Y s KIDS REGISTRATION SCHOOL AGE CARE
|
|
- Kristin Boyd
- 5 years ago
- Views:
Transcription
1 Y s KIDS REGISTRATION SCHOOL AGE CARE Office Use Only: Site AM PM 1 HR Immunizations Registration Billing Parent Agreement TE Form Start Date CHILD First Name Middle Initial Last Name Birthday Gender Home Apt City State Zip Grade in Fall School MOTHER/GUARDIAN INFORMATION Kindergarten after school care only available at school child attends if available. Child will be served at their home school first. Name Home Phone Cell Phone Place of Work Work Phone FATHER/GUARDIAN INFORMATION Name Home Phone Cell Phone Place of Work Work Phone EMERGENCY CONTACT/AUTHORIZED PICKUP NEVER AUTHORIZED TO PICK UP Name Name Are there any court orders relating to the child s custody? Yes If Yes, a copy of the court order will be required. Relationship Relationship No
2 Y s KIDS REGISTRATION SCHOOL AGE CARE Child s Name MEDICAL INFORMATION Child s Physician Physician Phone Child s Dentist Dentist Phone Date of last physical exam Immunizations Current Allergies (food, drugs, other) Possible allergies Possible Reactions Date of last dental exam List any limitations or special medical or behavioral concerns. (Copy of IEP required if applicable) Site Closure: I understand that any YMCA program may close throughout the year due to situations outside of YMCA control. Release/Participation: I am the parent or legal guardian of the above named child. I give permission for my child to participate in YMCA activities and field trips including transportation. I understand that accidents can sometimes happen. Therefore, in exchange for the YMCA allowing my child to participate in YMCA activities, I understand and express acknowledge that I release the YMCA, its employees, board members, volunteers or guests from all liability for any injury, loss or damage connected in any way whatsoever to participation in YMCA activities whether on or off the YMCA s premises and including transportation. I understand that this release includes any claims based on negligence, action or inaction of the YMCA, employees, board members, volunteers or guests. Medical Treatment: I give permission for YMCA staff or volunteers to provide emergency medical treatment for my child as necessary. I consent to medical treatment for my child deemed immediately necessary or advisable by a physician. I consent to emergency transport of my child via ambulance when deemed necessary. Insurance: I understand that the YMCA does not provide any accident or health insurance for its members or participants and further understand it is my responsibility to provide such coverage. Property Loss: The YMCA is not responsible for personal property lost, damaged or stolen while participating in YMCA programs, including parking lots. Photograph Permission: I give permission for the YMCA to use, without limitation or obligation, photographs, film footage or tape recordings which may include my child s image or voice for purposes of promoting or interpreting YMCA programs. Parent Signature Date:
3 Y S KIDS REGISTRATION PARENT AGREEMENT SCHOOL AGE CARE Child s Name(s): Registration Fee: $50 per child, $15 Program fee (not applicable to full facility members). Before School Tuition: $160 paid by the 1st of the month. This is a flat rate whether you attend one day or five days per week. After School Tuition: $225 paid by the 1st of the month. This is a flat rate whether you attend one day or five days per week. One Hour Care: Burlington-Edison School District Only: $150 paid by the 1st of the month. Only available for children enrolled in the Burlington School District in grades Kinder-2 nd. These children are released at 3:30 take the bus. Payment Options: Private Pay DSHS Subsidy- I agree to pay my co-payment of $ per month. Discounts Available: 10% discount for families enrolled in both the Before and s. SITE AND PROGRAMS MY CHILD WILL ATTEND. Burlington Sites: Bay View Bay View 1 Hr. Program Lucille Umbarger Lucille Umbarger 1 Hr. Program West View Elementary Sedro Woolley Sites: Mary Purcell Elementary Mount Vernon Sites: Jefferson Elementary Lincoln Washington Elementary Anacortes Sites: Fidalgo Homework Club (No DSHS Subsidy) Whitney Elementary Parent Signature Date:
