2025 Summer Camp Application

Parent/Guardian #1 Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Place of Work
Work Number
Please enter a valid phone number.
Parent/Gaurdian #2 Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Place of work
Work Number
Please enter a valid phone number.
Emergency Contact #1

First NameLast Name
Phone Number
Please enter a valid phone number.
Relation
Emergency Contact #2

First NameLast Name
Phone Number
Please enter a valid phone number.
Relation

Pediatricians Name

First NameLast Name
Pediatricians Phone Number
Please enter a valid phone number.
Date of last physical

MonthDayYear
Date
Does your child have allergies?*
If yes, please explain
Does your child have any medical conditions?*
If yes, please explain
Is your child currently on any medications?*
If yes, please explain
Will your child need to take any prescription medication while at Unity Ice Academy?*

NoYes
Does your child require an EpiPen?*

NoYes
If yes, you will be required to provide a doctors note and a prescription EpiPen to be kept at camp during your child enrollment.
Are there activities that are restricted for health reasons?

Unity Ice Academy does not discriminate on the basis of race, color, gender, handicap, religion or national origin. Unity Ice Academy reserves the right at its sole discretion to refuse an application or dismiss a child from the after school program.

I understand that enrollment in the Unity Ice Academy After School Program is a year-long commitment. I also acknowledge that there is a required monthly fee, which is non-refundable.

I give Unity Ice Academy permission to photograph and/or videotape my child for public relations and/or marketing purposes. Photos will remain archived at Unity Ice Academy and can be used for promotional purposes without notification.

I give permission for Unity Ice Academy to transport my child off camp location for the purpose of field trips and/or medical care. I understand that a schedule of events will be available to me and that all events are subject to change due to weather and/or scheduling conflicts without notice.

I authorize the camp management to act as the agent of the parents in any emergency situation or to administer basic first aid for the health and welfare of the camper involved. I am responsible for the expenses involved if the services of a physician or hospital are required.

By signing below I agree to adhere to all the Policies and Procedures set for by Unity Ice Academy.
Agreement*

I have read and agree to the policies & procedures
Signature*

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Unity Ice Academy Equipment Agreement Loan Agreement
THIS AGREEMENT is made on the   Date* by and between Unity Ice
Academy, a nonprofit corporation, with its principal place of business at The Rinks- Lakewood Ice- 3975 Pixie ave, Lakewood, CA 90712, herein referred to as the “UIA After School Program", and the under-signed, herein referred to as the "Parent/Guardian".

WHEREAS, the UIA After School Program is willing to lend certain equipment to the child of the Parent/Guardian for the purposes of participating in the ice skating camp, provided that the Parent/Guardian agrees to return such equipment at the end of the camp or pay Unity Ice Academy a specified fine.

1. **LOAN OF EQUIPMENT:** Unity Ice Academy agrees to lend one pair of ice skates to the child of the Parent/Guardian for the duration of the camp. The Parent/Guardian agrees to return the ice skates in good condition at the end of the camp.

2. **LOSS OF EQUIPMENT:** The Parent/Guardian acknowledges and agrees that he/she is responsible for the ice skates, and agrees to pay Unity Ice Academy the sum of $250 if the ice skates are not returned at the end of the program.

3. **RETURN OF EQUIPMENT:** The ice skates are to be returned to Unity Ice Academy at the conclusion of the after school program. If the ice skates are not returned by this date, the fine as described in Section 2 will be due immediately.

4. **PAYMENT:** In the event that the ice skates are not returned, the Parent/Guardian agrees to pay the fine by cash, check, or electronic transfer.

5. **GOVERNING LAW:** This Agreement shall be governed by and construed in accordance with the laws of the state of California.

6. **ENTIRE AGREEMENT:** This Agreement constitutes the entire agreement between the parties pertaining to its subject matter and it supersedes all prior contemporaneous agreements, representations, and understandings of the parties.

THIS AGREEMENT is entered into willingly and has been read and understood by the Parent/Guardian.
Parent/Guardian Name *

First NameLast Name
Parent/ Guardian Signature*

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Parent Pick Up Form
Your child’s safety is of paramount importance to all of us at

Unity Ice Academy. Please indicate the individuals that have your

permission to pick your child up from Unity Ice Academy. Please

note that any individual not on this list will require us to call you

before we can release your child to that person.
Approved to Pick Up Student *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Approved to Pick Up Student *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Approved to Pick Up Student

First NameLast Name
Phone Number
Please enter a valid phone number.
Anyone picking up a student prior to the end of the school day must sign out that child with a Unity Ice Academy staff member.
Childs Name *

First NameLast Name
Parent/Guardian Name *

First NameLast Name
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Unity Ice Academy After School Program 2025-2026

Unity Ice Academy Equipment Agreement Loan Agreement

Parent Pick Up Form