Junior Chef Academy Enrollment Form - Creator's Kitchen
Complete this form to finalize your child's enrollment in the summer camp at Koncept House. Have your child's details and emergency contacts ready.
Student Information
Child's First Name
*
Child's Last Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Please Select
10
11
12
13
14
Gender
Please Select
Prefer not to say
Girl
Boy
Non-binary
Other
School and Grade for Fall 2026
Chef Apron and T-Shirt Size
*
Please Select
Youth S 6-8
Youth M 10-12
Youth L 14-16
Adult Small
Adult Medium
Adult Large
Week You're Enrolling For
*
Week 1 Italian June 1-5
Week 2 Mexican June 8-12
Week 3 Asian Fusion June 15-19
Week 4 Brunch Cafe June 22-26
Week 5 Baking and Pastry June 29-July 3
Week 6 Healthy and Vegan July 6-10
Week 7 Southern Comfort July 13-17
Week 8 Fine Dining and Graduation July 20-24
Parent Guardian Information
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
Relationship to Child
*
Please Select
Parent
Guardian
Grandparent
Other
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Full Name
*
Emergency Contact Relationship to Child
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Email
example@example.com
Authorized Pickup Persons
*
Photo and Video Consent
*
Please Select
Yes for all use including social media
Yes for internal use only
No photos or video
Health and Safety
Food allergies
*
Peanuts
Tree Nuts
Fish
Shellfish
Dairy/Milk
Eggs
Gluten/Wheat
Soy
Sesame
No Allergies
Allergy details and severity
Carries EpiPen or emergency medication?
*
Please Select
Yes EpiPen
Yes Other medication
No
Has the child had an anaphylactic reaction before?
*
Please Select
Yes
No
Unsure
Dietary restrictions
Vegetarian
Vegan
Halal
Kosher
No Pork
No Red Meat
No Seafood
None
Medical conditions or diagnoses
Current medications, including dosage and timing
Does the child have a physical limitation that may affect kitchen participation?
*
Please Select
Yes
No
Physical limitation details
Pediatrician or doctor name and phone
Culinary Background
Cooking experience level
*
Please Select
Beginner - little to no experience
Some Experience - helps at home
Experienced - cooks regularly
Kitchen skills
Used a stove or oven
Used a knife
Baked from scratch
Made pasta or dough
Followed a recipe
Measured ingredients
Cooked eggs
Taken a cooking class
Handled money and made change
None of the above
Prior selling experience
Please Select
Yes
No - this will be their first time
Selling experience details
Cuisines or foods they love
Foods they strongly dislike
What they hope to get from this program
Behavioral or social notes for instructors
Anything else we should know
Agreements and Waiver
By submitting this form I agree to the following: The program runs Monday-Friday 9AM-4PM. Friday Pop-Up runs 3-5PM open to the public. I understand the program involves a real commercial kitchen with heat and sharp tools. I authorize emergency medical treatment if I cannot be reached. All allergy information provided is accurate. Friday Pop-Up proceeds after food and packaging costs go directly to my child. I agree to the refund policy behavior policy and pickup requirements. My child will not be released to anyone not on the authorized pickup list.
Acknowledgements
*
I agree to the full Participation Agreement and Release of Liability
I confirm all health, allergy, and emergency contact information is accurate
I understand Friday Pop-Up proceeds go to my child after costs
I understand and agree to the refund policy, behavior policy, and pickup requirements
I would like to receive updates about future Creator's Kitchen programs
Parent/Guardian Full Legal Name
*
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit Enrollment
Submit Enrollment
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