4 Site Closure: I understand that any YMCA program may close at any time due to situations outside of YMCA control. School: I understand that my child will be served at his or her home school unless the site is full or a program is not offered at my child s home school. There will be no exceptions. Registration: I understand that a $50 non-refundable registration fee shall be charged upon enrollment and annually each September that my child is enrolled. Attendance: I understand that when I enroll my child, I am reserving a space for him or her. There are no credits given for absences. I agree to notify the YMCA billing office anytime my child will be absent. Holidays: I acknowledge YMCA Before and s will be closed on the following holidays: Labor Day, Veteran s Day, Thanksgiving Day and the day after, Christmas Day, New Year s Day, President s Day, and Memorial Day. NSF Charge: I understand that there is a $30.00 NSF charge for checks returned for non-payment. I understand if a check is returned for non-payment, all future payments must be made by cash or money order. Late Pick-UP Fee: I acknowledge there is a $1.00 charge per minute outside of our normal operating hours. Our hours of operation are end of school day to 6:00pm. Withdrawal: If I plan to withdraw my child from the program, I will submit written notice two weeks prior to withdrawal. I understand that if I do not give prior written notice, I will be responsible for two weeks of my child s regularly scheduled time billed at the daily rate. Monthly Payments: I understand all monthly payments/dshs copayments are due on the 1 st of each month. A late fee of $25.00 will be assessed after the 5 th of the month. I understand that if my child s tuition is one-month delinquent in payment he or she will not be allowed to attend the program until my account is current. All accounts delinquent more than one month will be sent to collections and additional collection fees added to my account. DSHS Subsidies: I understand an award letter must accompany my enrollment paperwork in order for my child to begin at the site. Child s Name(s): Parent Signature Date: SKAGIT VALLEY FAMILY YMCA
5 CHILD S NAME: SITE MY CHILD ATTENDS: Please complete Option 1, 2, or 3 but not both. Thank you. Option 1: Electronic Funds Transfer from Bank Account Funds to be withdrawn on the 1 st day of each month. New Electronic Check Authorization Electronic Check Cancelation request. Please allow 14 days to process your cancelation request. Name on Bank Account Billing Phone Number Billing City State Zip Bank or Credit Union Name Routing Number Account Number I hereby authorize Skagit Valley Family YMCA to initiate electronic check charges to the referenced account on the date listed above. I further understand if a transfer fails due to insufficient funds or an unreported account change, I will incur a $30.00 EFT NSF fee. Option 2: Tuition Express.Com Registration Cardholder Name Billing Phone Number Billing City State Zip (For Tuition Express ID): 4 Digit Login Preference: I wish to register at so I can make Online Payments using my Visa or MasterCard. I understand the YMCA will not maintain my credit/debit card information on file and I am responsible for processing my monthly payments no later than the contracted due date each month. I further understand if I submit my payment after the due date, I will incur a $25.00 late fee. Option 3: Single payment by cash, credit or check: Payments can be made in office at 204 N Skagit St. Burlington, WA Signature Date
Requirements for New Cats Club Enrollment
Requirements for New Cats Club Enrollment Registration Form Charge Requirement Form Auto Debit Form with voided check Parent Handbook Receipt KY Immunization Certificate with Hepatitis A immunization (per
More informationY-CLUB AFTERSCHOOL PROGRAM
2017-2018 Y-CLUB AFTERSCHOOL PROGRAM AFTERSCHOOL PROGRAM The Y-Club Program is a fun place to be after school with lots of positive staff interaction and learning opportunities. We provide a healthy afterschool
More informationUniversal Satori Learning Centers, Inc. Extended-day/After-School Hours Program Parent/Guardian Contract
Universal Satori Learning Centers, Inc. Extended-day/After-School Hours Program Parent/Guardian Contract *REGISTRATION: The registration fee is $60 per student, and is due upon enrollment. This is a non-refundable
More informationFLAGSTAFF FAMILY YMCA AFTER SCHOOL ADVENTURES
FLAGSTAFF FAMILY YMCA 2018-2019 AFTER SCHOOL ADVENTURES Child s name Birth date Grade Age Parent s name Birth date (Required for registration) Address City AZ Zip code Home # Work # Cell# Parent s E-mail
