Summer Camp Registration

Student Information

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact Information

The first attempt will be made to contact parents/guardians. Emergency Contacts listed below must be able to pick your child up in the event of an emergency.

Terms and Conditions of Enrollment

Enrollment Requirements and Program Policies for Symone Center Summer Program
Enrollment in the Symone Center Summer Program requires completion and up-to-date documentation of the following paperwork: Participant Application, Camper Health History Form, Medication Administration Form (if necessary), Registration Fee, Assumption of Risk Form, and Payment.
Refund Policy: No refunds will be granted if a participant voluntarily leaves the program or is removed due to inability to adjust, function adequately, or comply with program rules. There will be no reductions or refunds based on missed days due to absence, illness, or early withdrawal. Changes in weeks initially applied for will not qualify for refunds.
Payment Information: A one-week camp deposit is due upon registration. Weekly payments must be settled by Monday of the current week, no later than 9:00 AM. Late payments are subject to a $40.00 weekly late fee.
Attendance and Safety Policies: For safety reasons, advance notice of expected attendance is required. Any changes in camp weeks must be communicated to the site coordinator. Only enrolled children are permitted at the summer camp. No refunds will be issued for absences or closures due to Covid-19 safety protocols.
Compliance and Termination: Students must comply with the rules and regulations of the summer program. Failure to comply may result in termination from the Symone Center Summer Program.
Media Consent: I hereby provide consent for the taking of photographs, movies, Internet use, and videotapes of my child by Symone Center or its representatives. I grant permission for the use and editing of said products for educational or public service purposes, releasing all rights, titles, and interests in said products.

Grant Permission

8. Personal Belongings: Symone Center for The Arts Summer Program is not liable for any personal items that are lost, stolen, or damaged while attending the program.

9. Medical Emergency Consent: I consent that in the event of an emergency, Symone Center may obtain necessary medical treatment for my child. I understand that I will be informed as soon as possible if medical treatment is required.

10. Agreement to Terms: I have thoroughly reviewed the application and confirm that all provided information is accurate and truthful. I agree to abide by all terms and conditions outlined.

11. Assumption of Risk Form: I have received and agree to the assumption of risk form provided by Symone Center.

12. Illness Policy: I understand that if my child displays any signs of illness, they will not be permitted to attend the camp.

Health Information

List any specific medical conditions or behavioral problems? Does your child have any other allergies (food, hay fever, etc)?

Yes

Are there any activities in which your child may not participate?

Yes

Are there conditions or specific needs that require special attention?

Yes

as parent/guardian, authorize Symone Center for the Arts personnel to

seek emergency treatment as required and to transport my child to the appropriate medical facility in the event that urgent/emergency care is necessary.

The information listed on this health information form is correct to the best of my knowledge, and the participant described herein has permission to engage in all prescribed program activities, except as noted on this form. 

Who is responsible for making payments?

I hereby, agree to submit summer program payments to the Symone Center for the Arts, Inc. I understand that if I pay late my account will be charged a $40.00 late fee per week/per occurrence. Additionally, non-payment may result in the termination of all services conducted by Symone Center for the Arts, Inc. I understand that I am enrolling my child for the weeks indicated in the application. I understand that I am responsible for the payment of fees for the 2023 summer program.

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Thanks for submitting! We look forward to being of service to your family!