Results Learning - 2018 C.E.O. Executive Functioning Skills Summer Camp
NOTE: Please be sure to select the correct session from the choices below.
I am registering my child for: Please note that several of the sessions are full; however, continue to register your child so they will be added to the wait list. If there are enough students on the wait list, additional sessions will be added. *
Student's First and Last Name (If enrolling more than one child, please register separately.) *
Your answer
Grade Student Entering *
Student Gender *
Parent or Guardian First and Last Name(s) *
Your answer
Parent or Guardian Email(s) *
Your answer
Parent or Guardian Phone Number(s) *
Your answer
Full Address (Street, City, State and Zip Code) *
Your answer
Payment: Option 1: Make full payment $1050.00. Option 2: To secure a camp spot a deposit of $250.00 must be received within 10 days of registration completion. Final payment is due two weeks prior to camp start date. (Information on payment process will be included in a follow-up email.) *
Emergency Contact(s) First and Last Name, Relationship and Phone(s) *
Your answer
Doctor's Name & Phone Number *
Your answer
Medical Insurance Provider and Policy Number *
Your answer
Pick-up information *
Required
Please list names of any individuals authorized to pick-up your child. Include phone numbers. Note: Designated person will be asked to provide a license for identification and, if need be, the password provided below. *
Your answer
Please provide us with a password that your child knows and can be shared with emergency contacts and anyone who might be picking up your child. *
Your answer
Dietary restrictions *
Please list all allergies (food, medicine, etc.). *
Your answer
Parent/Guardian Statement of Understanding. The following information is important for the safety and protection of your child. Please read this information and authorize below. *
Required
BEHAVIOR AGREEMENT - At Results Learning, LLC C.E.O. Summer Camp, we take learning very seriously. Results Learning, LLC C.E.O. Summer Camp is a place for learning, creating memories and life-long experience with skills to become successful. Our efforts in conjunction with the children and parents will allow a fun and healthy environment for everyone by following some simple, but effective rules. Failure to abide by this agreement could result in the removal from this program. All incidents will be recorded and put in the student's file. 1st Incident - Verbal Warning. 2nd Incident - Meeting with Parent/Guardian. 3rd Incident - Removal from program. Notwithstanding the foregoing, Results Learning, LLC may require removal from the program after occurrence of the 1st incident if the severity of the incident is such that Results Learning, LLC, in its sole discretion, determines that it cannot guaranty the safety of your child or other participants, staff, volunteers or third parties. Below is a list of expectations which requires your approval. Please read it with your child and be sure you both understand it in its entirety. This will help us have a great experience at Results Learning, LLC CEO Summer Camp. Thank you! *
Required
STUDENT TECHNOLOGY USE POLICY FOR CELL PHONE-LAPTOP-TABLETS - To access policy click this link: https://tinyurl.com/yak5hz4d *
Required
PARTICIPANT WAIVER OF LIABILITY AND RELEASE AGREEMENT ACKNOWLEDGEMENT OF - To access waiver click this link: https://tinyurl.com/yck7uug4 *
Required
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