Summer Camp Form and Page

Guardian's 1 Full Name

Guardian's 1 Relation to Child(ren)

Guardian's 1 Email

Guardian's 1 Phone

Guardian's 2 Full Name

Guardian's 2 Relation to Child(ren)

Guardian's 2 Email

Guardian's 2 Phone

Select your week(s) of camp attendance. If you have some students who will only attend on certain days other than your other students please ensure that you list their desired days of enrollment next to their names and D.O.B. in the following question.

Week 1: Jun 9-12

Week 2: July 7-10

Week 3: July 14-17

Children's Name, DOB, any concerns or conditions we should be aware of. (Please complete medical needs/concerns on the medical form)

I permit Arrows Learning Academy to release my child(ren) and any personal information regarding them into the care of the following named emergency contact(s)/alternate pick-up person(s) listed below.

Please Include the full name and phone number of each person listed. We are not permitted to allow children to leave with anyone not on this list without written permission from the guardians.

I permit Arrows Learning Academy and associates to seek immediate emergency medical care for my child in the occurrence of a medical emergency. I understand and assume all responsibilities and costs associated with such care. *Guardians will be contacted by Arrows Learning Academy in the case of a medical

I understand that it is everyone's responsibility to ensure a healthy learning environment, therefore, I agree not to bring my child to Arrows Learning Academy if they or someone they have recently been in contact with exhibits any symptoms of a communicable disease.

I understand that my child must be fever, diarrhea, and vomit free for a minimum of 24 hours before returning to any Arrows Learning Academy Class, Event, or Activity

I understand that if my child becomes ill while in attendance at Arrows Learning Academy, myself or my listed emergency contacts may be contacted to come and pick up my child. Pick-up must occur within a reasonable time after notification is received. I understand that my child may be isolated from others as well as provided a mask to wear, while they await someone to come and pick them up. I also understand that my child may not return to Arrows Learning Academy for at least 24 hours.

I understand that Arrows Learning Academy and its associates will do their best to provide a safe and healthy environment. I understand that depsite these procedures and precautions that there may still be risks associated with participation. I release Arrows Learning Academy and associates from any liability associated with our participation.

I authorize Arrows Learning Academy to use my/my child(ren) photo/video/audio/work related to our experiences with Arrows Learning Academy. My consent is freely given as a public service to Arrows Learning Academy, without expecting anything in return. I can revoke this release at any time in writing to Arrows Learning Academy.

I the undersigned, guardian of the children listed within this form, certify that the information in this form is correct and agree to the terms and conditions set forth as part of this agreement for enrollment in Arrows Learning Academy.

Please type your full name and date in the space provided above, as your signature for this enrollment agreement with Arrows Learning Academy

Camper Information Form