More informationYMCA OF SNOHOMISH COUNTY
CAMP RESERVATION & SAFETY PACKET YOUR SUMMER ADVENTURE STARTS WITH A FEW EASY STEPS: Save time and register online at ymca-snoco.org/camp. No need to calculate deposits or mark your calendar for payment
More informationSTREET ADDRESS CITY STATE ZIP / / / /
Please fill out the registration for completely and return to : YMCA of Northern Michigan 434 East Lake Street, Petoskey, MI 49770 231-348-8393 Fax 231-348-8402 Camper Information CHILD S NAME GENDER Male
More informationLakeside Academy Before/After School Care Ridgecrest Rd. Victorville,Ca Phone (760)
Lakeside Academy Before/After School Care 12303 Ridgecrest Rd. Victorville,Ca Phone (760) 245-8680 www.lakesideacademy.com Lakeside Academy Kids Club 12303 Ridgecrest Rd. Victorville, CA 92395 (760) 245-8680
More information2017 WINTER BREAK CAMP REGISTRATION FORM
2017 WINTER BREAK CAMP REGISTRATION FORM Child s Information: Last Name: First Name: MI: Nickname: Gender: Female Male Birth Date: / / Age: Primary Phone #: ( ) Full Privilege Member: Yes No List Previous
More informationFLYERS AFTER SCHOOL PROGRAM APPLICATION FOR CHILD. Childs Information. Date of Application: Child s Name (first & last name)
FLYERS AFTER SCHOOL PROGRAM 2014-2015 APPLICATION FOR CHILD *All information must be complete in order to enroll Childs Information Child s Name (first & last name) Name of School and Grade Date of Birth
More informationAftercare Program Enrollment Packet
Aftercare Program 2016-2017 Enrollment Packet 1. Payment Methods Annual Plan Significant savings are available to your family by enrolling in an Annual Plan. Families electing this option for the 2016/17
More informationLOSS/DAMAGE/THEFT OF PROPERTY
Kickin Kids After School Martial Arts Program Club Membership Agreement 2018/2019 American Kenpo Karate Studio 220 Business Center Drive Reisterstown, Maryland 21136 (410) 833-6090 Student s Name: Section
More informationYMCA AFTER SCHOOL CARE REGISTRATION PACKET
YMCA AFTER SCHOOL CARE REGISTRATION PACKET 2016-2017 Welcome! We look forward to having your family join us in the YMCA After Care Program! Sarah Kim Child Care Director 734.661.8058 skim@annarborymca.org
More informationWELCOME TO STANLY COUNTY GYMNASTICS!
WELCOME TO STANLY COUNTY GYMNASTICS! 1960 Post Rd. Albemarle, NC 28001 Phone: 704-983-2414 Email: stanlycountygymnastics@gmail.com Website: www.stanlycountygymnastics.wildapricot.org Stanly County Gymnastics,
More information2017/18 Out of School Program Registration Form
2017/18 Out of School Program Registration Form Child: First Name MI Last Name YMCA Member Non Member E-mail NOTE: There is a one time, non-refundable $20 registration fee per child required to secure
More informationKids R.O.C.K. Summer 2019 Registration Packet
City of Inver Grove Heights Parks and Recreation Department Kids R.O.C.K. Summer 2019 Registration Packet Please carefully complete all of the following pages. Your child s registration will not be processed
More informationSession I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church
th Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church Session II: June 12th - June 16th, Performance June 13th; Music On Wheels Academy Music Camp
More informationThe College of Science, Engineering, and Technology
Health and Science Summer Academy APPLICATION JUNE 25TH JULY 20TH 2018 * MONDAY FRIDAY * 9:00AM 4:00PM I. APPLICANT INFORMATION (PLEASE PRINT CLEARLY OR TYPE) Name [Last] [First] [MI] Birth Date / / Mailing
More informationMetzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly
Metzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly Last Name: Parent s Name: Address: City: State: Zip Code: Home Phone: Cell Phone: E-mail address: Work Phone:
More informationSUMMER CAMP REGISTRATION
SUMMER CAMP REGISTRATION 2019 Please return completed registration to: YMCA of Northern Michigan, 523 W. Jefferson Street, Petoskey, MI 49770. CAMPER INFORMATION Child s First Name: Last Name: (One form
More informationBefore and After School Care
Before and After School Care BLAIR FAMILY YMCA 2016-2017 School Year Registration Forms To put Christian principles into practice through programs that build a health spirit, mind and body for all. -YMCA
More informationCheer Tumbling Registration Form. (Please complete all fields and understand all information stated below) Student Information
