2018 Summer L.A.B
2018 Summer Learning And Beyond Registration Form
CHILD'S INFO
Child's Name: *
Your answer
Which workshop(s) are you registering for? *
Required
Which School does your child attend ? *
Birth Date: *
MM
/
DD
/
YYYY
Gender: *
Required
Purpose Of Summer Programming: *
Please Check One
Required
Please share any academic, behavioral, or health challenges (Allergies) Branches Of Learning should be aware of:
* Afternoon snack is provided.
Academic: *
Your answer
Behavioral: *
Your answer
Health ( Allergies/Physical Restrictions: *
Your answer
Child's Doctor: *
Your answer
Doctor's Phone: *
Your answer
PARENT INFORMATION
Parent/Guardian #1: *
Your answer
Daytime Phone: *
Your answer
E-mail Address:
Your answer
Mobile Phone: *
Your answer
Parent/Guardian #2:
Your answer
Daytime Phone:
Your answer
E-mail Address:
Your answer
Mobile Phone:
Your answer
Other persons responsible for the child in case of illness, accident, or emergency if parents can’t be reached:
Name: *
Your answer
Phone: *
Your answer
CONDITIONS
EMERGENCIES *
In case of emergency, every effort will be made to contact parents, the guardians, the emergency numbers and doctors listed. Failing to contact any of these, I give my permission to the school to call a physician and secure proper emergency treatment while efforts to locate the parents continue.
Behavioral Expectations: It is imperative that your student(s) comes ready to learn. Our program encourages students to embody the 3 R’s; being Respectful, Responsible and Ready To Learn. We believe in learning, students must have the right Attitude, Take Action (ownership in learning)and show their best Effort each session in order to Add Value to their education.
PHOTO RELEASE *
Occasionally BOL photographs or takes videos of the activities during Summer Learning Workshop. These are used on bulletin boards, brochures, displays, advertisements, social media, etc. I hereby give my permission for BOL to use any pictures or videos taken of my child for the purposed stated above.
Signed: *
Please Print Your Name
Your answer
Today's Date: *
MM
/
DD
/
YYYY
Time
:
Outside Premises
Play At Your Own Risk. All persons using outside premises outside of their session time do so at their own risk. Owner is not responsible for any accidents or injuries.
Learning Workshop Time Commitment Statement
I understand that Bring on Learning sessions will begin promptly on time and my student(s) will need to be picked up promptly on time.
Payment Method
All services require Pre-Payment cash or check prior to the beginning of of services, payable to Branches Of Learning. Applicable bank fees will apply to all returned checks.
Parent/ Guardian Signature: *
Please Print Your Name
Your answer
Relation to the child: *
Your answer
Today's Date: *
MM
/
DD
/
YYYY
Time
:
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.