Adventure and Activity Camp Admission Agreement Form
Child’s First Name:
Child’s Last Name:
Child’s Date of Birth:
Mother’s / Guardian’s Name ( First and Last):
Father’s / Guardian’s Name ( First and Last):
Please confirm the following acknowledgements and acceptance of responsibility that this agreement is shared with all legal parents, guardians and authorized parties involved in the child’s life (ie. nanny, family members involved in child’s care).
I have received a copy of the Technique Adventure and Activity Camp Parent Handbook. I have read and understood its policies and procedures, and agree to comply with the program rules and regulations.
The A2C is a licensed daycare facility providing a sports and activities based curriculum for five to twelve year olds. We strive to engage your child in fun adventures and activities throughout the day including: rock climbing, gymnastics, soccer, trampolines, outdoor water activities, ninja gym and acro, crafts, group time, organized games, cooking classes and themed activities. We are licensed for 70 children.
Healthy children will be admitted and accorded equal treatment and access to services without regard to race, religion, color, national origin, or ancestry. The Technique Adventure and Activity Center is for children ages 5 to 12 years old. The day your child turns 4 year and 9 months and is enrolled in kindergarten for the fall, they are eligible for our program. Children must be toilet trained by the day of entry. Children must be ready for the type of group experiences offered and able to benefit from the program. The following forms must be completed and turned in to A2C BEFORE your camper may be admitted into the program: Copy of Admission Agreement, Notification of Parents’ Rights, Personal Rights, Identification and Emergency Information, Consent for Emergency Medical Treatment, Child’s Pre-Admission Health History-Parent’s Report, Physician’s Report, and all facility waiver forms. A2C will not admit your child into our camp until all paper work is completed.
Days and Hours of Operation
A2C is open Monday through Friday, 9:00am-4:30pm. Complimentary extended care is available from 8:00am-9:00am and from 4:30pm-5:30pm.
I understand that on a day that my child is unable to attend a previously reserved date, it is my responsibility to notify A2C in writing one week prior to missed date. At the point of receiving a written notice, a credit may be transferred to another camp day. Without written notice, no credit or refund will be given.
I understand that I will be contacted should my child become ill while at A2C. I agree to pick up my child promptly upon such notification. I also understand that my child cannot attend camp on a day in which he or she is ill, as defined in the Parent Handbook.
When dropping off my children, I understand that I must sign my child in and out. It is the California law! We become responsible when you sign in, and you resume responsibility when you sign out. You, as the adult, must sign your child in and out. You must use your full signature and not just initials.
Release of Child(ren)
I understand that my child will be released only to myself, a legal guardian, the other parent (except where prohibited by court order), and to those persons whose names I have listed on my child’s Emergency Information Form. I understand that if someone other than my child’s parents/guardians is to pick-up my child on a specific day, I must notify A2C, even if they are listed on the Emergency Information Form. All individuals picking up your child will be required to show a picture ID.
I understand that I am required to maintain at all times, at least one additional emergency contact other than myself, including full names, home and work addresses, home and work phone numbers, and cell phone numbers. I understand that in the event of an emergency for which I or my emergency contact cannot be reached, the staff may contact police or other emergency authorities.
Change of Information
I understand that it is my responsibility to inform A2C of any changes to the information on the Emergency Information Form, as well as other forms in the registration packet, including, but not limited to: address, home phone number, parents’ work numbers, medical conditions, and pick-up authorizations.
In the Event of an Emergency
In the event of an emergency, if I cannot be reached, A2C had my permission to contact the physician(s) listed on my child’s registration forms, or have my child transported to a local hospital for care. I will not hold A2C or its’ employees liable. I understand that I am responsible for all expenses incurred.
Violent or Unsafe Behavior
I understand that I may be contacted should my child display violent, unsafe, or continually inappropriate behavior. I agree to pick up my child promptly upon such notifications.
If your child does not have a lunch, a $5 healthy lunch will be provided for them, and a $5 charge will be added to your account. Payment is expected by the next day.
Late Pick-Up Charge
It is imperative that parents pick up their children on time. There will be a five minute grace period, after that the charge is $1.00 per minute and is due at the time of pick-up in cash or check.
There are no refunds given in the event of an illness. In certain circumstances, a credit will be given and able to be transferred. Changes in your child’s set schedule- With proper notice of one week, registered dates may be transferred to another date. This notification must be in writing one week prior to original registered date.
Children benefit most when the program and the home have similar philosophy of teaching and discipline. Should the time arise when either the A2C or the parent feels that the child is not benefiting from the program, either party may request withdrawal without prejudice with a two week written notice.
Drop-ins will not be allowed at A2C. I understand that I may call the morning of to verify room for my child in camp; however, I understand that I may not bring my child for a drop-in day at camp unless I receive verbal confirmation of drop-in enrollment from the Director.
Fees Specific to Your Child
I understand that the fee for my child to attend Technique Adventure and Activity Camp will be based on the days enrolled per the registration agreement. Any additional days will be added to my bill. I also understand that any changes to my child’s set schedule must be submitted in writing one week prior to original registered date.
Rights of the Licensing Agency
The Department of Social Services licensing department has the authority to inspect, according to the Health & Safety Code Sections 1596.852, 1596.853, and 1596.8535. They have the right to interview children attending Technique Adventure and Activity Camp, or Technique Adventure and Activity Camp staff without prior consent. This authority includes the right to inspect, audit, and copy the child’s records upon demand during normal business hours.
Terms of this Admission Agreement
This admission agreement is valid for the 2018-2019 school year, or if the parents withdraw their child with 30 days written notice.
Conditions of Termination
Technique Adventure and Activity Camp had the right to terminate this agreement and ask a parent to withdraw enrollment, if any of the following occurs:
Technique Adventure and Activity Camp will not change this contract without at least a 2 week written notice.
I have read, understand, and will comply with the policies and procedures included in the Admission Agreement and in the Technique Adventure and Activity Camp Parent Handbook.
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Signed by Kathy Olvera
Signed On: August 20, 2019
If you have questions about the contents of this document, you can email the document owner.
Document Name: Adventure and Activity Camp Admission Agreement Form
Agree & Sign