Afterschool Creative Adventure Club Registration

After School Adventures Camp Registration for the 2024-2025 School Year

Santa Cruz Learning Center
Participant Name (Student):

First NameLast Name
DOB of Student:

MonthDayYear
Age of Student as of August 2024
Grade level Fall 2024
School (enter homeschool, if the student is not registered to a school)
What time does your child need to be picked up from school?
Which days do you wish for your child to attend After School Adventures Camp?

MondaysTuesdaysThursdaysAre you interested in Wednesdays? We are just considering this option and haven't implemented it yet. Please select this option if you would be interested in us adding Wednesdays.
What is your child's classroom number?
What is/are the name(s) of your child's teacher(s)?
Please describe the designated pick-up plan for your child. For instance, please meet them at their class room #4 or, my child will meet you at the school entrance, or at the top of the stairs on Prospect Heights, etc.
We will be transporting your child via minivan or SUV. We have boosters available for all our students. 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
What types of activities does your child most enjoy doing?
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: Santa Cruz Learning Center may use the above-listed participant's photo for promotional purposes. Does Santa Cruz Learning Center have permission to use photos or videos of your child?

YesNoOther
The parent or guardian signing shall be responsible for payment of amounts owed to Santa Cruz Learning Center under this agreement. Sign below to indicate you have read and agree to these terms*

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In the case of illness or accident, Santa Cruz Learning Center is authorized to secure emergency medical treatment at my expense. Please sign below to indicate that you agree to these terms. *

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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. *

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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.

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Name of person signing this registration form

First NameLast Name
Should be Empty:

After School Adventures Camp Registration for the 2024-2025 School Year

Information for Parent or Guardian 1

Information for Parent or Guardian 2

Participant Information

Emergency Contact

Financial Commitment Form

Medical Insurance Information

Health Information

RELEASE SECTION