* Student's Name
Grade Next Year
Primary Contact Name
* Primary Contact Name
* Contact Number
Secondary Contact Name
* Secondary Contact Name
* Contact Number
* Home Address
Camp runs from Monday to friday, 8:45 am-3:30 pm. drop-off starts from 8 to 9 am, and pick-up starts from 3:30 to 4 pm. optional aftercare service is available from 4 to 6 pm at $5/day. weekly lunch service is available at $5/lunch. Camp is closed on July 4th.
PARENT/GUARDIAN ACKNOWLEDGMENT & AUTHORIZATION
the parent/ guardian of
give my authorization for Creative World to seek medical assistance for my child should the need arise. Creative World has my permission to take my child to a hospital and sign any authorization for emergency medical treatment. I understand that I am responsible for all medical costs, and release Creative World and the school’s individual employees, contracted professionals, and volunteers of all responsibilities and any medical and/or other costs associated with any medical emergency. I acknowledge that I am responsible to notify Creative World if any of the below information changes.
WAIVER & FIELD TRIP AGREEMENT
1. I understand enrollment is based on first come first serve basis.
2. I authorize Creative World (CW) to contact 911 in the event of an emergency and I cannot be reached. I authorize my child/ren to be treated by the first available licensed EMT, physician, dentist, or surgeon, at the first available medical facility or hospital. I understand that I am responsible for the medical fees of the above minor/s should s/he require emergency medical treatment while attending summer camp or during summer camp activities.
3. I hereby agree that neither CW, nor its individual staff or volunteers shall be liable or responsible for any injuries that may occur at anytime or any place during the summer camp.
4. I must disclose any special needs or allergies my child may have and agree to provide arrangements as required by CW.
5. I understand cancellation of any session has a $100 non-refundable fee. Participant cancellations made two weeks prior to the start of camp will result in a refund minus the $100 non-refundable fee. Participant cancellations made after camp starts will result in a 50% refund.
6. I understand there are no refunds if my child is absent due to illness, early withdrawal, or is removed from camp due to behavior or disciplinary problems.
7. I understand that CW reserves the right to substitute camp activities as necessary.
8. I allow my child to be in promotional materials from the camp.
9. I certify that I have legal authority to sign this release/waiver of liability, and sign it without coercion.
10. I have read and understood the CW rules and policies.
Student and parent/ guardian agree to:
1. Represent Creative World; the student agrees to behave with the highest degree of appropriate behavior and to comply with all Creative World policies for the duration of all activities.
2. Acknowledge that each student is assigned to an adult chaperone and a specific group for the duration of the field trip.
3. Follow individual and group instructions and/or rules for the duration of the field trip.
4. Release Creative World individual staff from all liability.
5. Accept the consequences of improper behavior. Creative World has the right to expel students who participate in illegal activities such as, but not limited to theft, or vandalism. Parents will assume all costs for damages to rooms, buses, facilities, return transportation home, etc. Any advance payments will be forfeited.
I declare that the information on this form is true and correct. I certify that I have legal authority to sign this release/ waiver of liability, and sign it without coercion. I have read and understood the CW rules and policies.
Our staff will be contacting you soon to confirm your registration and collect a $100 deposit. Registration is considered complete once the deposit has been received.
If you have any questions or need assistance with anything, please contact us at: 626-445-6005 / firstname.lastname@example.org