Education EDA Peak Week

EDA Peak Week Enrollment & Consent Form

Program Session:    Dates: through    Location:

Student Information

Date of Birth:    Student ID:    Grade / Program:

Parent / Guardian (if student is minor)

Relationship:    Phone:    Email:

Emergency Contact & Medical Information

Relationship:    Phone:

Policy / ID Number:    Physician Name:    Physician Phone:

Program Fees & Payment

Total Tuition: $    Deposit Required: $

Payment Plan Selection (select one):

Full payment due by start date

Installment plan (institution will provide schedule upon enrollment)

Scholarship or financial aid request (submit supporting documentation separately)

Cancellation & Refund Policy: The deposit is non-refundable except for program cancellation by the institution. Withdrawals submitted in writing more than 21 days prior to the program start date are subject to a partial refund of tuition less deposit and any non-recoverable expenses. Withdrawals within 21 days of program start or voluntary departure during the program do not receive a tuition refund. The institution reserves the right to cancel the program; in such event, full tuition (including deposit) will be refunded or credited.

Conduct, Safety & Participation

Code of Conduct: Participants must comply with all program rules, staff directions, and applicable local laws. Unacceptable conduct includes harassment, theft, possession or use of illicit substances, and any behavior that endangers others. Discipline may include warnings, parental notification, dismissal from the program without refund, and referral to law enforcement where appropriate.

Attendance: Regular attendance and active participation are required. Missed instruction may not be made up. Certification of completion may be withheld for failure to meet attendance or performance standards.

Media Release & Privacy

I grant permission for photographs, audio, and video recordings of the participant to be used by the institution for educational, promotional, and archival purposes. Permission is granted without obligation of compensation. If permission is not granted, do not check the consent box.

I consent to photo, audio, and video use as described above

Liability Waiver & Medical Authorization

Waiver of Liability: To the fullest extent permitted by law, the participant and parent/guardian hereby release, waive, discharge, and covenant not to sue the institution, its trustees, officers, employees, volunteers, or agents for any and all liability, claims, demands, or causes of action whatsoever arising out of or related to any loss, damage, or injury (including death) that may be sustained by the participant while participating in program activities, whether arising from the negligence of the institution or otherwise, except where such liability is non-waivable by applicable law.

Medical Authorization (for minors): If the participant is a minor, the undersigned parent/guardian authorizes program staff to obtain emergency medical treatment for the participant if parents/guardians cannot be reached. Authorization includes consent for emergency medical care, hospital treatment, and administration of medication as deemed necessary by licensed medical personnel.

By signing below, the signer affirms that the information provided is true and complete, that they have read and understood all program policies set forth in this document, and that they accept the terms stated herein including the waiver and medical authorization provisions.

Acknowledgments & Declarations

I acknowledge receipt of program policies, code of conduct, and fee schedule and agree to comply.

I certify that the information supplied in this form is accurate and complete to the best of my knowledge.

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