Element Explorer 2025_2026 Re-Enrollment

Hi Element Parents! Please complete the Annual Returning Student Enrollment form below. We are required to update our records annually. We will need the following:

1.) Completed Online Enrollment Form prior to start date.

2.) Updated Immunization record (Blue Card) or Immunization exemption. The Director will contact you if needed.

3.) Form of Affidavit for Parents/Guardians (required annually)

4.) Child's Medical Form (required annually)

5.) Annual registration fee (non-refundable) of $100. Along with first week tuition($160).

6.) Supply fee of $25 covers all needed supplies for the school year.

7.) Payments are due the Friday week before care. Pay for spot and not attendance.

*Please note the Director will contact you for any additional information needed.*

First Name*

Last Name*

Gender*

FemaleMale

Child's Birth Date*

MonthDayYear

Age*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone*

Area CodePhone Number

Is your child returning to Element Explorer's for the 2024-2025 school year?*

Is your child potty trained?*

Doctors Name*

First NameLast Name

Doctors Address

Doctors Phone Number*

Area CodePhone Number

Full Name*

First NameLast Name

Relationship to Child*

E-mail*

example@example.com

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

Parent's Work Place

Work Phone

Area CodePhone Number

Where would you like to be reached while your child is at Element Adventures?*

Address - Same As Child*

YesNo

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Full Name

First NameLast Name

Relationship to Child

E-mail

example@example.com

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

Parent's Work Place

Work Phone

Area CodePhone Number

Where would you like to be reached while your child is at Element Adventures?*

Address - Same As Childs*

YesNo

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Full Name*

First NameLast Name

Relationship to Child*

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Please list the people authorized to pick up your child.*

Does your child have any food, medication or environmental allergies?*

YesNo

If yes, please list any food, medication or environmental allergies

Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*

YesNo

If yes please list.

Does your child have any chronic illness, or medical conditions?*

Are there any special medical, physical, or emotional needs that the staff needs to be aware of?

I understand that all essentials such as diapers, pull ups, wipes, 2 sets of changing clothes, and any other items my child may need must be brought each day in a labeled bag or carrier with my child's name.*

Agree

I understand that the Element Adventures Explorer's is an active program with physically challenging activities available for student participation.*

Agree

I give permission for my child to be transported by Element Adventures staff to and from Element Adventures facility for field trips.*

Agree

I understand that climbing walls, indoor and outdoor play equipment, inflatable obstacles, slides, and basketball play entail certain risks. Those risks can include increased heart rate, blood pressure, strained or sprained muscles, fractured bones, partial or complete paralysis, heart attacks, psychological injury, death, or any possibility of other serious injuries. I elect to allow my child to participate in spite of these risks.*

Agree

I understand my child may be photographed and photos may be used in media publications that would represent Element Adventures and its program in a positive manner.*

Agree

I understand that registration and first week tuition is due to ensure my child's enrollment. I understand that I pay to reserve a spot and not attendance. I understand that the payment policy is no transfers, no credits, and no refunds.*

Agree

I knowingly and voluntarily assume all risks involved in my child's participation, and do hereby release Element Adventures, and its members, trustees, officers, employees, independent contractors and agents from any and all liability, damages, costs, and expenses arising out of or relating to bodily or psychological injury, loss of life or personal property that may occur as a result of participating in this program, on the account that all safety procedures have been taken on behalf of Management and Staff?"*

Agree

I understand that each week of care must be pre-paid two weeks in advance and weekly payments are due each Friday the week before care. There is a $25 late fee for accounts that fall past due.*

Agree

I understand that bad language and behavior that is disruptive, disrespectful, and/or aggressive will not be tolerated and further agree that dismissal of the student is at the discretion of the Program Director.*

Agree

Element Adventures has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*

Agree

I give Element Adventures and any employees permission to administer first aid in the event of an injury or illness.

Agree

I understand that Element Adventures Explorer's Program is based on Muscle Shoals City Schools schedule and inclement weather policy which includes: closures, delays, and early dismissals.

Agree

I agree to give a two week written notice if I would like to withdraw my child from the program. The remaining balance must be paid in full at the time of notice.*

Agree

My child and/or I have read, understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the said program.*

Agree

Parent Signature*

License Exemption

Element Adventures LLC has chosen the license exemption offered to church childcare centers. Not only will we meet the minimum standards as required by the state, but in almost all cases, we will exceed in reaching a higher standard than is required by the current state law. We have prepared an affidavit for you to print & sign that we turn in to the Department of Human Resources ANNUALLY. I have read and understand the above stated policy on Element Adventures status of exemption and I understand that I must print & sign a notorized affidavit ANNUALLY.

My Products

2024-2025 Element Explorer's Annual Registration Fee$100.00

Supply Fee$25.00

Weekly Tuition$160.00

Total $0.00

Credit Card

Element Explorers 2025-2026 Enrollment Form

Child's Information

Parent/Guardian Info

Parent/Guardian Info (2)

Emergency Contact

Other Infomation

Credit Card