Afterschool Application Student Information

Any special instructions, such as custody or restraining orders must be attached to this application and discussed.

Kreative Success Academy does not discriminate based on race, color, sex, handicap, religion, or national origin. Kreative Success Academy reserves the right at its sole discretion to refuse an application or dismiss a child from camp. No refund will be made of fees if the child has attended any portion of the camping period.

I give Kreative Success Academy permission to photograph and/or videotape my child for public relations and/or marketing purposes. Photos will remain archived at The Peoples Channel and can be used for promotional purposes without notification.

I give permission for Kreative Success Academy to transport my child off camp property for the purpose of field trips and/or medical care. I understand that a schedule of events will be available to me and that all events are subject to change due to weather and/or scheduling conflicts without notice.

I authorize the Kreative Success Academy staff to act as the agent of the parents in any emergency or to administer basic first aid for the health and welfare of the camper involved. I am responsible for the expenses involved if the services of a physician or hospital are required. Please request a waiver for persons requesting exemption from medical treatment.

By signing below, I agree to adhere to all the Policies and Procedures set for by Kreative Success Academy:

The medical background of each Student is required as part of the registration process. Kreative Success Academy staff must be advised in writing of any condition that would limit the camper's ability to participate in any program.

List of past medical treatments

Will your child need to take any prescription medications while at camp? Yes/No If yes, please request a medical dispensing form. Return the form and medication in a ziplock bag with your child's name on it on the first day that they attend camp. Allergies: (Please put N/A if your child does not have an allergy)

If yes, you must provide the camp with an Epi-pen to be kept at camp during your child's enrollment. Epi-pen must be accompanied by a current prescription and a doctor's note.