Summer Camp Application

Parent/Guardian #1

Parent/Guardian #2

Emergency Contact

Medical Release Information

Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma. Seizures).

The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.

Deposit

A $100 deposit is due at the time of camp registration. This deposit will be put towards camp

tuition.

SUMMER CAMP TUITION & PAYMENT

Summer camp tuition fee is due on every Monday the week that your child is enrolled, either by cash or check. If a camper's tuition is not paid they will not be able to attend camp.

The financially responsible party signing this form understands and agrees to follow the Tuition Payment and Fees Policy. If multiple parties are paying for tuition, a Tuition Agreement is required for all Financially Responsible Parties.

Camp Tuition Total: __________________________

Photo Release

I hereby give permission for my child to be photographed while at the C-Cube Learning Center Camp. I understand the photos will be used to keep a journal of activities, to share during powerpoint presentations and/or reports, for promotional purposes including but not limited to flyers, brochures, newspaper, social media and on the internet. I understand that although my child’s photograph may be used for advertising, his/her identity will not be disclosed. I do not expect compensation and that all photos are the property of C-Cube Learning Center.

Terms of Agreement

C-Cube Learning Center Camp is not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders.

Children's photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).

Participation Consent Form (REQUIRED)

I consent to the care and local field trips for my child(ren) at C-Cube Learning Center.

I, the undersigned*, hereby release discharge, indemnify, hold harmless and defend C-Cube Learning Center Camp (Daycare), its directors, administrators, employees and volunteers from any and all liability (claims, demands, losses, causes of action, suits, judgements) of any kind that I or my family may have against Daycare due to death, personal injury or llness, loss or damage to property, or future causes that occur during the 2025 C-Cube Learning Center Summer Camp. In the event of any medical emergency, I authorize and consent for Daycare to act on behalf for medical care deemed necessary for the participant.