Afterschool Creative Adventure Club Registration

After School Creative Adventures Camp Registration for the 2025-2026 School Year

Santa Cruz Learning Center
Participant Name (Student):

First NameLast Name
DOB of Student:

MonthDayYear
Age of Student as of August 2025
Grade level Fall 2025
School (enter homeschool, if the student is not registered to a school)
Will your child need to be picked up from school or will they be dropped off at the Learning Center?

My child will need to be picked up from schoolMy child will be dropped off at the learning center
Which days, if any, does your child have early release?
What is your child’s regular dismissal time?

Hour Minutes

AM/PM Option
What is your child’s early release dismissal time?

Hour Minutes

AM/PM Option
Which days do you wish for your child to attend After School Creative Adventures Camp? Check all that apply.

MondaysTuesdaysWednesdaysThursdaysFridays
What is your child's classroom number?
What is/are the name(s) of your child's teacher(s)?
What is your child’s current pick-up plan? (Example: “Meet at Classroom #4,” “At the school entrance,” “Top of the stairs on Prospect Heights,” etc.)We’ll work with you and your child to adjust or finalize this plan so it coordinates smoothly with After School Creative Adventures Camp.
Will your child require a booster seat?
Information for Parent or Guardian 1
Parent or Guardian 1 Full Name:

First NameLast Name
Does the student live full time with parent or guardian 1? If no, please describe when the child stays with parent or guardian 1.
Parent/Guardian 1 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship(s) of parent or guardian 1 to the student (mother, father, etc.)
Cell phone number of parent/guardian 1
Enter cell number here
Work phone of parent/guardian 1
Enter work number here
Email for parent/guardian 1
example@example.com
Information for Parent or Guardian 2

Leave blank if only Parent or Guardian 1 is the only Parent or Guardian
Parent or Guardian 2 Full Name:

First NameLast Name
Does the child live full time with parent or guardian 2? If no, please describe when the child stays with parent or guardian 2.
Parent or Guardian 2 address Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship(s) of parent or guardian 2 to the student (mother, father, etc.)
Cell phone of parent/guardian 2
enter cell number here
Work phone of parent/guardian 2
enter work number here
Email for parent/guardian 2
example@example.com

Participant Information

Tell us a little about the student
Tell us a little about your child
What types of activities does your child most enjoy?
Has your child ever been placed on a behavioral plan at school? If so, please give us some information about this.

RELEASE SECTION
Photo/Video Release: We occasionally use photos or videos of our students for promotional purposes. Do we have your permission to use images or videos of your child?

YesNoOther
By signing below, the parent or guardian agrees to be responsible for all payments owed to Santa Cruz Learning Center and confirms they have read and agree to the terms of this agreement.*

Clear
In the event of illness or accident, I authorize Santa Cruz Learning Center to secure emergency medical treatment for my child at my expense. I understand that a separate medical release form will also be completed. Please sign below to indicate your agreement to these terms.*

Clear
The Santa Cruz Learning Center reserves the right to dismiss any participant who does not show respect for the facility, including but not limited to property, equipment, policies, other members, volunteers, and staff. Participants who are dismissed will not receive a refund of fees paid. Please sign below to indicate that you agree to these terms. *

Clear
The Santa Cruz Learning Center and its employees, contractors, and volunteers assume no responsibility for personal property. By signing this enrollment form, I (we) hereby waive any and all claims against the Santa Cruz Learning Center and its employees, independent contractors, and volunteers. I understand and agree that by signing this agreement, I am relinquishing my (or the minor for whom I sign) right(s) to make any claim against the Santa Cruz Learning Center, its agents, employees, volunteers, and independent contractors, including the right to sue them, for bodily or personal injury, property damage, or any other loss that I might suffer while using Santa Cruz Learning Center services, except as limited by law. Please sign below to indicate that you agree to these terms.

Clear
Name of person signing this registration form

First NameLast Name
Should be Empty:

After School Creative Adventures Camp Registration for the 2025-2026 School Year

Information for Parent or Guardian 1

Information for Parent or Guardian 2

Participant Information

Emergency Contact

Financial Commitment Form

Health Information

RELEASE SECTION