Education Summer Planning Package

EDUCATION SUMMER PLANNING PACKAGE

Student Information

Student Name:

Parent / Guardian Information

Program Selection and Schedule

Program Name:

Session Option(s):

Transportation & Pickup Authorization

Transportation consent (select all that apply):

Medical Information & Emergency Contacts

Authorizations and Consents

Emergency Medical Authorization: In the event of illness or injury requiring medical attention, I authorize program staff to obtain emergency treatment and consent to necessary medical procedures for the student named in this form. I understand that program staff will make reasonable efforts to contact primary contacts prior to treatment when feasible.

Medication Administration: Program staff may administer medication to the student only as specified in writing below. All medication must be delivered in original containers with clear labeling. Staff will follow documented dosing instructions.

Photo and Media Release: I grant permission for the student to be photographed, videotaped, or otherwise recorded during program activities. Such media may be used by the program for educational, promotional, or administrative purposes, and will not identify personal contact information without additional consent.

Fees, Payment, and Refund Policy

Tuition Amount: $

Payment Plan (select one):

Cancellation and Refund Policy: Requests for cancellation must be submitted in writing. Refund eligibility is conditional on date of cancellation relative to the program start date and any non-refundable deposits. Administrative processing fees may apply; prorated refunds may be issued for documented, extenuating circumstances at the program director's discretion. Fees for supplies, materials, or contracted third-party services may be non-refundable.

Behavioral Expectations and Standards

Students are expected to follow program rules, follow instructor directions, and treat staff, volunteers, and peers with respect. The program reserves the right to suspend or dismiss a student for conduct that endangers others, disrupts programming, or violates stated rules. Parents/guardians will be notified of disciplinary incidents and are responsible for prompt pickup if dismissal is required.

Data Privacy and Records

The program will maintain records necessary for enrollment, health and safety, billing, and program evaluation. Personal information will be handled in accordance with applicable education privacy laws. Information will be shared internally with staff and contractors on a need-to-know basis for the safe operation of the program. Parents/guardians may request access to their child's records in accordance with program procedures.

Acknowledgment and Certification

By signing below, I certify that I am the parent, legal guardian, or adult student with authority to enroll the student in the selected summer program. I certify that the information provided on this form is true and complete to the best of my knowledge. I acknowledge the program's policies, consent to the authorizations checked above, and accept financial responsibility for tuition and fees as described.

Sign Now