Clone of Summer Camp All-Stars 2026-Registration

SNR After School Program 2026-Registration Form
Student Name

First NameMiddle NameLast Name
Please take a picture of the student participating in the SNR After School Program.
Take Photo
Gender:
Date of Birth:
Where does you student attend school?
If other is noted above, what does your student attend?
Will your student need transportation from their school?
If other is noted above, how will your student be transported?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email -program communication and billing
example@example.com
Payee Email (if applicable)
example@example.com
Payee Phone
Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician

First NameLast Name
Physician Phone
Please enter a valid phone number.Format: (000) 000-0000.
Hospital Preference
Insurance Carrier
Policy Number
Group ID #
One-on-One Policy

One-on-one status is determined by collaborating with parents, guardians, and case workers. SNR reserves the right to change one-on-one status if necessary. One-on-one staffing is arranged by the participant's family. SNR does not provide One-on-one staffing.
SNR defines one-on-one care as meeting one or more of the following criteria: 
1. The student exhibits behavior problems such as aggression, explosive outbursts, wandering, or running away. 
2. The student cannot follow simple directions. 
3. The student is not toilet-trained. 
4. The student will not remain in a group setting. 
5. The student cannot perform basic care, walk without assistance, feed themselves, etc. 
Will your student require one on one care as described above?
One-on-One Information

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Agency Name
Agency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Program Communication
TeamSnap is a free app used to communicate daily program scheduling and announcements. All parents, guardians, care providers, and support staff must use TeamSnap.

The participants' agency is responsible for providing SNR with the name and contact information of the staff member attending programs with your student.

The agency staff member must use the TeamSnap app to communicate with SNR staff. Failure to adhere to these rules will result in removal from the program.
Communication Contact

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Household Financials

Data collected from the following questions could improve our eligibility for grants, donations, scholarship eligibility, and the Community Reinvestment Act.
Please check all that apply:
Liability Release Waiver
I am aware that participation in recreational activities may have obvious and latent hazards, which may be caused by my actions or inactions, by the actions of others participating in the event, or by conditions in which the events take place. I fully accept and assume all such risks and all responsibility for losses, costs, and/or damages I may incur because of my participation. I also understand that Specialized Needs Recreation has no medical insurance to cover medical expenses; all medical costs are my responsibility.  
 
I hereby release, discharge, and hold harmless Specialized Needs Recreation all staff, directors, administrators, and volunteers in any/all programs sponsored by Specialized Needs Recreation. I also release, discharge, and hold harmless, any person transporting me before, during and/or after such activities. 
 
If I should need emergency medical treatment during my participation in Specialized Needs Recreation activities and I am not able to give my consent or make my arrangements for that treatment, I authorize Specialized Needs Recreation to take whatever measures are necessary to protect my health and well-being, including, if necessary, hospitalization. 
 
I also permit pictures and/or videos of myself to be used by Specialized Needs Recreation and any other group they approve of for public relations purposes. 
I have read this Liability Release Waiver, Assumption of Risk.

Code of Conduct
Specialized Needs Recreation (SNR) offers participants opportunities to meet new people and try new activities in a fun and safe environment. There is a mandatory Code of Conduct for everyone involved to ensure that all participants, parents/guardians, staff, Board members, and volunteers enjoy the SNR experience. Your signature below is implied and informed consent that you have reviewed, understand, and will follow the Code of Conduct while participating in SNR events.

Code of Conduct:

·         All communication is conducted appropriately and respectfully. Inappropriate tones, foul language, unkind words, pushing, shoving, threats, comments in a sexual nature, and bullying are not allowed.

·         Handholding, kissing, or any form of sexual contact is not allowed.

·         Cell phones, handheld games, and other electronic devices are allowed; however, SNR is not responsible for any damage, loss, or theft. If the device contains offensive content or becomes disruptive, it will be put away until after the day’s activity. This includes inappropriate messages to others involved in SNR.

·         Jeans with excessive holes, shorts that do not reach to mid-thigh, graphic t-shirts with lewd, foul language or depict drugs/alcohol/sexual themes, or crop tops exposing the stomach, halter tops, and spaghetti strap (less than two inches tops) are not allowed. Clothing, hats and any personal items are not to be shared.

·         Individuals shall behave in a manner that does not endanger their health and safety or that of others.

·         All participants are to show respect to both the property of SNR, and locations visited during an SNR activity. Stealing, damaging, or failing to care for the property of SNR and others is unacceptable.

·         Use of illegal substances, tobacco products, vaping devices, and alcohol is prohibited at SNR or SNR events.

·         Possession of any item considered a weapon (including, but not limited to, firearms, knives, pocketknives, and switchblades) is prohibited at all times.

·         Participation at SNR and its events is voluntary and violation of any of the above Code of Conduct may result in being asked to leave SNR for the day. At the discretion of SNR Staff and Board, a major violation can result in being barred from all future SNR activities.

IF A VIOLATION OCCURS:

The individual will be redirected to a more appropriate behavior and receive a verbal warning. The incident will be discussed with them, their parent, and/or their guardian. The verbal warning will be documented in their file.

If the problem persists, or if a second but different violation occurs with the same individual, the individual will be redirected, and a written warning will be issued and documented in the individual's file, including but not limited to documenting the specifics of the behavior and the corrective action that took place.

If there is a third occurrence or if the individual's behavior threatens his/her immediate safety or that of any other individuals, SNR will have the right to ask the individual to leave (or be picked up immediately). The behavior will be documented, and the Executive Board will be notified and has the right to refuse further participation in all SNR programs.

Depending on the severity of the offense/behavior/incident, SNR has the right to expel the individual(s) from further participation in SNR at any time without following these procedures.

No refunds will be given to individuals who are removed from the program for violating the Code of Conduct.
I have read this “Code of Conduct” and fully understand it.

After School Schedule

Please check all of the days you would like your student to attend the after school program. Upon completion of registration, you will receive confirmation of days selected. Space is limited and spots are at a first come first serve.
After School Program runs Tuesday, Wednesday and Thursday from 2:30pm-5:30pm, your student will be picked up from their school by SNR and is to be picked up at the SNR Facility at the end of the day. SNR, 3700 Government Way, Suite J, CDA, ID 83815
After School Program Days (choose any/all that you're interested in):

Other - please contact SNR (208)755-6781 or brianna@snridaho.org

Payments
You will receive an invoice based on the number of days you have selected upon registration. Invoices will be due at the 1st of the month, prior to student attending. Cash & Check payment only! Failure to pay invoices will result in student being removed from the program.
Participant/Guardian/Caregiver Signature
Parent/Guardian/Care Provider Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

SNR After School Program 2026-Registration Form

Please take a picture of the student participating in the SNR After School Program.

Emergency Contact

One-on-One Policy

Program Communication

Diagnosis

Household Financials

Liability Release Waiver

Code of Conduct

After School Schedule

After School Program runs Tuesday, Wednesday and Thursday from 2:30pm-5:30pm, your student will be picked up from their school by SNR and is to be picked up at the SNR Facility at the end of the day. SNR, 3700 Government Way, Suite J, CDA, ID 83815

Payments