Summer Ready for Kindergarten Application 2025

8 week SUMMER group for Rising k-5

2025 Summer: For 5 year old children who will be entering Kindergarten fall 2025. One eight week session. Choose you meeting day below. One application per participant
Child's Name*

First NameLast Name
Current OT4Kids client
DOB * . My child prefers to be called * .
Allergies * . Allergies to farm animals ? *
Likes and dis-likes ? * . Favorite snacks / food?*
T-Shirt size blanks* Required)
Are there challenges in the areas of emotional awareness, self regulation, social skills, health and wellness, or others you would like to share with us ? or type none*
Were you able to access the "Ready for Kindergarten check list on our web page? blanks .
To determine if a sibling is attending. Do you have more than one child you would like to register for this rising K-5 summer group? blanks If yes, what is their name and age? blank
Responsible Party*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Is your child entering K-5 fall 2025*
Which Exceptional Me K-5 summer group would like to attend ?*
PAYMENT AGREEMENT

-The Exceptional Me rising K-5 Program runs in one 8-week summer session 1 time a week for 3 hours per meeting. The discount cost is ($480) per eight-week session. Regular price outside of discounted offers is $600 per session. Price is calculated accordingly during the checkout process.

-If joining after the eight-week session has begun, a prorate will be calculated for the reminder of the session.

-Each child: Purchase one T-shirt for $10 to wear while attending the group.

-Payment in full is due the Friday before the summer session begins. If you would like to continue the Exceptional Me journey by joining groups that meet during the school year, we will offer the same discount you received when you signed up for summer camp even if the promotion is no longer in effect. This rate will remain in effect until the end of the academic school year if attendance is consecutive.

-Unless prior arrangements have been made with our coordinator, if payment in full is not received the Friday before the session begins, we will recognize that confirmation of your child's intention to attend has not been confirmed offering the position to a child on our waiting list. The deposit is nonrefundable.

-$100 non-refundable deposit is due with each application. This applies to the cost of the eight-week session. A payment link is provided below for the deposit and a separate link can be found on our web page to pay the remaining balance. This deposit holds your child's place. A deposit is only required when first entering the program.

-Due to the importance of attendance when engaged in small groups and discounts offered, once a group session is paid for in full and has begun, any missed meetings are forfeited. Extenuating circumstances will be considered.

-If the Instructor must cancel a class due to unforeseen circumstances or illness, the class will be made up by extending the session accordingly.
Responsible Party * . Date *
Signature of responsible party*

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Personal Injury Waiver Form

This Personal Injury Waiver (the "Waiver") is made by the undersigned for the purpose of utilizing the facilities and premises managed by OT4KidsInc., (the "Company"), with the location at 440 Central Ave, NC 27292. and in the acknowledgment that in the utilization of the premises and facilities of the Company, occupies risk of personal injury that may arise or happen at any time.

In consideration of the Company allowing the undersigned to make use of the venue and its facilities and equipment for the relevant purpose by which the Company allows, the undersigned agrees to assume the foreseeable and unforeseeable risk of personal injuries related to the activity, and agrees to release, discharge, and hold harmless the Company, its owner(s) and employees free from any and all liabilities, claims, cause of action, damages, or losses, which may be incurred by the undersigned in using said premises and its equipment and/or facilities, and which may arise from any reason whatsoever, specifically including, but not limited to, any negligence on the part of the owners, its employees, or losses arising from theft or for any other reason whatsoever.

This Waiver shall be binding upon the parties, their respective heirs, representatives, successors, and assigns.

In case any part of this Waiver be construed as improper or invalid, such invalidity will affect only that part of this Waiver and the rest shall remain valid and enforceable.

Any alteration, modification, or amendment to this Waiver shall not be considered as valid unless otherwise written and signed by the undersigned herein.
Name of responsible party * . Date * .
Signature*

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I hereby grant The Exceptional Me and OT4 Kids inc. staff the irrevocable right and permission to use photographs and/or video recordings of me and/ or my child on OT4 Kids and other websites, publications, social media platforms, in promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me. This request is in efforts to offer this small groups opportunity to others who can benefit from the unique setting the Exceptional Me Program offers.
to the above statement
My Products: **Please make a selection by clicking the box to the left of each description **
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Summer Ready Session1 day a week for 3 hours for 8 weeks
$480.00 Quantity



Exceptional Me T-shirtRequired: 1 per child
$10.00 Quantity



Sponsor a Childhelp a child who can't afford to attend
$380.00 Quantity



For Administrator
$ Free Quantity



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8 week SUMMER group for Rising k-5