PaymentCheck made out to Flip4KidsZelle to firstname.lastname@example.org
The cost of Teacher Workdays is $100 per student and includes a pizza lunch and two snacks. Hours are from 8:30 - 5:30. There is a minimum of 4 students for each date to run. Please mark the days you will attend.
September 26October 5October 31November 8December 19January 23February 13March 31April 21
Age at Start of the Program
Date of Birth
What rising grade will your child be in?
What school will your child be attending?
Would you like to add an additional parent/guardian contact?
Is English your child's first language?
If no - what is?
Besides English, what other languages does your child speak?
Does your child have any allergies?
If yes - please specify
Does your child require routine or non-routine medication and/or other special medical attention?
Please be advised that we require a parent-designated caregiver to remain on premises to attend to a child who may require medicationadministered or may need special medical attention.
Does your child have any food restrictions (In addition to allergies listed above)?
Are there any other special needs that we should be aware of? (mobility issues, naps, habits, family circumstances, behaviors)
I authorize FLIP4Kids to obtain necessary emergency medical assistance, including hospital emergency room?
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone
We will check ID for authorized pick-ups. We will need written permission if anyone other than those listed come to pick up your child.
Flip4Kids will follow the CHCCS calendar and determinations for inclement weather.
Parents represent that their child can separate and is toilet trained. In the event that a child is not adjusted to separation or toilet trained, a caregiver must remain on the premises to assist with the child. No refunds or school credits are made to compensate for separation or toilet training issues.
Parents assume all liability for loss or damage to personal items brought to the premises.
Parents of children who may require medical care are advised that FLIP4Kids staff will not administer medical treatment. Instead a parent or caregiver must remain on premises to manage care in the event that a drug or other treatment becomes necessary.
In the event that a minor injury occurs, First Aid will be administered at the camp location by the camp staff. The following procedures will be followed: First Aid will be provided and the parent will be contacted. Any restriction on First Aid should be provided in writing to Flip4Kids via email to email@example.com.
In consideration of registration for the above programs for myself or as legal guardian of said minor(s), 1,intending to be legally bound, hereby for myself and heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against Flip4Kids or H3J inc, their representatives, successors, assigns and host landowners, for accident or injury incurred by myself or said minor during or because of this event. The Releasor releases and forever discharges the Releasee, their directors, officers, employees, agents, assigns and successors from all manner of actions, causes of action, debts, accounts, claims and demands for or by any damage, loss or injury to person and property which may be sustained while attending said event. I, as parent or legal guardian, do hereby grant Flip4kids staff the right to authorize general emergency medical treatment for the registered participant(s) in the event that I, or my designated representative, cannot be reached. I agree to hold harmless Flip4Kids and H3J inc and its agents from liability arising out of an accident. The NC Good Samaritan Law will apply. This agreement will be construed in accordance with and governed by the laws of the State of North Carolina. It is declared that the terms of this Release of claim are fully understood.
• Early Payments: One-time discount: Pay in full by August 15 | Twice a year payment: Pay in full by August 15 and January 15.
Payment due by the Early Enrollment discount deadline above for discount to apply.
• FLIP4Kids accepts personal checks (payable to "FLIP4Kids''), Zelle, or PayPal.
• Because we are a small program, losing a student has a big impact on whether we can sustain the program for the year. We ask you commit for the year so that we can pay our teachers and keep the afterschool program running. However, should emergencies arise, please provide notice as soon as possible. We will be able to refund before the start of each semester only.
• Withdrawal notice should be given at least two months ahead of time, in writing, to Hao@flip4kidsnc.com.
Because Flip4Kids has contracts with teachers based on enrollment, our refund policy is: Refunds will be given only for requests made before August 15th for the first semester and before November 15th for the second semester.
On occasion children may be part of a photograph or videotape taken during the program day or a birthday party. So, at some point they may appear in a photograph seen by others. If you do not want your child to appear in a photograph or videotape, please indicate this in the box below.
Please do not photograph or videotape my child.
I have read and agree to the policies above.
Please leave this field empty.