Registration

    SUMMER CAMP 2022

    Child will Attend:

    Child will Attend:

    PARENT/GUARDIAN INFORMATION

    Parent/Guardian #1

    First Name
    Last Name
    Email
    Cell Phone
    Address
    City
    State
    Zip
    Home Phone
    Would you like to add an additional parent/guardian contact?

    Parent/Guardian #2

    First Name
    Last Name
    Email
    Cell Phone
    Address
    City
    State
    Zip
    Home Phone

    CHILD INFORMATION

    First Name
    Last Name
    Gender
    Age at Start of the Program
    Date of Birth
    What rising grade will your child be in?
    What school will your child be attending?
    Is English your child's first language?
    If no - what is?
    Besides English, what other languages does your child speak?

    HEALTH INFORMATION

    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.
    Please detail
    Does your child have any food restrictions (In addition to allergies listed above)?
    Please explain
    Are there any other special needs that we should be aware of? (mobility issues, naps, habits, family circumstances)
    Please advise

    FAMILY PHYSICIAN

    Physician Name
    Physician Phone
    I authorize FLIP4Kids to obtain necessary emergency medical assistance, including hospital emergency room?

    NON-PARENT EMERGENCY CONTACT

    Emergency Contact Name
    Emergency Contact Relationship
    Emergency Contact Phone

    PICK-UP AUTHORIZATION (IN ADDITION TO PARENTS)

    THE FOLLOWING INDIVIDUALS ARE AUTHORIZED TO PICK-UP MY CHILD

    Authorized Person #1

    Name
    Address
    Phone

    Authorized Person #2

    Name
    Address
    Phone

    Authorized Person #3

    Name
    Address
    Phone
    We will need written permission if anyone other than those listed come to pick up your child.

    TERMS and CONDITIONS

    SCHEDULING

    Headcount is limited so we may not be able to admit a child arriving on a day that he/she is not enrolled. MAKE-UPS No refunds or credits are made to compensate for absences for which we cannot schedule a make-up.

    SEPARATION/TOILETT RAINING

    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.

    PERSONAL ITEMS

    Parents assume all liability for loss or damage to personal items brought to the premises.

    MEDICAL CONDITIONS

    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.

    EMERGENCY CARE

    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 hao@flip4kidsnc.com.

    LIABILITY RELEASE

    In consideration of registration for the above programs for myself or as legal guardian of said minor(s), 1,i ntending 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.

    DISCOUNTS/PAYMENTS

    • Early Payment: Full payment must be received by the discount deadline to receive the discount. Payment in full: $2975, two payments at beginning and middle: $1550 Monthly: $350 for September through May (9 months)

    PAYMENTS

    Payment due by the Early Enrollment discount deadline above for discount to apply.
    • FLIP4Kids accepts personal checks (payable to "FLIP4Kids'').VISA, Mastercard, and Discover ("credit card"), money orders, or cash.

    CHANGES AND WITHDRAWALS

    • FLIP4Kids charges a $50 Class Change or Withdrawal/Cancellation Fee.
    • Requests to change dates must be received at least two weeks prior to the start date. Requests to change and withdraw must be made in writing via email Hao@flip4kidsnc.com.

    REFUNDS AND CREDITS

    Because Flip4Kids has contracts with teachers based on enrollment, our refund policy is:
    • Because we are committed to paying our staff a living wage, we ask that you commit to a year. If you are unable to commit to a year, please give us at least 30 days notice.

    PHOTOGRAPHS & VIDEOS

    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.