to help you face your fear of packing and get on to the fun. Though we still have a few months to go, it is never too early to start the packing process, and we think the sooner, the better. Here are some tips on exactly how to pack, stress-free!



Step 1- Organization: First and foremost, you must go in to the packing process with a clear idea of exactly what you need. Consider all the possible weather conditions, you will want not only summery clothes such as shorts and tank tops, but also sweatpants and long sleeve shirts. And you will of course want your customized Camp Half Moon apparel! Remember, in an overnight camping environment “it is better to have and not need than to need and not have.” For this reason, before you even lay out your clothes or shop at all, make an exact list (excel spreadsheets may sound over the top, but can be quite useful) with checkboxes so you can keep up on all the items you want and whether or not you have them.



Step 2- Miscellaneous: Of course, your list already includes the basic clothing items and shoes. But often it is easy to forget the miscellaneous items. Do not forget to include all your personal hygiene needs. (shampoos and hairsprays, face washes, etc.) It is also important to have outdoor ready products such as sunscreen, bug repellents, deodorant, and hats.



Step 3- Shopping: Obviously, the items that you have put on your list are not all already in your possession. However, the key to shopping for camp is to not over – or under – shop. Before leaving for the store go through every item on your list, including small things such as nail clippers and bed sheets. Look around your house for all of these items and locate them, don’t just assume that you have it. Once you know exactly what you already have, mark it on your list and head out to the store. You may need to buy an additional item even if you already have it, for example an extra bottle of shampoo or a back up pair of sneakers- it is better to be safe than sorry, so mark it on your list and purchase an extra one. Also, not everything that you have in your home is “camp friendly.” Certain things have a tendency to get dirty or ruined while at camp. Take this in to consideration when laying out what you do and do not need. Once you have all your home items gathered, you can collect the new ones.



Step 4: Labeling: Labeling your personal belongings is a very important thing to do. For the purpose of laundry, you may need to label all clothing items. Buy sew-in or iron-on labels with your child’s full name inside and place these in clothes. You can take to socks and underwear with a permanent marker (just initials will do), and a folded label or handwritten name on the tag of bathing suits will suffice. Most importantly, do not forget the small stuff. Though no laundry will be separating your child’s flip flops or toothpastes, these items still need labels. Being in a bunk with many other campers can cause items to be lost or confused for someone else’s. For easy identification, label (with vinyl stick-ons, stamps, or permanent marker) personal belongings.



Step 5- The Setup: Easy unpacking once at camp starts with organized packing beforehand. To make it easy for your camper to get settled in, pack with a method. Put similar types of clothing in the same piles in your trunks, and pair shoes on one side. Keep bathroom items in plastic shoe boxes or crates, and put small items and jewelry or money in a lockbox or small drawer unit. This will help you to keep track of what types of things you have already packed, and will help to ensure an easy unpacking! What a relief.



Step 6- The Final Touches: Once you’ve put everything together, towels in stacks, stuffed animals in place, and water bottles in line, it’s time to do the finishing check. Make sure everything on your list is ready and accounted for. Survey the boxes and trunks that are packed up and look for organization and a full count of all items you wished to bring. It is a good idea to pack a fresh copy of your packing list (with unchecked boxes) in to your bags so it can be used to account for all items you packed prior to camp and re-pack to come home!



Now that you have all the tips to the packing process, it’s time to get started! No need to fear the under packing or missing items any longer, with this detailed guide there is no way to fail. Go in prepared and remember to follow all of your steps. Packing this year will be easy as pie, and camp coming so soon is just the cherry on top   
Camp Adventure