Summer Camp Registration

SUMMER CAMP REGISTRATION

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Gender

Parent/Guardians Full Name

Parent/Guardians Phone Number

Email Address

Does your child have any allergies or medical conditions? If so, please list them below along with their severity (e.g., airborne, contact, or ingestion allergy) and any additional details we should be aware of.

Does your child require any accommodations or services, such as, OT, Speech, ABA, Respite, 1:1 services, DDA, etc.?

Does your child have an IEP?

Yes

Is your child potty trained? Do they need any sort of assistance in the bathroom?

Is your child up to date on vaccinations?

Pediatricians Name & Number

Emergency Contact #1 Name & Phone Number

Emergency Contact #2 Name & Phone Number

Name and Number of any individuals allowed to pick up my child:

If someone not listed above will be picking up your child, written permission from a parent/guardian will be required. For the safety of all children, individuals—including parents/guardians—may be asked to provide identification at the time of pick-up.

I understand

Please pick up your child at their scheduled time to be picked up, promptly. A late fee of $1 a min will be charged, If a true emergency happens, please call 360-443-2399 to notify staff you will be late.

I understand

How did you hear about us? If from a friend or family, who referred you?

All children in our camps are required to bring a snack from home and a water bottle. Those signed up for the extension hour are required to bring a packed lunch from home.

I understand

Are there any court or custody documents that we need to be aware of? Example: If a parent is not allowed to pick up.

Yes

Other

I consent to allow my child to be included in photos taken during summer camps that may be used for Tiny Notes Music & Movement LLC media accounts and marketing.

I agree

I do not agree

I understand that if I decide to withdrawal my child from Tiny Notes Summer Programs, tuition is non refundable.

I understand

I give Tiny Notes Music & Movement LLC consent to seek and accept medical treatment for my child.

I agree (By checking this box, the above parent or guardian agrees to consent to treat)

I do not agree

Are there any items that help soothe or calm your child (e.g., stuffed animals)?

Behavior Expectations

To maintain a positive environment, children must be able to participate in the program safely and independently. If multiple professionals determine that a child cannot do so, options include:

Arranging for one-on-one support at an additional cost of $25/hour.
Receiving a refund and discontinuing participation.

Examples of behaviors that may require such measures include:

Elopement (leaving the designated area without permission).
Inability to stay with the group.
Aggressive behaviors (hitting, spitting, biting).
Inappropriate behaviors (excessive tantrums, consistent use of inappropriate language).

I have read and understand the Behavior Expectations outlined above. If my child is unable to meet these expectations, I acknowledge that we will need to explore one of the alternative options provided.

I understand

Additional Comments/Concerns?

Which camp will your child be attending? (Please note: Elementary Sibling Camp is only available for families with a child enrolled in the Preschool Camp. Spaces are extremely limited.)

Preschool Camp

Elementary Sibling Camp

Which session(s) would you prefer for your child to attend? (Please select all that apply. Note: We do not offer an all-day camp option.)

Morning Session (9:00 - 12:00, T-F)

Lunch Extension* (12:00-1:00) *only available for children attending morning sessions

Afternoon Session (1:00 - 3:00, T-Th)

Either (No preference)

A minimum payment of one week of camp is required as a non-refundable deposit to secure your child's spot. You may choose to pay for additional weeks upfront or opt to pay for one week now and receive an invoice for any remaining weeks. Payment for all weeks must be completed by May 1st to avoid forfeiting the deposit and withdrawal from camp. Registrations submitted after May 1st will require full payment upfront for all selected weeks. After May 1st, all payments are non-refundable, and changes to enrollment that involve dropping paid weeks will not be refunded. If you wish to change the week(s) your child is signed up for, this must be done before May 1st. Requests to change weeks after May 1st will incur a $25 administrative fee per change and will only be accommodated if space is available for the desired week. If no space is available, your child will be added to the waiting list for that week.

Transferring to another week may still be possible if space allows, but spots are extremely limited this year. For payment plans or further assistance, please contact us at 360-443-2399.

Payment Options

Morning Camp (9-12) - 1 Week$125

Morning Camp w/ Lunch Extension (9-1) - 1 week$165

Afternoon Camp (1-3) - 1 week$65

Waiver and Release of Liability

I agree that this Waiver and Release of Liability shall apply to each day I am at Tiny Notes Music and Movement LLC, regardless of the date this form is signed below. This form does not apply to regular class times where staff is responsible for my child. This form is intended for times when children are in the care of their parents or guardians while on the premises.

I acknowledge and accept that Tiny Notes Music and Movement LLC has jungle gym equipment and other play structures on the premises. I understand that the use of this equipment involves inherent risks, including but not limited to, falls, collisions, and other accidents that may result in injury. I agree to assume all risks and full responsibility for any injuries, losses, or damages that might occur to my child, myself, or other family members resulting from the use of this equipment.

To the maximum extent permitted by law, I waive and release any and all claims, suits, or related causes of action against Tiny Notes Music and Movement LLC, including its owners, officers, employees, or agents, for any injury, loss, death, costs, or other damages arising from the use of any equipment, play structures, or facilities, whether on the premises or during off-site programs or activities.

I further agree to indemnify, defend, and hold harmless Tiny Notes Music and Movement LLC, its owners, officers, employees, or agents from any and all liability, including claims, suits, or causes of action asserted by third parties, that may arise from injuries, losses, or damages caused by my conduct, my child’s conduct, or the conduct of other family members while participating in the preschool’s programs, activities, or use of equipment.

I specifically understand and agree that Tiny Notes Music and Movement LLC is not responsible for supervising, inspecting, or ensuring the safe use of jungle gym equipment, play structures, or similar apparatuses when children are under the care of their parents or guardians. All use of such equipment is at my own risk, and I am solely responsible for ensuring the proper supervision and safety of my child and any accompanying family members.

I further release, indemnify, defend, and hold harmless Tiny Notes Music and Movement LLC from any liability whatsoever for future claims that may be presented by my child, myself, or other family members for any injuries, losses, or damages arising from the use of any equipment, facilities, or participation in activities.

I have read, understand, and agree to the above waiver and release of liability.

I agree. By checking this box the above named parent or guardian agrees to terms and conditions of the liability waiver.

Thank you for joining Tiny Notes Music and Movement LLC. By signing below and submitting this form you are verifying that all of the submitted information above is true and that you are the parent or legal guardian authorized to grant permission for the child to participate.

Parent/Guardian Signature

Company name

SUMMER CAMP REGISTRATION

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