2026 Summer Camp – Daily Drop-In Interest Form

Families interested in participating must call the Summer School Program line at 702-848-2770 to speak directly with the Summer Program Director, Mrs. Sakay. This will serve as the primary contact number for all summer program inquiries, enrollment questions, and drop-in requests during the summer program dates of June 16th through July 17th.

Rate: $50 per day

Summer program hours are Monday through Friday from 8:30 AM to 2:45 PM.

Requested Drop-In Date(s)

Student Name

First NameLast Name

Birth Date

MonthDayYear

(Entering) Grade

Is your child currently enrolled at TCMI Academy?

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email

example@example.com

Parent/Guardian Phone

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Name

First NameLast Name

Emergency Contact Phone

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Relationship to Student

Authorized Pick-Up Names and Phone Numbers

Does your child have allergies?

Allergy Details

Allergy Action Plan

Does your child have any medical conditions or health concerns we should be aware of?

Please Explain:

Does your child require medication during program hours?

Please Explain:

How did you hear about the TCMI Academy Summer Program?

Additional comments or information we should know about your child:

Parent Acknowledgments

I understand that submitting this form does not guarantee a spot in the Summer Program.
I understand that space may be limited and enrollment must be confirmed by TCMI Academy.
I understand that payment is $50 per day and is due, in cash, upon arrival.
I understand that the Summer Program operates Monday through Friday from 8:30 AM to 2:45 PM.
I understand that I may be contacted by the Summer Program Director to confirm enrollment and answer any questions.

TCMI Academy Summer Program Waiver and Release of Liability

I, the undersigned parent or legal guardian of the child named below, hereby acknowledge and agree to the following:

Assumption of Risk: I understand that participation in TCMI Academy Summer Program involves activities that may carry inherent risks, including physical activity, outdoor play, and group participation. I voluntarily assume all risks associated with my child’s participation.
Medical Authorization: In the event of an emergency, I authorize TCMI Academy staff to seek medical treatment for my child, including first aid, emergency transportation, or hospital care, as deemed necessary. I understand that I am responsible for all medical costs incurred.
Release of Liability: I release, waive, and hold harmless TCMI Academy, its staff, volunteers, and affiliates from any and all claims, actions, or causes of action arising from injury, accident, or illness resulting from participation in the Summer Program, except in cases of gross negligence or willful misconduct.
Photo/Video Release: I understand that my child may be photographed or recorded during program activities for school-related use, including newsletters, social media, or promotional materials. I consent to the use of such images unless I have submitted a separate opt-out form.
Potty-Training Requirement (Ages 3–4): If my child is 3 or 4 years old, I confirm that they are fully potty trained, able to wipe themselves, and capable of changing clothes or unbuttoning/buttoning pants independently.
Compliance: I agree to follow all rules and guidelines established by TCMI Academy for the Summer Program. I understand that failure to comply may result in the removal of my child from the program without refund.

By signing this waiver, I acknowledge that I have read and understand this document, and that my consent and agreement are given freely.

Parent/Guardian Name

First NameLast Name

Signature

TCMI Academy Summer Camp – Daily Drop In Interest Form