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Impact Learning Center
Summer 2026 Registration

Summer Camp 2026

Ages 6–10 · $175/week

Register now with a $25 registration fee to secure your child's spot. Includes 3 meals daily, creative arts, game room, field trips, and more!

11269 N. Main Street, Jacksonville, FL 32218·(904) 723-4405

What's Included

A full summer of fun, learning, and growth at Impact Learning Center.

Creative Arts

Painting, crafts, music, and dance activities

Game Room

Indoor game room with age-appropriate entertainment

3 Meals Daily

Breakfast, lunch, and afternoon snack included

Field Trips

In-house field trips and onsite vendor experiences

Onsite Vendors

Special guests and interactive workshops

Safe & Supervised

5-Star rated facility with trained staff

See It In Action

Summer Camp Reels

Get a glimpse of the fun, learning, and excitement your child will experience this summer.

Enrollment Application

Complete the official enrollment form below. A $25 registration fee is required to secure your spot.

Parent/Guardian Contact (Required)

This information is used for payment processing and communication. It will not appear on the DCF form.

State of Florida

CHILD CARE APPLICATION FOR ENROLLMENT

Student Information:
Date of Birth:
Sex:
Date of Enrollment:
Full Name:
Last
First
Middle
Nickname
Child's Physical Address:
Primary Hours of Care:
From
To
Days of the Week in Care:
Meals Typically Served While in Care:
********************************************************************************
Family Information:
Child Lives With:
Mother's Name:
Address:
Home Phone:
Employer:
Address:
Work Phone:/Cell:
Father's Name:
Address:
Home Phone:
Employer:
Address:
Work Phone:/Cell:
Custody:
********************************************************************************

Medical Information:

I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

Doctor:
Address:
Phone:
Doctor:
Address:
Phone:
Dentist:
Address:
Phone:
Hospital Preference:
Please list allergies, special medical or dietary needs, or other areas of concern:
********************************************************************************

Contacts:

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached:

Name
Address
Work#
Home#
Name
Address
Work#
Home#
Name
Address
Work#
Home#
Name
Address
Work#
Home#
June 2014I-149-03

Helpful Information About Child:

Section 65C-22.006(2), F.A.C., requires a current physical examination (Form 3040) and immunization record (Form 680 or 681) within 30 days of enrollment.

Section 402.3125(5), F.S., requires that parents receive a copy of the Child Care Facility Brochure, "Know Your Child Care Facility" (CF/PI 175-24), or

Section 65C-20.11(2)(c)(1), F.A.C., requires that parents(s) receive a copy of the family day care home brochure, "Selecting a Family Day Care Home Provider" (CF/PI 175-28).

Section 65C-22.006(3)(c)2., F.A.C., requires that parents are notified in writing of the disciplinary practices used by the child care facility, or

Section 65C-20.010(6)(c), F.A.C., requires that a written copy of the family day care provider's discipline policy be available for review by the parent(s).

Your signature below indicates that you have received the above items and that all information on this enrollment form is complete and accurate.

Signature of Parent/Guardian
Date
June 2014I-149-03

Registration Fee: $25.00

A one-time $25 registration fee is required to secure your child's spot. Weekly tuition of $175 is billed separately. You will be redirected to a secure Stripe checkout page after submitting.

Have Questions or Want to Schedule a Tour?

Fill out the form below and our team will get back to you within 24–48 hours.

You'll also receive a confirmation email once your inquiry is submitted.