ASAAP PETAL 2025 SUMMER CAMP ENROLLMENT FORM

ASAAP SUMMER CAMP 2025

ASAAP EAST (Petal) ONLY
Student Name*

First NameLast Name
Parent Name*

First NameLast Name
Student's Current Grade*
Student's T-Shirt Size
Cell Phone Number*
Additional Phone Number
E-mail Address*
example@example.com
Full Day/ Full Summer Camp $125/Week

6/2-7/11 Monday-Friday 7:30-5:30 ( East Location Only)
K-2nd
3rd-4th
Medical Information

ONLY COMPLETE IF INFORMATION HAS CHANGED
Preferred Hospital
List of Allergies
Indicate all medical conditions:
Please describe
Current Medications
Misrepresentations
Our service for students is based upon an agreement between ASAAP and parents. This program agrees to provide services in exchange for the parents’ payment of tuition/costs and their promise to abide by the policies, procedures, and rules of the program. The information provided on this form induces the program to enter into this agreement and, therefore, ANY MISREPRESENTATIONS, INACCURACY, OR UNTRUTH IN THE INFORMATION PROVIDED HEREIN, WHEN DISCOVERED, MAY BE GROUNDS, IN THE SOLE DISCRETION OF THE PROGRAM, FOR SUBSEQUENT REMOVAL OF THE STUDENTS(S) FROM THE SCHOOL AND THE TERMINATION OF THIS AGREEMENT
Education of children with special needs
Please list any accommodations or supports the student requires.
After School Academics & Arts Program does not discriminate and we believe that all can benefit from an educational experience. In reality, due to limited financial resources, we are not able to effectively provide appropriate educational programs for all students. Some students require certain educational program modifications and resources that we are not able to provide within our schools. The law recognizes this in the fact that, while public schools must make a “reasonable accommodation” to educate all students, we are called upon to make ONLY “minor adjustments.” Provided that your child is otherwise qualified for admission if the required program modification constitutes “minor adjustments,” the child may be admitted. However, if more than “minor adjustments” are needed, then the child would be better served by an institution equipped to serve that particular need. ANY TIME IT BECOMES APPARENT THAT THE CHILD REQUIRES MORE THAN “MINOR ADJUSTMENTS” TO BE EFFECTIVELY SERVED, THE PROGRAM RESERVES THE RIGHT TO MAKE THIS KNOWN TO THE PARENTS ALONG WITH THE FACT THAT THE CHILD’S NEEDS WOULD BE BETTER SERVED ELSEWHERE.
Permission Slip
My signature below indicates consent to my child’s participation in the ASAAP program and any activities associated with enrollment. I waive all claims against (release and hold harmless) the staff and volunteers on any trip. In the event of an emergency or serious injury or serious health problem, I give my permission (per my signature below) for you to obtain medical treatment for my child from EMS personnel and/or at the nearest hospital, doctor, or medical facility at my expense. I further certify that the info I have provided on my child’s personal health history is correct to the best of my knowledge. Any information missing from personal health history or new or temporary health problem, activity restriction, and/or change of insurance provider is noted on this form. I understand that all medications are to be given to the staff members when I drop my child off and that I am responsible to request the return of any medications when I pick up my child. I agree to notify the staff of any health issues within the 24 hours preceding the trip.

All Students will need to wear their ASAAP t-shirts when traveling on field trips!
Signature*
Date*

MonthDayYear
Hour MinutesAM/PM Option
Authorization Agreement Form
I have read and understand all policies and procedures in the After School Academics & Arts Program Parent handbook. My signature below is my agreement to comply with all statements in the After School Academics & Arts Parent Handbook.
I grant After School Academics & Arts Program and its employee’s permission to photograph my child during observations, class projects, field trips, or any other classroom activity. I understand that only first names will be used and that the pictures may be used in any portfolio or displayed within the center.
I grant After School Academics & Arts Program permission to use my child’s photo on their website, www.asaap.us or social media pages. I understand the website has a large audience and my child’s photo will be available to the general public.
I grant After School Academics & Arts Program permission to take my child off the premises and on excursions that will take place during regular childcare hours. I understand that trips will be supervised and all precautions will be taken for the safety and well-being of all children. Consent is for ALL PLANNED activities such as a trip to the park and/or library, to the farm to visit the animals, AS WELL AS OUT OF TOWN FIELD TRIPS. All children will be in certified, age appropriate seat belts.
I grant After School Academics & Arts Program, in case of accident or illness requiring medical attention, permission to call a health care provider or to take my child to the nearest hospital or doctor, and it is understood that if possible, their services will be obtained, at the parent(s) expense. If neither parents nor preferred health care provider can be contacted, After School Academics & Arts Program and its employees, is authorized to contact another health care provider.
Date*

MonthDayYear
Print Name*

First NameLast Name
Signature*

Pay Summer Camp Registration*

Full Day/ Full Summer Registration Fee

Registration is PER CHILD 6/9-7/18

$100.00

Total

$0.00

Credit Card

Should be Empty:

ASAAP SUMMER CAMP 2025

Full Day/ Full Summer Camp $125/Week

Medical Information

Misrepresentations

Education of children with special needs

Permission Slip

Authorization Agreement Form

Credit Card