Summer Program Registration Summer Program Registration Step 1 of 3 33% REGISTRATION FORM - Summer Program 2023 Parent/Caregiver Name(s):*Address* Street Address City State / Province / Region ZIP / Postal Code E-mail* Primary Phone Number*Secondary Phone NumberEmergency contact:*NamePhone Number Child 11. Child’s Name*Birth Month and Year*AllergiesSpanish Experience*YesNoProgram*Children's House (Ages 4 to 7 yrs. old) NIDO (ages 15 mo. To 3 yrs. old)Children House Summer CampNido Summer CampLocation*Newton Corner – 75 Vernon street, Newton, MA 02458Newton Highlands – 991 Boylston, Newton, MA 02461Location*Newton Corner – 75 Vernon street, Newton, MA 02458Newton Waban – 1671 Beacon street, Waban, MA 02468Total number of weeks attending (Children House):*2345678Total number of weeks attending (Nido):*2345678Please check the weeks your child will be attending (Children House):* Week 1: July 3-7 Week 2: July 10-14 Week 3: July 17-21 Week 4: July 24-28 Week 5: Jul 31- Aug 4 Week 6: Aug 7-11 Week 7: Aug 14-18 Week 8: Aug 21-25 July Holiday (Childen House) Price: -$55.00 Please check the weeks your child will be attending (Nido):* Week 1: July 3-7 Week 2: July 10-14 Week 3: July 17-21 Week 4: July 24-28 Week 5: Jul 31- Aug 4 Week 6: Aug 7-11 Week 7: Aug 14-18 Week 8: Aug 21-25 July Holiday (Nido) Price: -$80.00 Extended days (3:00-5:00 PM)?*yesnoNumber of Extended Care weeks*$130 full week Price: $130.00 Quantity: Number of Extended Care weeks*$160 full week Price: $160.00 Quantity: add child?*yesnoChild 22. Child’s Name*Birth Month and Year*AllergiesSpanish Experience*YesNoProgram*Children's House (Ages 4 to 7 yrs. old) NIDO (ages 15 mo. To 3 yrs. old)Children House Summer CampNido Summer CampLocation*Newton Corner – 75 Vernon street, Newton, MA 02458Newton Highlands – 991 Boylston, Newton, MA 02461Location*Newton Corner – 75 Vernon street, Newton, MA 02458Newton Waban – 1671 Beacon street, Waban, MA 02468Total number of weeks attending (Children House):*2345678Total number of weeks attending (Nido):*2345678Please check the weeks your child will be attending (Children House):* Week 1: July 3-7 Week 2: July 10-14 Week 3: July 17-21 Week 4: July 24-28 Week 5: Jul 31- Aug 4 Week 6: Aug 7-11 Week 7: Aug 14-18 Week 8: Aug 21-25 Please check the weeks your child will be attending (Nido):* Week 1: July 3-7 Week 2: July 10-14 Week 3: July 17-21 Week 4: July 24-28 Week 5: Jul 31- Aug 4 Week 6: Aug 7-11 Week 7: Aug 14-18 Week 8: Aug 21-25 July Holiday Price: -$55.00 July Holiday Price: -$80.00 Extended days (3:00-5:00 PM)?*yesnoNumber of Extended Care weeks*$130 full week Price: $130.00 Quantity: Number of Extended Care weeks*$160 full week Price: $160.00 Quantity: add child?*yesnoChild 33. Child’s Name*Birth Month and Year*Program*Children's House (Ages 4 to 7 yrs. old) NIDO (ages 15 mo. To 3 yrs. old)Children House Summer CampNido Summer CampLocation*Newton Corner – 75 Vernon street, Newton, MA 02458Newton Highlands – 991 Boylston, Newton, MA 02461Location*Newton Corner – 75 Vernon street, Newton, MA 02458Newton Waban – 1671 Beacon street, Waban, MA 02468AllergiesSpanish Experience*YesNoTotal number of weeks attending (Children House):2345678Total number of weeks attending (Nido):2345678Please check the weeks your child will be attending (Children House):* Week 1: July 3-7 Week 2: July 10-14 Week 3: July 17-21 Week 4: July 24-28 Week 5: Jul 31- Aug 4 Week 6: Aug 7-11 Week 7: Aug 14-18 Week 8: Aug 21-25 Please check the weeks your child will be attending (Nido):* Week 1: July 3-7 Week 2: July 10-14 Week 3: July 17-21 Week 4: July 24-28 Week 5: Jul 31- Aug 4 Week 6: Aug 7-11 Week 7: Aug 14-18 Week 8: Aug 21-25 July Holiday Price: -$55.00 July Holiday Price: -$80.00 Extended days (3:00-5:00 PM)?*yesnoNumber of Extended Care weeks*$130 full week Price: $130.00 Quantity: Number of Extended Care weeks*$160 full week Price: $160.00 Quantity: Total $0.00 Payment Method:*CheckPhotographic ReleaseOccasionally we photograph or videotape classes for promotional purposes. Do we have your permission to use photographs of your family in our promotional materials, provided that any identifying information, such as names, remain anonymous?*YesNoPolicies and DetailsPayment & Registration: Enrollment requires both a completed registration form and payment received by ABC Spanish in Motion. Payment may be made online at the center or by mailing a check (payable to ABC Spanish In Motion) to our address below. The session will open only with a minimum level of enrollment. Refunds & class Cancellation: If a session is canceled due to low enrollment, a full refund will be issued. A partial refund less a $75 enrollment fee may be issued only if written notice is given before the session starts. There will be no refunds once the session begins. Missed classes will not be refunded. Medical permission: I understand that by signing this document, and the event of a medical emergency, I hereby give ABC Spanish In Motion permission to administer basic first aid and CPR, and enlist the aid of Emergency Medical Technicians (EMTs/Ambulance) who may transport my child(ren) to a hospital to receive treatment deemed necessary by medical staff. Arrival: ABC is not responsible for children prior to arrival or after departure from the Spanish Summer Camp. Departure: I understand I will notify ABC Spanish In Motion staff of any changes related to my child(ren)’s release. I understand ABC Spanish In Motion will not release my child(ren) to another person without my consent. There is a fee for late pick-up. Please check the box beside the statement:* I agree to release from any and all liability ABC Spanish in Motion, its agents and employees for any and all personal injury and property loss or damage occasioned by, or in connection with any activity of this program. Signature*Date* Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
