Register before March 31st! W3 PK AM - Let's Go On Safari. PM

Student Full Name (First Last) *

Student's Date of Birth (MM/DD/YYYY) *

Student's Grade in 2023 Spring Semester *

Emergency Contact Phone Number *

Extended Care Select all that apply Morning Care (8:00am - 9:00am) - 5 Days (+ $25.00) Option 1: Mandarin Afternoon Care (4:00pm - 6:00pm)- 5 Days (+ $50.00) Option 2: AFFICIENT ACADEMY Math or ELA program Afternoon Care (4:00pm - 6:00 pm) - 5 Days (+ $50.00) We don't need this service.

lunch Select all that apply one week (+ $40.00) We don't need this service.

Please notice all PK campers are fully potty-trained. We ask you to store your child's back-up clothing at Champion, and we will return any unused item on the last camp day. Select all that apply I acknowledge.

Accident Release, First Aid, Media and Financial Responsibility Wavier Select all that apply I authorize and grant permission for a representative of Champion Camp to treat minor injuries including scrapes, small cuts, splinters, and insect bites. I authorize and grant permission for a representative of Champion Camp to obtain emergency medical care from any licensed physician or hospital and/or medical clinic should my child become ill or injured. I therefore freely and voluntarily execute this release with such knowledge, assume the risk of personal injury and/or property loss arising from or in any way connected with participation in any programs offered by said child care center. I hereby release and discharge said child care center and any and all agents from any liability, claim, cause of action, demand or damages from injury or damages of any kind to my child or my property as a result of participation in the programs of Champion Camp. I grant permission and understand that photos and other images taken during this event could be used in print advertisement and other forms of media. I understand that should my child become a disruptive force during the educational program that the instructor may choose to release him/her from the program with no refund.

I acknowledge and understand that any changes made on camp should be done at least 7 days prior to the camp starts to avoid extra charges. (please read refund policy below) All Camps subject to cancellation if its minimum enrollment has not been met (<3). Select all that apply I agree

Allergy or other medical information (Please notice that you may store your Child's medication at Champion office and take it back when checking out Champion Camp.) *

I assert that I have read the camp policy and agree to be bound by them (AUDIO, VIDEO, PHOTOS & MARKETING MATERIALS, CODE OF CONDUCT, SAFETY, CONTACT WITH CAMP STAFF & TEACHER, REFUND, ART MATERIALS, ACCOUNT & SOFTWARE & WEB CONTENT). Select all that apply Yes, I assert and agree

Register before March 31st! W3 PK AM - Let's Go On Safari. PM - Ancient Technology