Signature of Parent/or Legal Guardian Cheer Tumbling Registration Form (Please complete all fields and understand all information stated below) How did you hear about us? Referral Name: Student Information
More informationRIVERSIDE ACADEMY TUITION & FEE SCHEDULE Tuition Rates
RIVERSIDE ACADEMY 2017-2018 TUITION & FEE SCHEDULE Tuition Rates FAMILY TUITION DISCOUNTS (Deducted from total) Children Discount High School (9 th -12 th ) $6,248.00 2 13% Middle School (6 th -8 th )
More informationMilliken 2015/2016 School Year Registration Form
Child s Name: Milliken 2015/2016 School Year Registration Form Child s Full Name Birthday Start Mother s Name Home or Cell Phone: Mother s Home Address/City/Zip: Place of Business & Address/City/Zip: Work
More informationSummer Camp Application INTERNATIONAL DEVELOPMENT 101
INTERNATIONAL DEVELOPMENT 101 Student Information Student Name: Sex : Male / Female Student Preferred/Nickname: Mailing Address: Home Phone Number: Cell Phone Number: School: Grade (Entering): Date of
More informationYMCA of the Coastal Bend Summer Camp 2018 Enrollment Form
PARTICIPANT INFORMATION: YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form Child (1) Name: Sex: [M] [F] (circle one) of birth: / / Camp Type/Location: YMCA Day Camp (Pre-K - 5 th ) Downtown YMCA
More informationParent/Guardian Signature Required Date
C3 CYBER CLUB MEMBERSHIP AGREEMENT FORM Student Information New Student Returning Student Last Name Gender Male Female First Name DOB / / School Name Parent/Guardian Information Name SSN# Phone (H) Phone
More informationSummer Day Camp 2012-Registration Form (Each child requires a separate registration form)
GARDENA-CARSON FAMILY YMCA 1000 W. Artesia Blvd., Gardena, CA 90248 P 310 523-3470 F 310 539 6049 www.ymcala.org/gc Office Use Only Membership I.D. # Receipt # Date Packet Waiver Staff Initial Shirt Rec
More information2018 EAST JEFFERSON YMCA Summer Camp Registration
Child s Name: _ Grade: Please Circle One: Member Non-Member I will be signing my camper up for Youth Camp C.I.T. Youth Camp (entering grades K-6 th ) Member: 150/Week Non-Member: 190/Week (30/individual
More informationStudent's Name (First) (Middle) (Last) Address (Street) (City) (Zip)
TRINITY LUTHERAN CHURCH & SCHOOL * 3016 West Vine Street * Kissimmee, Florida 34741 * (407) 847-5377 2017-2018 Application for Enrollment Pre-K 3 - Tenth Grade * * * * * * * * * * * * * * * * * * * * *
More informationRegistration Form. Address City State Zip Home Phone (if different) Employer Name Employer Address City State Zip Work Phone Address
Registration Form First Parent/Guardian Name SSN: Address City State Zip Home Phone (if different) Employer Name Employer Address City State Zip Work Phone Email Address Second Parent/Guardian Name SSN:
More informationPryme Tyme Before & After School Program Enrollment Form
Enrollment Form Child s Name Sex DOB / / Age Child s School Grade AM PM Both Lunch Status: E-Mail Mother s Name Cell #: Home #: Place of Employment: Work Phone: Employer s Full Address: Father s Name Cell
More informationAfter School Program Registration Form
2018-19 After School Program Registration Form Office Use Only Date registered: _ Staff: Please fill out this form entirely. If there are blanks it may slow down your child s enrollment process. If a line
More informationEnrollment Agreement - Page 1
1414 Walnut St., Berkeley, CA 94709 5811 Racine St, Oakland, CA 94609 Ph: 510-848-0237 Fax: 510-848-0170 Ph: 510-595-9222 Fax: 510-595-9223 JCC OAKLAND AFTERSCHOOL 2018-2019 SCHOOL YEAR Enrollment Agreement
More informationVirginia Application for Dental Insurance
Section A. Dental Coverage Options: 1. Select who the coverage is for: Primary Applicant Only Primary Applicant and Dependent(s) Child(ren) Only 2. Select what coverage applicant(s) is/are applying for:
More informationBefore and After School Care Program
Before and After School Care Program 2018/2019 School Year Updated 7/30/2018 What is Crusader Club Crusader Club (CC) is a before and after school program providing Mission Viejo Christian School students
More informationPOWAY UNIFIED SCHOOL DISTRICT EXTENDED STUDENT SERVICES (ESS) PROGRAM ALTERNATIVE PROGRAMS PARENT CONTRACT PLEASE LIST CHILDREN:
POWAY UNIFIED SCHOOL DISTRICT EXTENDED STUDENT SERVICES (ESS) PROGRAM ALTERNATIVE PROGRAMS PARENT CONTRACT PLEASE PRINT LEGIBLY IN INK PRESS HARD SCHOOL NAME STARTING DATE IN ESS PARENT/GUARDIAN LAST NAME
More information*Please initial beside each statement.
