Select Your WeekWeek 1: July 3 - July 7 *no class on 7/4 make-up day another weekWeek 2: July 10 - July 14Week 3: July 17 - July 21Week 4: July 24 - July 28Week 5: July 31 -August 4
Select Your LanguageSpanishFrench
Child will Attend:
5 days (M-F)3 days (M,W,F)2 days (T,Th)
Child will Attend:
Full Day (9-3:30)Half Day - AM (9 - 12)Half Day - PM (12:30 - 3:30)
Would you like to add an additional parent/guardian contact?
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?
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)
I authorize FLIP4Kids to obtain necessary emergency medical assistance, including hospital emergency room?
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone
We will need written permission if anyone other than those listed come to pick up your child.
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.
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 firstname.lastname@example.org.
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 Payment: 10% discount before 2/10 and 15% multiweek discount. Highest one applies.
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.
• FLIP4Kids charges a $55 Class Change or Withdrawal/Cancellation Fee.
• Requests to change dates must be received at least one month prior to the start date. Requests to change and withdraw must be made in writing via email Hao@flip4kidsnc.com.
Because Flip4Kids has contracts with teachers based on enrollment, our refund policy is:
• All changes must be sent in writing to email@example.com. Before April 1, full refund minus the application fee. Before May 1, credit for another week or the following year. Before June 1, credit for another week during the current summer.
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.