Summer Program-2026 Registration

Child's Name *

First NameLast Name

I, the parent/guardian of the above listed minor student, do hereby consent to my child’s participation in all classroom activities, outdoor activities including intramural sports, science experiments and general outdoor play. I also agree to forever release Outreach Alliance Supporting Neurodevelopment (OASN), Ocala Preparatory Academy, it's staff, volunteers, board of directors, Heritage Management, agents, and any and all individuals and organizations assisting or participating in all classroom activities, outdoor activities including intramural sports, science experiments and general outdoor play. (“the Releasees”) from any and all claims, rights of action and causes of action that may have arisen in the past, or may arise in the future, directly or indirectly, from personal injuries including, but not limited to, death, illness, injury and/or disease, and including any death, illness, injury, to my child or property damage resulting from my child’s participation in any activities. I also promise, to indemnify, defend, and hold harmless the Releasees against any and all legal claims and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, arising from personal injuries to my child or property damage resulting from my child’s participation in all classroom activities, outdoor activities including intramural sports, science experiments and general outdoor play. I further affirm that I have read this Consent and Release Form and that I understand the contents of this Form. By signing this Form, I affirm that I have decided to allow my child to participate in all classroom activities, outdoor activities including intramural sports, science experiments and general outdoor play with full knowledge that the Releasees will not be liable to anyone for personal injuries and property damage my child or I may suffer in all classroom activities, outdoor activities including intramural sports, science experiments and general outdoor play while on the the property of OASN and Ocala Preparatory Academy.

Parent/Guardian Name signing below in agreement with the above listed liability release. *

Signature*

Parent #1 Contact Phone#*

Area CodePhone Number

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian #2 Name

Parent/Guardian #2 Contact Phone #

Area CodePhone Number

Parent/Guardian #2 E-mail

example@example.com

If Parent/Guardian #2 lives at a different address, please list this address here:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Child's Date of Birth*

Child's Age on 6-2-25*

Please upload or take a current picture of your child here

Browse Files or Take Photo

Please be sure the photo is from the waist up.

I am in agreement that OASN is a faith based organization, Ocala Preparatory Academy is a religious school, and we will have prayer and some faith based curriculum. I wish to proceed with my application for summer program enrollment.

Please explain academically what grade level your child is on or other relevant information so that we can assist your child with educational resources. *

Please list anything that will help us to get to know your child better (ie what can we do to assist with sensory overload, helping your child get ready for a new activity, etc.). We want your child to be successful in our program. Please feel free to share whatever you think will help us to make your child's time with us be memorable:*

Authorized Persons allowed to pick up your child (must show driver's license)*

Please list any food/environmental allergies, intolerances, or personal/religious restrictions below*

If your child does not have any food allergies, please write NA

Does your child take any medications or supplements that would need to be taken onsite (or keep onsite in case your child forgets to take or rescue meds)? If your child will need to take medication onsite, you will need to fill out an additional form for our staff to dispense medication or supplements.*

Please use this area to provide any additional information that will help us to get to know your child or ask our staff questions here:

Yes, my child has seizures and I will provide a seizure plan and complete paperwork to dispense rescue meds or regular meds.No, my child does not have seizures.

YesNo

OASN takes photographs of activities involving students; which incidentally, may capture your child's participation, directly or indirectly.These photos may be published through our websites, social media pages, news bulletins, and ads. With this, we seek for your consent in allowing us to publish photos which may involve your child to the said platforms. We require your response below. Thank you.*

I hereby allow the reproduction and publication of my child(ren)'s photographic image.I do not allow the reproduction and publication of my child(ren)'s photographic image.

Initial below please*

YesNoOther

OASN reserves the right to refuse continued participation in our 12th Annual Summer Educational Program under these circumstances:

1. A student of our Summer Educational Program mistreats our staff (including volunteers), anyone of the individuals or families we serve or any of the support therapists that visit clients in our facility.

2. Stealing property from OASN or any therapist or technician that visits clients in our facillity.

3. Parent or guardian of our Summer Educational Program does not follow our Family Partnership as shown below:

FAMILY PARTNERSHIP (excerpt from our policy) We believe that a positive constructive working relationship between our staff & a student’s parents/guardians and extended family members (including anyone who drops off/picks up or has any communication with our staff) is essential to the fulfillment of our mission. As a community, it is important that we all collectively engage in an affirming, encouraging atmosphere. The expression of negative feelings & even supposedly "constructive" criticism can do much to undermine any school’s atmosphere. The board, the executive director and the associate director do not seek to suppress any parent concern or grievance, however, we do ask that such concern or grievance be handled in a healthy, constructive manner.

4. We reserve the right to refuse service for any other reason not listed (this is not a common occurence but we do reserve this right)

I am electronically signing that understand all policies & procedures listed above & understand that OASN offers NO refunds. Furthermore, I am releasing OASN, its subsidiary company, Ocala Preparatory Academy, any businesses that OASN contracts or subcontracts with OASN, OASN volunteers, OASN staff, interns, board members and vendors from any liability associated with the OASN Summer Educational Program. *

NON REFUNDABLE TWO WEEK SESSION June 2-12, 2026$160.00

Two week non refundable session fee.

NON REFUNDABLE TWO WEEK SESSION June 16-26, 2026$160.00

Non refundable two week session.

NON REFUNDABLE ENTIRE 4 WEEK PROGRAM- June 2-June 26, 2026$300.00

Non Refundable 4 week session-entire program

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Subtotal $0.00Tax $0.00Total $0.00

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Please click the RED submit button to complete registration for our 11th Annual OASN Summer FUN Academic Program. Unless there is an question or an issue with your registration, this will serve as your completed registration for the week(s) chosen. Have a great day!