TUITION CONTRACT THIS IS A BINDING CONTRACT, PLEASE READ CAREFULLY [PLEASE PRINT] 1. Name of each Student: Student Grade Discount Annual Tuition *Please initial beside each statement. 1 0% $ 5% $ 10% $
More informationMaury ES & Tyler ES Polite Piggy s Before and After School Requirements
Maury ES & Tyler ES Polite Piggy s Before and After School Requirements Polite Piggy s Registration Application, permission slip, health form, media release form Income Verification and Policies A. If
More information2019 WEST ST. TAMMANY YMCA Summer Camp Registration
Child s Name: _ Grade Entering 2019: Please Select One: Member Non-Member I will be signing my camper up for Pre-K Camp Youth Camp Leaders Camp Pre-K Camp (ages 3-5, must be 3 by start of session, must
More information2018 BELLE CHASSE YMCA Summer Camp Registration
Child s Name: _ Grade Entering: Pre-School (3-4 years old, must be potty trained) Member: 145/Week Non-Member: 185/Week (30/individual or 50/family one time registration fee) Youth Camp (entering grades
More informationTEEN LEADERSHIP DEVELOPMENT REGISTRATION FORM
TEEN LEADERSHIP DEVELOPMENT REGISTRATION FORM 2017-2018 Teen First Name Last Name Please select the program(s) that you are wanting to register for the 2017-2018 school year and include your deposit(s)
More informationTo enroll your child in our program, please provide the following 4 items:
4211 Waialae Ave #30, Honolulu, HI 96816 Phone: (808) 735-8811 Email: info@bbprekhawaii.com Aloha! Welcome to Bright Beginnings! To enroll your child in our program, please provide the following 4 items:
More informationYMCA OF AUSTIN-AFTERSCHOOL REGISTRATION FORM General and Emergency Pickup Information
REGISTRATION FORM General and Emergency Pickup Information For Office Use Only: Workforce CCS Financial Assistance YMCA Member To comply with State Licensing laws, all sections of this form must be completed
More informationStark Museum of Art Application for Summer 2016 Art Quest Program, Health Form/Consent, and Liability Waiver
Stark Museum of Art Application for Summer 2016 Art Quest Program, Health Form/Consent, and Liability Waiver Camp Sessions and Costs Listed on Page 2 Application Due June 9, 2016 Application must be complete
More informationPADDINGTON BRITISH PRIVATE SCHOOL
ENROLLMENT INFORMATION School Year: CHILD S NAME Last First M.I. Male Female of Birth: Age on Sep 1st: Years Months Nationality: Languages Spoken: Last School Attended: Has your child been potty trained?
More informationThe Clubs of Prestonwood Junior Golf Academy Summer Golf Camps 2016
The Clubs of Prestonwood Junior Golf Academy Summer Golf Camps 2016 Creek Course 9:00am 12:00pm / 4:00pm 2016 Golf Summer Academy Camp Sessions Session 1 June 7-10 Session 2 June 21-24 Session 3 July 5-8
More informationSTUDENT REGISTRATON. Emergency Contact: Medical conditions / allergies: Yes No If yes, please explain: Parent/Guardian's Signature:
STUDENT REGISTRATON Student's Name: Age: Male/Female: of Birth: / / Are you a returning Footworks student (Y/N)? Years dance experience: E-mail address: How did you hear about us? (circle) WO TIMES-SW
More informationNorth Carolina Application for Dental Insurance
Section A. Dental Coverage Options: 1. Select who the coverage is for: Primary Applicant Only Primary Applicant and Dependent(s) Child(ren) Only 2. Select what coverage applicant(s) is/are applying for:
More informationBE A PART OF SOMETHING GREATER Membership Application BRAD AKINS BRANCH
BE A PART OF SOMETHING GREATER Membership Application BRAD AKINS BRANCH YMCA Mission: To put Christian principles into practice through programs that build healthy spirit, mind, and body for all. Because
More informationSHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2017 EcoRangers Application, Health Form/Consent, and Liability Waiver
SHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2017 EcoRangers Application, Health Form/Consent, and Liability Waiver CAMP SESSIONS AND COSTS LISTED ON PAGE 2 APPLICATION DUE DATE: JUNE 23, 2017 Application
More information2019 Nashville Pilot Camp Registration
2019 Nashville Pilot Camp Registration Camp Information The following pages contain the registration form, code of conduct, and all medical paperwork to be filled out. Be sure to fill these out and mail,
More informationCITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR
CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR Please print clearly. Completion of the registration process is required for each participant prior to program start
More informationTOLEDO ZOOLOGICAL SOCIETY LEGAL RELEASE OF RESPONSIBILITY
TOLEDO ZOOLOGICAL SOCIETY LEGAL RELEASE OF RESPONSIBILITY Dear Parent(s) /Guardian(s): The Toledo Zoological Society is pleased to have you and/or your son/daughter as a participant in its overnight program.
