2026 Summer Seedlings Camp Registration Form

Camper's Physician*
Practice*
Phone*
Format: (000) 000-0000.
YesNo
Person's permitted to remove Camper from facility:

If there are any restrictions preventing either parent from picking up/legal custody, please provide legal paperwork with those details to the office as soon as possible.
YesNo
YesNo
Emergency Contacts (NOT A PARENT/GUARDIAN)

Please provide the names of individuals to be contacted in case of illness, accident, or emergency if parents or guardians cannot be reached. These contacts must be authorized to remove the child from the facility. Emergency contacts cannot include Parent One or Parent Two and should be someone within driving distance of Sunflower.
Emergency Contact One Name*

First NameLast Name
Emergency Contact One Cell Number*
Format: (000) 000-0000.
Emergency Contact One Relationship*
Emergency Contact Two Name*

First NameLast Name
Emergency Contact Two Cell Number*
Format: (000) 000-0000.
Emergency Contact Two Relationship*
Other persons authorized by the parents or guardians to take the child from the facility (if different from above).
Authorized to Pickup One Name

First NameLast Name
Authorized to Pickup One Phone
Please enter a valid phone number.Format: (000) 000-0000.
Authorized to Pickup One Relationship
Authorized to Pickup Two Name

First NameLast Name
Authorized to Pickup Two Phone
Please enter a valid phone number.Format: (000) 000-0000.
Authorized to Pickup Two Relationship
Please help us get to know your family better by providing the following details. Include the info for the child you are registering. Thank you!
First Name of oldest child in family
younger or older sibling of child you are enrolling
Birth Date of oldest child in family

MonthDayYear
First Name of second oldest child
younger or older sibling of child you are enrolling
Birth Date of second oldest child

MonthDayYear
First Name of third oldest child
younger or older sibling of child you are enrolling
Birth Date of third oldest child

MonthDayYear
First Name of fourth oldest child
younger or older sibling of child you are enrolling
Birth Date of fourth oldest child

MonthDayYear
Is there anyone else that you haven't already listed above who is important to your child that we should know about?
YesNo
Parent Signature*

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Date Signed*

MonthDayYear
Date

Alternate Nutrition Plan Agreement

Required by the Palm Beach County Health Department. ARTICLE XII, B, PBC Rules require the parent and the center to complete an ALTERNATE NUTRITION PLAN AGREEMENT if the meals or snacks are furnished by the child’s parent.
Camper's Full Name*

First NameLast Name
ALTERNATE NUTRITION PLAN AGREEMENT:
Indicate Special Dietary Requirements:
I understand and approve the use of the Alternate Nutrition Plan.
Sunflower provides a morning and afternoon snack. Parents of children staying full day provide a lunch for their child, which is refrigerated at the center. If my child needs an Alternate Nutrition Plan, I agree to provide the center with a suggested meal pattern and menus and to discuss any problems which might develop in the use of the Alternate Nutrition Plan that is created.
Parent Signature*

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Date Signed*

MonthDayYear
Date

Enrollment Policy

Sunflower Summer Camp is a unique educational program stemming from a specific philosophy and a core set of beliefs about child development and the social, emotional, and environmental needs of young children. For Sunflower Summer Camp to be effective, both parents (or guardians) must be supportive of the methods and goals of the program. Consequently, Sunflower Creative Arts reserves the right to refuse admission to any family that we believe is not truly supportive of our model. While this decision is always hard we firmly believe that it is in the best interest of the child, the family, and the health of Sunflower’s programing.
Sunflower Creative Arts Photo/Video Release

I/We hereby give to Sunflower Creative Arts, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees, the right to reproduce in any of its printed and online publications (such as newsletters, annual reports, websites, social media posts and blog posts), as well as any media that has yet to be created, all pictures, audio and video that it has produced of myself and/or my child(ren). I/we authorize Sunflower Creative Arts to use all such pictures, audio and video and duplicates thereof, in perpetuity, for its publicity purposes and dispose of them as they may see fit. I/we hereby release Sunflower Creative Arts, from all claims of every kind on account of such use. Electronic Signature Agreement: By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select the "I Accept" button constitutes your signature acceptance and agreement as if actually signed by you in writing. Please contact the Sunflower office if you have any questions • 561 501-6615.
I acceptI do NOT accept
Sunflower Creative Arts Release and Waiver of Liability

“Sunflower” means Sunflower Creative Arts, Inc., a Florida not-for-profit corporation, its officers, directors, volunteers, employees, representatives, agents, successors, assigns and licensees. “Sunflower Activities” means any and all events, classes, programs, and/or services, formal and informal, offered and/or provided by Sunflower. This “Agreement” means this Release and Waiver of Liability agreement.

In consideration of participation in any Sunflower Activities, you, as a parent or guardian, on behalf of yourself and your child/children, waive, release and forever discharge any and all rights and claims for injuries, death, damages, losses, demands, recoveries, suits, payments, actions, and judgments of every nature and description, against Sunflower for injuries or death which may ever be sustained or suffered by you and/or your child/children during any Sunflower Activities.

You hereby agree to indemnify and hold Sunflower harmless and faultless for any damages, harms or injuries that arise out of or are in any way related to Sunflower Activities and/or your participation and/or your child’s/children’s participation in Sunflower Activities, even if arising from the actions, acts of omission, negligence and/or gross negligence of Sunflower.

You on behalf of yourself and/or your child/children hereby knowingly and freely assume any and all risks of injury, known or unknown, from participating in any Sunflower Activities including but not limited to: physical injury, psychological or emotional injury, paralysis, or death.

You hereby certify that you are legally capable and competent to understand and execute this Agreement without coercion on behalf of yourself and/or your child/children.

You hereby represent that you and/or any child or children in your care who will participate in any Sunflower Activities are physically, mentally and emotionally fit to participate in Sunflower Activities.

You hereby certify that you have read and fully understand this Agreement, that you have executed this Agreement as a voluntary act of your own free will, and that you understand that by executing this Agreement you are giving up important legal rights for yourself and/or your child/children.

You are free to agree or not agree to this Agreement by choosing not to participate and/or to not permit your child/children to participate in Sunflower Activities. You have the right to discuss this Agreement with Sunflower prior to participation.

You and/or your child/children, by participating in Sunflower Activities, consent to and grant Sunflower license to use your and/or your child’s/children’s likeness(s), voice(s), and/or name(s), without compensation, for use in any and all media, whether now known or hereafter devised, in perpetuity, and you release Sunflower from any and all liability in relation to all of said uses.

You agree to follow and adhere to all Sunflower rules and understand and agree that you may be asked to leave at any moment and for any reason without any effect to the validity of this agreement.

You understand and agree that your and/or your child’s/children’s participation in Sunflower Activities indicates that you hereby waive your rights and/or the rights of your child/children to sue or bring other legal action against Sunflower as stated above and to indemnify and hold Sunflower harmless as stated above.

You agree that in the event any clause or provision of this Agreement shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining clauses and provisions of this Agreement, which shall continue to be unmodified and enforceable.

Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select the "I Accept" button constitutes your signature acceptance and agreement as if actually signed by you in writing.
I accept
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Parent One Name*

First NameLast Name
Parent One Signature*

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Signed Date*

MonthDayYear
Date
Parent Two Name

First NameLast Name
Parent Two Signature

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Signed Date

MonthDayYear
Date
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Summer Seedlings Camp (Half Day) requires a $25 non-refundable deposit per week, per child. Select the number of weeks you are registering for in the quantity field. Example: Registering for 3 weeks will require a $75 deposit.
$25.00 Quantity

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2026 Summer Seedlings Camp Registration

Registration & Enrollment Form

Please select the weeks you would like to register for and choose Mornings, Afternoons, or Full Day.

Person's permitted to remove Camper from facility:

Emergency Contacts (NOT A PARENT/GUARDIAN)

Other persons authorized by the parents or guardians to take the child from the facility (if different from above).

Please help us get to know your family better by providing the following details. Include the info for the child you are registering. Thank you!

Camper Permissions

Permission for Application of Topical Lotions, Sprays and Ointments

Permission for Administration of Oral Arnica and Benadryl

Alternate Nutrition Plan Agreement

ALTERNATE NUTRITION PLAN AGREEMENT:

Enrollment Policy

Sunflower Creative Arts Photo/Video Release