2025 Summer Camp Enrollment Application

Parent / Guardian Information
Parent/Guardian #1*
Parent/Guardian #2
Are there any special circumstances of which we should be made aware regarding family living situations, etc? If so, please provide details here. *

Student Medical Consent, History, & Facts
In the event of an emergency, I hereby authorize the transportation and or administration of any medical procedure deemed necessary by a doctor or should a doctor be unavailable, any other physician or medical personnel.
Signature*

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Please fill in any of the following which may apply to your child:
Authorization & Release for Epipens & Inhalers
Please select the correct option:

Epipen (select if your child may need an Epipen administered during school hours)Inhaler (select if your child may need an inhaler administered during school hours)
Directions for use:
Please indicate dosage, frequency etc.
I,Parent full name, parent/legal guardian of Child's full name request that the administration of the above noted medication be provided. I understand this will be done by a person with no medical or nursing training. All training will be the parents' responsibility. I agree to provide OTM with an updated medical statement if there is any change in the physicians instructions with respect to medication. I hereby release OTM, its employees and contractors from all manner of actions causes of actions, lawsuits, damage or injuries, however caused, arising out of the administration or failure to administer medication as provided herein.
Signature Date
PHOTOGRAPHY: Please select all that apply.*

I DO consent to my child's photograph being used on OTM's marketing or social media account.I DO consent to my child's photography being used in the PRIVATE facebook groups OTM privately manages for the school and classrooms.I DO NOT consent to my child's picture being used anywhere at any time.
THERAPY & Other ANIMALS: Please select ONE.*

I DO consent to my child interacting with a therapy dog.I DO NOT consent to my child interacting with a therapy dog.
TERMS & CONDITIONS

All such policies are outlined in the Family Handbook, which is ALWAYS available on our website, www.otmenrichment.com. Over the Moon admits students of any race, color, ethnicity or religious affiliation and does not discriminate based on the aforementioned.
STUDENT ASSESSMENT & PARENTS INTERVIEW/TOUR:

Once your application is received, an administrator will reach out to you within 2 business days. They will review your application and ask you questions about your child.

Please note that our camp cannot meet the needs of children who require 1:1 supervision &/or care. If your child requires extra support for behavioral &/or physical needs, or has consistent difficulty participating in a group setting, OTM may not be a suitable fit for them. While we absolutely work with providers and enroll children with one or multiple related services, we assess all students on their ability to participate, learn and be cared for in a group setting.
Please include any notes, comments, questions or requests regarding your child and enrollment. This is also a great place to tell us a little about them. *
Print Full Name*
Date*

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Signature*

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Application Fee*

USDApplication Fee

Payment Details
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2025 Summer Camp

Student Information

Enrollment Information

Parent / Guardian Information

Student Medical Consent, History, & Facts

Authorization & Release for Epipens & Inhalers