More informationCamp Tatanka Summer Camp Registration Form
WTAMU and the City of Canyon Child s First Name Camp Tatanka Summer Camp Registration Form Camper & Parent s Information Last Name Grade Fall 2018: Age (on 1 st day of camp): Birth Date: / / M / F Child
More informationPerforming Arts Academy
Please complete this form and bring it to auditions Performing Arts Academy 4400 Lewis St. Middletown, OH 45044 513-594-7242 MUSICAL THEATRE REGISTRATION FORM ENROLLMENT FOR SUMMER 2018 STUDENT NAME BIRTH
More information2018 Summer Application
GEORGIA MOUNTAINS YMCA 2018 Summer Application SUMMER CAMP LOCATION: CAMP PHOENIX - J. A. WALTERS FAMILY YMCA CAMP RAVEN SOUTH HALL CAMP RAIDER HABERSHAM COUNTY CAMP LIONHEART WHITE COUNTY CAMP EVERGREEN
More informationExtended Day Care Program
Dear Parents/Guardians: Extended Day Care Program 2017-2018 Thank you for your interest in our Extended Day Care Program. Orlando Science School would like to welcome you and your student(s) to our Program.
More informationPARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE:
Spring Break Camp PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Have you attended Camp C-Woo before? Yes No CWU ID Number Spring
More informationDate of Function: Start Time: End Time: # Guests: Type of Function:
Today s Date: Date of Function: Start Time: End Time: # Guests: Type of Function: Total Rental Time Including complimentary 30 minutes prior and 30 minutes after conclusion of function (for Lakeview Room
More information2017 SUMMER DANCE PROGRAM NEWTON REGISTRATION AGREEMENT
Student ID: (Office use only) Parent ID: (Office use only) 863 Washington Street, Newtonville, MA 02460 SDP@bostonballet.org 2017 SUMMER DANCE PROGRAM NEWTON REGISTRATION AGREEMENT This form must be accompanied
More informationU.S. GOLD GYMNASTICS & CHEER ACADEMY INC.
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ( AGREEMENT ) In consideration of participating in all activities at U.S. Gold Gymnastics and Cheer Academy, Inc., I represent
More informationSummer 2019 Incentives (All discounts are non-refundable and non-transferable and must be paid in full by the following outlined deadline dates):
YWCA Bergen County 214 State Street, Suite 207 Hackensack, NJ 07601 T: 201-881-1700 www.ywcabergencounty.org February 2019 Dear Families and Campers, Thank you for choosing the YWCA Bergen County for your
More information1770 Davidson Ave Bronx, NY P F
Summer Camp 2016 Thank you for your interest in attending Little Scholars Early Development Center Summer Camp. The camp will be for children of the ages 4-12 years old. Along with the many fun filled
More informationAeroCamp 2015 Camp Information
AeroCamp 2015 Camp Information Old Bridge Flight School is offering Aviation Camp (AeroCamp) for children ages 10 through 18. The program will run from Monday July 6 through Friday July 10, 2015, 09:00
More informationRecreational Dance & Acrobatic Class Policies
2016-2017 Recreational Dance & Acrobatic Class Policies Welcome to EXPRESS Dance & Acrobatics. Our mission is to teach the fundamentals of dance and acrobatics, with an emphasis on commitment, education,
More informationBUILDERS CHARACTER. Steps to Register for YMCA Licensed Child Care. 1. Fill out the registration forms completely.
CHARACTER BUILDERS Steps to Register for YMCA Licensed Child Care 1. Fill out the registration forms completely. 2. Turn in the registrations forms and licensing packets to the Program Administrator at
More information2019 SUMMER DAY CAMP REGISTRATION
2019 SUMMER DAY CAMP REGISTRATION Child: First Name MI Last Name [ ] YMCA Member [ ] Non Member Email Enrollment Date SUMMER DAY CAMPS CHOOSE YOUR CAMPS & LOCATION: [ ] Ages 5-12 (must have attended kindergarten)
More informationThank you for your interest in Palmetto Dance Center!
