Click Here for Winter Camp Flyer
To authorize us to release your child to adults (18 years and older) other than the guardians mentioned above, please fill out a seperate pick up authorization form at the center.
You will now select the desired camp schedule
Do not select any fields if you do NOT wish to enroll your child for that day and proceed to the next page by clicking on the NEXT button
Now please click on the NEXT button to proceed.
January 2nd to January 7th
9am to 6pm
Important: AM care should only be selected for the days your child is enrolled for.
RootsForKids Field Trip Permission
I give permission to my child to attend the RootsForKids field trip and have read and understood the terms and conditions below
Please read this carefully and be aware in registering yourself, your child, or ward for participation inthis program, you will be waiving and releasing all claims for injuries you or your minor child/ward might sustain arising out of the RootsForKids Afterschool program (hereinafter referred to as “program”).
As a participant in the program or the parent/guardian of a participant in the program, I recognizeand agree to assume the full risk of any injuries, including death, damages, or loss which I or my minor child/ward may sustain as a result of participating in any or all activities connected with orassociated with such program.
I agree to waive and relinquish all claims my minor child/ward or I may have as a result ofparticipating in this program against the person(s) conducting this program and the facility where the program is being conducted.
I do hereby fully release and discharge the facility, program and its officers, agents, servants, and employees from injuries, including death, damage, or loss which I or my minor child/ward may have or which may accrue to me or my minor child/ward on account of my participation in the program.
I further agree to indemnify, hold harmless and defend this program and its officers, agents, servants,and employees from any and all claims associated with the activities of the program. I/We carry personal medical/dental/vision insurance for my/our child in case of accident, injury or illness. Incase of accident or sickness, I consent to emergency medical care provided by ambulance or hospitalpersonnel.
I have read and understood the above Waiver and Release of All Claims and agree to abide by the aforementioned policies.
Summary of Charges
*Registration is not confirmed until payment is received in full by the due date.
Camp payment is non refundable and non transferable.
You should receive a copy of your submission via email to the email address(es) provided but we strongly recommend to PRINT a copy for your records.
Pls contact us at 650-720-5437 OR email us at firstname.lastname@example.org for any assistance or questions.