ELC Summer Camp Registration 2026

ELC Summer Camp Registration 2026
Child's Information
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your child currently enrolled in a Before/After School Care program?*

YesNo
If yes, at what school?
Grade Entering in the Fall*
For campers entering Kindergarten, has your child been in a year round preschool program this past year?

YesNo
Which School Attending
Does your child have any fears?*

YesNo
If "Yes" please list:
Is any language other than English used in the home?*

YesNo
If "Yes" please describe:
What are your child’s special interests or favorite activities?*
Please list any other information that may assist us in understanding and caring for your child.
Parent/Guardian Information
Mother's Name*

First NameLast Name
Home Phone Number
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Employer
Work Phone Number
Please enter a valid phone number.
Email*
example@example.com
Father's Name*

First NameLast Name
Work Phone Number
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Employer
Work Phone Number
Please enter a valid phone number.
Email*
example@example.com
Please list siblings and any other members of the household, their ages, and relationship to child.
How did you find out about our facility? *
If you were referred by a friend, please tell us their name here.

General Waiver of Liability
IMMUNIZATION RECORD

Admissions requirements by the Texas Department of Protective & Regulatory Services: They must be on file, within one week of admission, documentation of immunization records and a written statement from a licensed health professional who has examined the child within the past year.
I certify that a copy of my child’s current immunization record is on file at the following school:*
RELEASE TO SKILLS CLASS

I understand that the operation of skills classes (gymnastics, cheer, tumbling, etc.) offered at Explorers Learning Center is not regulated by Child Care Licensing. I give permission for my child to be released from Preschool, After School Care, and/or Camp to participate in a skills class. At the end of the skills class my child will return to his/her Preschool, After School Care, and/or Camp program.
Signature*

Clear
TRANSPORTATION RELEASE

I hereby grant permission for my child to be transported by Explorers Learning Center and/or its assignees to/from Field Trips during Camp.
Parent Signature*

Clear
PHOTO/VIDEO RELEASE

I grant my permission to ELC to use my children(s) or my image, likeness or sound of voice in publications, social media and other media used by, produced by or contracted by ELC. I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for my, or my children(s) participation. I understand I will not receive payment or other compensation for the use of any image or recording.
Signature

Clear
ADDITIONAL RELEASES

THE AGREEMENTS below pertain to participation at and for K2 TX LLC dba Explorers Learning Center and their respective officers, employees, volunteers, subcontractors, tenants and other agents, hereafter collectively referred to as “ELC”.

1. CONSENT TO PARTICIPATE FOR MINORS

As the parent(s) or legal guardian(s) of the student(s) named above, I hereby consent to their participation in any and all programs at or for Explorers Learning Center.

2. PERPETUAL COVENANT NOT-TO-SUE

In consideration for my child(ren)’s or my participation at ELC I hereby, for myself and/or my child(ren) and our respective heirs and successors, PROMISE NOT-TO-SUE and FOREVER RELEASE ELC from all liability resulting from damages or injuries incurred as a result of participation at or for ELC. This includes acts of ordinary negligence. I understand that this PERPETUAL COVENANT NOT-TO-SUE will apply to EACH AND EVERY OCCASION that my child(ren) or I visit or participate at ELC and that this agreement remains in force until I revoke it in writing.

3. ASSUMPTION OF RISK

I recognize that potentially severe injuries can occur in any activity involving height or motion, including tumbling and related activities including cheer leading, tumble tramp, trampoline, stunting, pyramids, dance, martial arts, gymnastics and physical activity in general.

I acknowledge that sports and activities involving height, motion or inversion including but not limited to gymnastics, trampoline, cheerleading, stunting, pyramids, ninja zone, parkour, martial arts, dance, swimming and ball sports carry the risk of severe injury, including paralysis or death. I recognize that any activity in or around water can result in brain damage or drowning. I acknowledge the contagious nature of certain bacteria and viruses, including, without limitation, COVID-19, and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by such bacteria or viruses by at tending ELC and that such exposure or infection may result in personal injury, illness, permanent disability or death. I understand that the risk of becoming exposed to or infected by COVID-19 at ELC may result from the actions, omissions, or negligence of myself and others, including, but not limited to, ELC employees, volunteers, and program participants and their families. I VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND

ACCEPT SOLE RESPONSIBILITY for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s or my attendance at ELC or participation in ELC programming.

4. MEDICAL AUTHORIZATION AND INDEMNIFICATION FOR POSSIBLE FUTURE MEDICAL EXPENSES.

In the event of a medical emergency I authorize that my child(ren) and/or I be transported to a medical facility for treatment and I hold ELC harmless in the execution of such. Additionally, I hereby agree to individually provide for all possible future medical expenses which may be incurred by my child(ren) or me as a result of any injury sustained while visiting or participating at or for ELC.
Signature*

Clear

Food and Environmental Allergy Action Plan
List child's allergies:*
Is your child asthmatic?*

YesNo
Please describe your child's allergic reaction(s):*

Mouth – itching and swelling of lips, tongue and mouthThroat – itching and/or sense of tightness in the throat, hoarseness, and hacking coughSkin – hives, itchy rash, and/or swelling about the face or extremitiesGut – nausea, abdominal cramps, vomiting, and/or diarrheaLung – shortness of breath, repetitive coughing, and/or wheezingHeart – “thready pulse”, passing out
Upload a photo of your child*

Cancelof
Physician's Name*
Physician's Phone Number*
Please enter a valid phone number.
Action for MINOR Reaction
1. If only symptoms are...*
Describe symptoms
2. Then give...*
Describe the appropriate medication or treatment
3. Then call...*
List who should be called and include phone number – i.e. mother, father, doctor or emergency contact.
If condition does not improve within 10 minutes, follow steps for MAJOR Reaction below...
Action for MAJOR Reaction
1. If ingestion is suspected, or symptoms are...*
2. Administer the below medication or treatment immediately...*
3. Call 911 then call contact listed above.

4. Then call child's physician.
Signature

Clear

Emergency Contact and Release
Please list any persons that we may contact in case of an emergency when parents/guardians cannot be reached.

MY CHILD MAY BE RELEASED TO THE FOLLOWING PERSONS FOR EMERGENCY AND NON-EMERGENCY SITUATIONS.

At least one emergency contact is required other than the Parent or Guardian.
Emergency Contact 1 Name*

First NameLast Name
Emergency Contact 1 Relationship*
Emergency Contact 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 1 Phone Number*
Please enter a valid phone number.
Emergency Contact 2 Name (optional)

First NameLast Name
Emergency Contact 2 Relationship
Emergency Contact 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 2 Phone Number
Please enter a valid phone number.
Please list anyone who DOES NOT have permission to pick up your child:
Are there any custodial issues that we need to be made aware of?*

YesNo
If yes, please describe:

Days/Week	9:00 a.m. - 4:00 p.m.	7:00 a.m. - 6:00 p.m.
2 days/week	$143	$166
3 days/week	$192	$219
4 days/week	$238	$263
5 days/week	$270	$298

ELC Summer Camp Registration 2026

Child's Information

Parent/Guardian Information

General Waiver of Liability

Camp Selection

Medical Needs

Policy Regarding Sick Children

Emergency Release

Medication Release

Food and Environmental Allergy Action Plan

Action for MINOR Reaction

Action for MAJOR Reaction

Emergency Contact and Release

Parent Handbook Acknowledgement

Payment Authorization