KIDS COLLEGE RELEASE FORM (2025)

CHILD'S NAME:*

First NameLast Name
IMPORTANT INFORMATION

THIS FORM IS REQUIRED FOR EACH CHILD BEING REGISTERED

Parents/Guardians should attend/watch recording of the orientation prior to the first day of the workshop. Orientation dates/times will be communicated to parents closer to the summer.

Refund/Cancellation Policy: Students enrolled in a Kids College workshop and then request to withdraw are subject to the following refund policy:

If a student withdraws ten business days before the start of a workshop, a full refund will be granted. No refund will be granted if withdrawal is within ten business days of the start of the workshop; however, the student may choose to switch to another workshop if available at the current rate. No refund will be given if a student is dismissed from a workshop. Students will be responsible for any outstanding balances. All refunds require the completion of a 'refund request form'. A full refund will be given if Atlantic Cape deems it necessary to cancel a workshop.

Drop Off and Pick Up: All participants must be dropped off and picked up at the designated location. The designated location will be indicated during the orientation. Please be sure to pick your child(ren) up on time.

Lunch and Snacks: Participants are responsible for providing their own lunches, snacks, and beverages. No refrigeration is provided.

OUR CAMPUSES ARE NOT PEANUT OR TREE NUT FREE

Shoes: Flip flops, heelies or sneakers with rollerblades are not allowed. Students participating in culinary arts workshops are required to wear closed-toed shoes.

Cell phones and Other Electronic Devices: Atlantic Cape Community College and Kids College staff are not responsible for lost or damaged electronic devices. Students are not allowed, unless instructed by the teacher, to use cell phones or other electronic devices while workshops are in session.

Late Arrival: Any participant arriving after 9 A.M. for morning sessions or 12:30 P.M. for afternoon sessions must report to a Kid's College staff member before going to their workshop.

Workshop Conclusion Times: Workshops conclude at 3:30 P.M. for full day programs and afternoon half a day program. Morning only half a day programs conclude at 12:00 P.M. An authorized adult (see Pick up Permission Form which is included in this document) must sign all participants in/out each day.

Participants with Disabilities: Atlantic Cape Community College provides reasonable accommodation for qualified participants with disabilities. However, all participants must meet the essential functions of the program. Parents are encouraged to contact Atlantic Cape’s Center for Accessibility by calling (609) 343-5680 or email at cfa@atlantic.edu.

Emergency Closings: The College is in operation Monday through Thursday. On certain occasions, the program may be delayed or canceled. Please check our website at www.atlantic.edu for more information or sign up for the College's text alert system.

Questions: Please call (609) 343-5655.

Health & Waiver Form: All registrations must include a fully completed and signed Health Waiver and Terms of Participation form or they will not be processed (These forms are included in this document). Please be truthful when completing these forms. Failure to disclose pertinent medical information may result in dismissal from the program.

Lost and Found: Inquiries regarding lost items may be made in person at the campus security desk.

Accidents/Illnesses: Accident/illness insurance is the responsibility of the participant's parent/guardian.

TERMS OF PARTICIPATION

BEHAVIOR: Atlantic Cape Community College has adopted a ZERO TOLERANCE POLICY! Participants who do not adhere to below behavior guidelines WILL be dismissed!

Students are expected to:
- Behave in a friendly, cooperative and responsible manner toward fellow participants, instructors and Kids College staff
- Respect the ideas and property of others
- Strive to do the best work possible in their workshops
- Be able to work independently
- Be able to focus on a task to completion
Students may be excluded from activities or dismissed from the program for not adhering to the behavior guidelines above for:
- Leaving the assigned area unaccompanied by a staff member
- Stealing or vandalizing college property of the property of others
- Bullying
- Jeopardizing the safety or well-being of oneself or others
- Disrupting the learning environment
WAIVER AND HOLD HARMLESS AGREEMENT

Please read this form carefully and be aware that in having your child registered and participating in this program, you will be waiving and releasing all claims for injuries your child might sustain in this program.
- As the parent/guardian of a participant in this program, you recognize and acknowledge that there are certain risks of physical injury arising out of this program and agree to assume full risk of any injury, damage or loss which your child may sustain as a result of participating in any and all activities associated with this program.
- You agree to waive, release, discharge and/or relinquish all claims or accrued costs you may have as a result of your child participating in this program against Atlantic Cape Community College, its Board of Trustees, officers, representatives, agents, faculty, and staff.
- You further agree to indemnify, hold harmless, and defend Atlantic Cape Community College, its Board of Trustees, officers, representatives, agents, faculty and staff from any and all claims resulting from injuries, damages and losses sustained by your child and arising out of, connected with or in any way associated with the activities of the program.

PARENT/GUARDIAN

CONTACT INFORMATION
PARENT/GUARDIAN'S NAME*

First NameMiddle NameLast Name
PRIMARY PHONE NUMBER*
MAILING ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
EMAIL*
example@example.com

EMERGENCY CONTACT AND

PICK UP PERSONS
EMERGENCY CONTACT NAME (If different from Parent/Guardian listed)*

First NameMiddle NameLast Name
RELATIONSHIP (Emergency contact's relationship to child)*
EMERGENCY CONTACTS PHONE NUMBER*
PICK UP PERSON 1 NAME*

First NameLast Name
DRIVERS LICENSE NUMBER
PICK UP PERSON 2 NAME

First NameLast Name
DRIVERS LICENSE NUMBER
PICK UP PERSON 3 NAME

First NameLast Name
DRIVERS LICENSE NUMBER
PICK UP PERSON 4 NAME

First NameLast Name
DRIVERS LICENSE NUMBER

HEALTH INFORMATION

Please be truthful when completing this form. Failure to disclose pertinent medical information may result in dismissal from the program.
CURRENT MEDICATION(S)*
(If no current medications, enter NONE)
REACTIONS TO ANY MEDICATIONS OR DRUGS*
(If no reaction to medications, enter NONE)
ALLERGIES (EXPLAIN)*
(If no allergies enter NONE)
CHILD'S PHYSICIAN'S NAME *

First NameLast Name
CHILD'S PHYSICIAN'S PHONE NUMBER*
MEDICAL INSURANCE COMPANY*
POLICY NUMBER*
NAME OF INSURED*

First NameLast Name
ACKNOWLEDGEMENT AND ELECTRONIC SIGNATURE

My full name typed in the box below confirms the following:
- I have read, understand and do hereby agree to abide to the information provided in this document.
- In the event of an emergency, I authorize Atlantic Cape Community College staff to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my child’s immediate care and agree to be responsible for payment of any and all charges for medical services rendered.
- I agree to imdenify and hold harmless Atlantic Cape Community College and its agents from any injury or damage to property or persons resulting from medical authorization to treat my child or from the treatment itself.
- I grant Atlantic Cape Community College the absolute right and permission to copy and/or publish photographs/videos of my child, in which my child may be included in whole or part for art, advertising, trade or any other lawful purpose whatsoever. I waive any right to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith or the use to which it may be applied.
Parent/Guardian Type Name on This Line
Should be Empty: