True North Elementary Summer Camp Enrollment Form
Name (First Child)
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First Name
Last Name
Name (Second Child)
First Name
Last Name
Student Information
Birth Date (First Child)
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Month
-
Day
Year
Date Picker Icon
Birth Date (Second Child)
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Month
-
Day
Year
Date
Sex (First Child)
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Please Select
Male
Female
Sex (Second Child)
Please Select
Male
Female
Grade K-6th grade (Frist Child)
Grade K-6th grade (Second Child)
Please indicate the weeks you would like to enroll in summer camp.
July 6-10 (All About Bees)
July 13-17 (Flowers and Friends)
July 20-24 (All About Water and Heat)
July 27-31 (Dissecting Fruits and Veggies)
Please choose: Full day (8am-2:30pm) Half day (8am-12pm) After Care (2:30-4:30pm)
Full Day $300/week
Half Day $200/week
After Care $75/week
Daily Drop-in $75
Special: 2 weeks $200/week
Special: 3+ weeks $175/week
Special: Sibling price per child $200/week
1st Parent/Guardian Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this your child's primary residence?
Yes
No
Shared Custody
Place of Employment:
*
Work Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
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2nd Parent/Guardian Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Same as first address:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this your child's primary residence?
Yes
No
Shared Custody
Place of Employment:
*
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Are there any custody arrangements we should be aware of? If so, please describe:
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Emergency Contact 1
An emergency contact is someone OTHER than the parents/guardians that can be reached and responsible for your child in the event of an emergency and we CANNOT contact the parents/guardians. This person is automatically authorized to pick up your child from school.
Name: (Family members who live together like grandparents can both be added here.
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First Name
Last Name
Name
First Name
Last Name
Relationship to Child:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Phone Number
-
Area Code
Phone Number
Emergency Contact 2
Name
First Name
Last Name
Relationship to Child:
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorized Pick-Up
Authorized pick-up are individuals legally able to pick-up your child from True North Elementary (like a babysitter or nanny but are not necessarily emergency contacts) and are required to have a State or Federal ID with them. It is mandatory for them to pick-up inside the school to verify identity and permission for the school to release your child until the staff are familiar with this individual. Please note, any staff member may ask for identification if they are unfamiliar with the individual picking up even if they are a legal guardian/parent.
Additional authorized pick-up:
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Relationship to Child:
*
Additional authorized pick-up:
Relationship to Child:
Additional authorized pick-up:
Relationship to Child:
Are there any individual(s) your child should never be released to? If so, please provide their name(s) and pertinent details:
Physician and Medical Information
Physician Name
*
First Name
Last Name
Phone Number
*
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Area Code
Phone Number
Preferred Hospital
Does your child have any of the following:
Food/medication allergy
Food sensitivity/intolerance
Asthma
Chronic health concerns
Mental health concerns
ADHD
Other
If selected, please explain further:
Has your child been diagnosed with a learning disability:
Dyslexia
Audio Processing Disorder
Dysgraphia
Autism Spectrum Disorder
Do you suspect your child has a learning disability but has not been diagnosed:
Dyslexia
Audio Processing Disorder
Dysgraphia
Autism Spectrum Disorder
ADHD
Does your child have any behavioral concerns? If so, please explain:
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True North Policies
My child is capable of taking care of their bodily needs, such as independently using the bathroom, getting water when needed, feeding themselves, applying sunscreen, getting dressed, putting on their shoes, and so on.
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Additional Information and Permissions
By enrolling, you are giving permission for your child's photos/videos in a group form to be posted on public platforms such as facebook, instagram, TN website, etc. Pictures and videos are a common day necessity in marketing for the financial health of our school.
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Please let us know if you prefer your child not to be posted in individual pictures or videos and we will do our best to respect your wishes. *This is not a guarantee your child will not be posted in group photos/videos.
No individual photos/videos
It is required that your child be allowed to use any and all playground equipment and toys, gardening equipment, cooking appliances and tools including knives, microwave, oven, toaster, etc. as part of our practical life/self regulation/physical education curriculum.
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Electronic devices of any kind will not be allowed on school property. These include but are not limited to: smart watches, phones, tablets, video games, cameras, and more. If brought to school, teachers will confiscate devices and parents will need to pick them up.
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True North is not ultimately or financially responsible for the loss of, theft of, or damage to any personal items brought onto school property by students, parents, or visitors. This includes, but is not limited to, incidents such as a child cutting or otherwise damaging their own clothing, lunch box, water bottle or other belongings being lost, broken, or tampered with by the student or others. Individuals are encouraged to leave valuable or sentimental items at home, as all personal property is brought to school at the owner’s own risk.
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Please note, as part of our nature and wellness focused curriculum your child may be outside for long periods of time and exposed to variations in temperature, including the heat of summer or the chill of winter. This also includes other naturally occurring elements such as sunshine, wind, water sources, rain, snow, ice, bugs, grass, pollen, animals etc. Your child may NOT opt out of mandatory outdoor activities. Children are required to come to school prepared to spend time in whatever weather is present on any given day. Children will not be outside in dangerous conditions and real time weather evaluations and the children's conditions will be made on the daily bases.
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True North will not apply sunscreen, lotion, lip balm, etc of any kind to the children. Parents are encouraged to provide hats, protective clothing, and teach their children to apply these items to themselves. (We will help apply personal bug spray).
It is understood that my child is expected to follow the directions of all TN staff at all times and that any behavior such as hitting, kicking, bullying, throwing objects, destroying property, and trying to leave the property is not permitted.
By enrolling in True North Elementary, my family and I are knowledgeable of the school policies and agree to abide by all of them. Breaking any one of these rules may result in fees, fines, penalties, denied entry, suspensions, immediate dismissal or the inability to re-enroll the next school year.
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Families may not enroll at True North Elementary without giving permission for their children to participate in all required activities. By completing this enrollment form, permission is given to the enrolled child to engage in all True North activities and events.
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Release and Liability Waiver : I hereby give my permission for my child to participate in daily activities at True North Elementary including field trips away from the school premises. Participation in any program which involves attendance and physical activity exposes the student to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the students from all conceivable dangers physically or emotionally. I will NOT hold True North Elementary, its owners, staff, affiliates, agents, or any other entity or individual connected to them, either directly or indirectly, liable for any result or injury from my student attending school. In consideration of my child’s enrollment and participation at True North Elementary, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:(A) I WAIVE, RELEASE, AND DISCHARGE True North Education LLC from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my child’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to my child. THE FOLLOWING ENTITIES OR PERSONS: The owners, directors, employees, volunteers, representatives, and agents of any and all entities authorizing this school, as well as the owners of the property (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation and attendance at this school, whether caused by the negligence of release or otherwise; (C) By signing this agreement, the signee agrees not to make or publish, especially on any social media platform, any negative commentary, including false, misleading, or disparaging statements, whether oral or written, that could harm the reputation of the Organization, its staff, affiliates, or partners. The Participant understands that defamatory statements may cause serious harm and acknowledges that the Organization retains the right to pursue legal remedies in response to any such conduct. This clause does not restrict the Participant’s right to report unlawful conduct in good faith to appropriate authorities, but True North Education LLC does reserve the right to dispute and sue for damages over false or inaccurate claims or reports. Medical Treatment Permission: In the event of illness or injury to my child while under school supervision, I hereby authorize True North Elementary and its representatives, employees, or agents to obtain and authorize all emergency medical treatment as deemed necessary, including the administration of epi-pens, over the counter medications supplied by parents, the transportation by ambulance, the administration of all drugs and treatments, including anesthesia and/or surgery, for the health and safety of my child.I understand that reasonable efforts will be made to contact me before such treatment is administered, but in the event I cannot be reached, I give permission to the attending medical personnel to provide any necessary care.I agree to be responsible for any costs incurred for such emergency medical care and transportation. Parental Responsibility for Property Damage I, the undersigned parent or legal guardian, acknowledge and agree that I am financially responsible for any damage to school property caused by myself, my child or any member of my family, friends, employees, or anyone who is at the school by my association whether such damage is intentional, accidental, or the result of tantrums, fits, medical episodes, behavioral issues, or negligence. I understand that the school may seek reimbursement for the cost of repair or replacement of damaged items or facilities and that failure to do so may result in further action as permitted by law. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. WHEN REGISTERING ONLINE, MY ONLINE SIGNATURE SHALL SUBSTITUTE FOR AND HAVE THE SAME LEGAL EFFECT AS IF I HAD SIGNED A WAIVER AND RELEASE AGREEMENT.
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