Parent Name
*
First Name
Last Name
Child Name(s)
*
If you have more than one child attending, please put all their names below.
Assumption of Risk & Liability
*
Participants voluntarily engage in camp(s) at The Center at their own risk, assuming all related risks, both known and unknown. The Center is not liable for any damage to clothing or personal belongings, and all risks of damage or loss are assumed by the participant.
Medical Responsibility
*
In the event that medical care or treatment is required, participants are financially responsible for any associated costs. It is recommended that individuals carry their own health insurance.
Damage & Liability for Property
*
Any damage to equipment or facilities resulting from willful actions, neglect, or recklessness by a participant or their family will be the financial responsibility of the individual responsible.
The Center is not responsible for lost, stolen, or damaged personal belongings, including electronics.
Refund & Credit Policy
*
A full refund will only be issued if The Center cancels a program due to low enrollment. If a child is unable to attend a program registered for, refunds cannot be issued but can be credited toward another program, class, or lesson.
Code of Conduct
*
Participants are expected to behave respectfully toward staff, peers, and camp property. Bullying, aggressive behavior, or inappropriate language will not be tolerated and may result in dismissal without a refund.
Drop-Off & Pick-Up Policy
*
Parents/guardians must drop off and pick up children within designated times.
Only authorized individuals (with prior written consent) may pick up a child.
Late pickups may result in additional fees.
Photography & Media Release
*
Photos and videos may be taken during camp for promotional purposes. Parents/guardians may opt out.
Emergency Contact #1
*
First Name
Last Name
Emergency Contact #1 Phone Number:
*
(###)
###
####
Relationship to Child
*
Emergency Contact #2
*
First Name
Last Name
Emergency Contact #2 Phone Number:
*
(###)
###
####
Relationship to Child
*
Please provide a list of approved adults who can pick up your child.
*
Include their full government ID name. Orange pick-up slips can be requested if you need someone who is not noted at time of filling this form at.
Does your child have any allergies we should know of?
*
If yes, please elaborate and list medications
Any Dietary Restrictions The Center should be aware of?
*
If yes, please elaborate
Any behavioral issues The Center should be aware of?
*
If yes, please elaborate and give us an example along with a solution to help them
Some examples:
My child may become overwhelmed and have difficulty regulating their emotions. When this occurs, providing a quiet space for them to rest with a small activity will help them regain a sense of calm.
My child sometimes acts impulsively, such as grabbing items, interrupting conversations, or running without thinking. Redirection and clear expectations help them stay engaged.
My child is sensitive to loud noises and may cover their ears, become upset, or try to leave noisy environments. My child will have noise-reducing headphones to help, but a nice quiet space can also help when needed.
Non-Prescription Medications
*
The Center has non-prescription medication stocked and can be used on an as needed basis to manage illness and injury. Please check the medications you would allow:
Anything additional you would like to add that would help faculty and staff here at The Center help make your child's experience the best?