Palmetto Dance Center of Elgin 2548 Main Street Suite G Elgin, SC 29045 Thank you for your interest in Palmetto Dance Center! Please look over the enclosed information and feel free to phone with your
More informationShining Stars Afterschool Program
Shining Stars Afterschool Program Monday-Friday 3:45-7:15 pm $40 per week/1st child $30 per week/2nd child *$36 for 3-Day Drop-In *Each Child* Games Crafts Movies Sports Homework Assistance Daily Snack
More informationDate of Function: Start Time: End Time: # Guests: Type of Function:
Today s Date: Date of Function: Start Time: End Time: # Guests: Type of Function: Total Rental Time Including complimentary 30 minutes prior and 30 minutes after conclusion of function (for Lakeview Room
More informationCONTRACT FOR ENROLLMENT Financial Agreement for 18 19
Westwood Schools 255 Fuller Street P. O. Box 528 Camilla, GA 31730 (229) 336 7992 www.westwoodschools.org Westwood Schools is a college preparatory school where all students are inspired to reach their
More informationD.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet
D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at 860-929-7692 or via email at dgittens@bgchartford.org Team
More informationSaint Vincent de Paul Parish School Student Tuition Contract School Year
Student Tuition Contract 2017-2018 School Year I understand that I am entering into a contractual agreement with Saint Vincent de Paul Parish School, and that I am obligated to pay the full tuition & fee
More informationKANJIZAI MARTIAL ARTS LLC 2018 CAMP REGISTRATION
KANJIZAI MARTIAL ARTS LLC 2018 CAMP REGISTRATION Camper #1 Information Name DOB Gender Special Requirements (allergies, medications, behavioral challenges, etc.) Camper #2 Information Name DOB Gender Special
More informationWELCOME TO YMCA SUMMER CAMP 2018!
WELCOME TO YMCA SUMMER CAMP 2018! The following pages are the registration materials required to complete your registration. Read your Parent Handbook carefully, as it contains important information, policies
More informationStudio Policies
2018-19 Studio Policies Welcome to EXPRESS Dance & Acrobatics. Our mission is to teach the fundamentals of dance and acrobatics, with an emphasis on commitment, education, safety, and fun in a healthy
More informationMEMBERSHIP APPLICATION; CONSENT and MEDICAL CERTIFICATION PROGRAM: AFTER-SCHOOL, SUMMER, FOOTBALL, SOCCER, BASKETBALL, MARTIAL ARTS, ETC.
MEMBERSHIP APPLICATION; CONSENT and MEDICAL CERTIFICATION PROGRAM: AFTER-SCHOOL, SUMMER, FOOTBALL, SOCCER, BASKETBALL, MARTIAL ARTS, ETC. MEMBER INFORMAITON Member Name: LAST FIRST MIDDLE Address: City
More informationHere is a checklist of a few things that are commonly overlooked and are mandatory in processing your application.
Application Instructions for Cigna Dental Application 1. Please print all pages of the application. 2. Complete all questions and sections of the applicaton. Please write legibly. 3. Complete the fax cover
More informationATHENS YMCA CAMP KELLEY SUMMER CAMP 2018
ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 POLICIES Cost: Full Week (5 Days) $115, Half Week (3 Days) $70; Additional Children: Any additional children will receive a $10 discount on full weeks ONLY. Registration
More informationTEXAS PEDIATRIC SPECIATLIES AND FAMILY SLEEP CENTER REGISTRATION FORM PEDIATRIC (Please Print) Referring Physician: _ Primary Care Physician: _
TEXAS PEDIATRIC SPECIATLIES AND FAMILY SLEEP CENTER REGISTRATION FORM PEDIATRIC (Please Print) Referring Physician: Primary Care Physician: Patient s LEGAL Last name: First: Middle Initial: Patient date
More informationWRAP/YMCA Expanded Learning Program
2018-2019 School Year School: Child s Last Name: First Name: Sex: M F Birth date: / / Age: Home Phone: ( ) Home Address: Cell Phone: ( ) City: State: Zip: Child lives with: Mom Dad Both Parents Other Begin
More informationParent & Camper Handbook/Manual
SLAM Sports Summer Camp Parent & Camper Handbook/Manual 2014 SLAM 5 5 5 SLAM 326-0003. SLAM SLAM SLAM Charter schools's d SLAM Academy 25.00 9:00 4 120.00 SLAM 5 5 SLAM SLAM SLAM SLAM main lobby of the.
