Summer Reading Enrichment Camp Registration Form

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Registration Ends on Friday, May 19th, 2023

'Register Now' to secure your child's spot.

Each session will be limited to a maximum of 10 students.

A 50% tuition deposit will be required at the end of registration to hold your child's seat.

This form must be completed in full to register your child(ren) for camp.

*This registration form is secure, and all of your information will be kept confidential*

www.EloquentSLT.com/camp

Child's Name *

Child's Birthdate
*

YYYY

Child's Age *

Parent/Guardian Full Name *

Address

Phone Number *

Email Address *

Emergency Name/Phone Number *

Child's Physical/Dietary Restrictions *

Child's Allergies *

Child's Current School *

How I heard about the program:

Eloquent Speech and Language Therapy website

Fun4TallyKids website

Google

Facebook

Friend

Other:

Required

My child is registering for the following session:
*

Session 1: June 5 - June 29, 2023 | (M-TH) | 8:30-11:30AM | Cost: $268.00 a week for 4 weeks

Session 2: July 10 – August 3, 2023 | (M-TH) | 8:30-11:30AM |Cost: $268.00 a week for 4 weeks

Please note the following Policies and Procedures:

A. Payment for Camp:

A 50% tuition deposit will be required at the time of registration in the amount of $536. The remaining 50% ($536) will be charged the first day your child attends camp.

B. Eloquent Speech and Language Therapy Refund Policy

Before May 5th, families are permitted to make the following changes without incurring a fee:

1. change the session of attendance, 2. receive a refund

After May 5th, families are permitted to make the following changes with a $100 fee:

1. change the session of attendance

Notices must be emailed to EloquentSLT@gmail.com with SREC (Summer Reading Enrichment Camp) in the subject line.

No refunds will be made past May 5th, 2023.

Refunds will not be issued for non-attendance. There are no refunds for missed days due to changed work or vacation schedules, illness, or other non-emergency reasons. We do not offer proration of fees. If Eloquent Speech and Language Therapy finds it necessary to unregister a child, a refund will be issued after deduction for days already attended. No full refunds will be issued.

Refunds are electronically credited to the credit card used for payment of the registration fee.

C. Pick Up and Drop Off

Camp will be held at Capital Preparatory, 2811 Industrial Plaza Dr. Tallahassee, FL 32301. Participants will be met by their Instructor, Asia Hutchins, M.S. CCC-SLP. Please be prepared to drop your child(ren) off on time and pick them up promptly at the end of the camp day (8:30am-11:30am). Pick up that occurs more than 5 minutes late will receive a late notice on the first occurrence. Second occurrence will result in a late fee of $1/minute past end of session. Third occurrence will result in dismissal from camp without reimbursement.

I agree to the Policies and Procedures for Camp

The following adults are authorized to pick my child up from camp:

The following people may be contacted in case of an emergency (include their full names and cell phone numbers):

EMERGENCY MEDICAL RELEASE (Please check):

In the event of any injury or serious illness, I give permission for Eloquent Speech and Language Therapy staff to obtain medical treatment for my child. I understand that if my child needs to be transported to an emergency facility this decision will be made by the emergency responder team.

Required

LIABILITY RELEASE (Please check):

I agree Eloquent Speech and Language Therapy assumes no liability for injury or damages arising from the result of participation in the activities unless due to willful fault or gross negligence on the part of the program.

I recognize that participation in a group setting will not allow for caregiver observation to protect the confidentiality of participants.

I hereby give my permission for photography to be taken of my child for educational and professional training purposes. These photographs will become property of Eloquent Speech and Language Therapy and may be used in the future without further consent.

Required

PARTICIPATION AUTHORIZATION

I hereby give permission for my child to participate in the Eloquent Speech and Language Therapy Summer Reading Enrichment camp. My signature confirms that the information provided is accurate, that I have read and understand the Policies and Procedures of the program, and that it is my responsibility to keep my child’s information current. I understand that participation in the entirety of camp (Monday-Thursday for 4 weeks) is required.

Yes

Required

Electronic Signature of Parent/Guardian and Date

Your child's registration is not complete until a 50% deposit amount of $536 is made. The remaining 50% ($536) will be charged the first day your child attends camp.

Please pay securely at the following PayPal link for Eloquent Speech and Language Therapy, LLC:

paypal.me/EloquentSLT

I understand that my child is NOT registered for camp if the 50% tuition deposit is not paid.

Required

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