More informationCHAMPS REGISTRATION Continued Hours at Mansfield Public Schools 255 East Street, Mansfield, MA ~
CHAMPS 2015-2016 REGISTRATION Continued Hours at Mansfield Public Schools 255 East Street, Mansfield, MA 02048 ~ 508-261-7539 Welcome to CHAMPS for the 2015-2016 school year. Registration is now open for
More informationThe DuPont Country Club 2018 Membership Application
APPLICANT NO. 1 The DuPont Country Club 2018 Membership Application For questions, call the Membership Office at (302) 421-1722. PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE. APPLICANT INFORMATION OFFICE
More informationSummer Camp Registration Form
2015 2017 Summer Camp Registration Form 11 of 6 2017 Summer Camp Registration Form All All forms are can available be found online: http://go.dtcc.edu/swcamps go.dtcc.edu/terrycamps q New Camper q Returning
More informationContact Information. Policy Information
Contact Information Student Name: Home Phone: Emergency Contact: Parent/Guardian Name: Parent/Guardian Cell Phone: Parent Guardian Email: Age: (If Under 18) Birthday: Address: City State: Zip Code PAYMENT/
More informationHamilton and Friends Musical Theatre Camp
JULY 9-20 SUMMER of 18! (Ages 9-13) Registration Form: $375.00/wk Early Bird Rate (now - March 1) $400.00/wk Standard Rate (beginning March 2) Child s Name: Date of Birth: Age: School Grade in the Fall:
More informationKids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child
Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Registration Form Please fill out and return to the address below
More informationMiddle School Mathematics Camp Monday through Thursday 9:00am 1:00pm
Monday through Thursday 9:00am 1:00pm Registration Form Name last first middle Mailing Address street city state zip School Gender School District Grade in September 2018 (6, 7, 8, or 9) Phone # Age Tee-shirt
More informationMembership Application
Membership Application Founder Active Associate Racquet Riding Boarding Member Riding Member (no horse) Lesson Program Name of Applicant: Date: Home Address: City: State: Zip: Billing Address (if different
More informationStark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver
Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver Camp Sessions Listed on Page 2 Application Due June 22, 2018 Application must be complete in
More informationMCC Summer Camp Application
MCC Summer Camp Application Summer Camp Enrollment Guidelines Applicants are considered on a first-come, first-serve basis. Only complete application packets are considered. A complete application packet
More informationSHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2019 EcoRangers Application, Health Form/Consent, and Liability Waiver
SHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2019 EcoRangers Application, Health Form/Consent, and Liability Waiver CAMP SESSIONS AND COSTS LISTED ON PAGE 2 APPLICATION DUE DATE: JUNE 21, 2019 Application
More informationNew Students Previous Training? Please list previous experience in dance/ theatre. Attach another sheet if needed
Reg. Pd. Tuition Pd. Signed/Initialed 2 Canton Street, Suite A-8 Stoughton, Massachusetts 02072 781-886-6136 2018-2019 REGISTRATION FORM Student Name (first & last) Age: & DOB Home Address City/State/ZIP
More informationMath + Leadership Camp Rancho Minerva Middle School July 11-22, Registration Form
Math + Leadership Camp 2016 @ Rancho Minerva Middle School July 11-22, 2016 Registration Form CONTACT INFORMATION Math for America San Diego Email: sandiego@mathforamerica.org Phone: 858-822-6284 OFFICE
More informationBefore & After School Care
Illinois Valley YMCA Before & After School Care A Foundation for Learning Serving: LaSalle Northwest, Peru Northview & Oglesby Lincoln Schools 2017-2018 Before and After Care School Program Billing and
More informationSacred Heart Tutorials A Catholic Homeschool Cooperative. Application for Admission
Application for Admission 2015-2016 Father s Name: Mother s Name: Home Phone: Cell Phone: (Father) (mother) Home Address: E-mail address: Please list the first name and current grade of each child enrolling
More informationJING KIDS Summer Camps!
JING KIDS Summer Camps! Space. The Final Frontier June 18 - August 17, 2018 Daily Schedule Time 8:00am 9:15am 9:45am Activity Learning Centers Chinese Language Activity Recess/Snack 10:15am Chinese Arts
More informationTEEN LEADERSHIP DEVELOPMENT PROGRAMS REGISTRATION FORM
TEEN LEADERSHIP DEVELOPMENT PROGRAMS REGISTRATION FORM 2018-2019 Teen First Name Last Name Please check the box for the program(s) that you are wanting to register for the 2018-2019 school year and include
More informationPast Medical History
Past Medical History Patient Name Age: Sex: M or F Allergies:_ of Birth Current Medicines: If Newborn: Was baby born in a Hospital: Y N If Yes what Hospital: Medical History BIRTH HISTORY (Please list
More information