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Summer Program Registration 

Student Information
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Week(s) Enrolling
Parent/Guardian 1

Parent/Guardian  2

Emergency Contact Information
The first attempt will be made to contact parents/guardians. Emergency Contacts listed below must be able to pick your child up in the event of an emergency.
Terms and Conditions of Enrollment

  1. No student  will be properly enrolled in Symone Center for The Arts Program without the following paperwork completed and up to date: participant application, camper health history form, medication administration form (if needed), registration fee, and payment.

  2. No refunds will be granted if the participant leaves the program, on his/her own account or is removed from the program due to an inability to adjust or is unable to function adequately or to comply with the program rules. There is no reduction or refunds based on missed days due to absence, illness, or early withdrawal. No refunds will be given based on changes in weeks signed up for as indicated in the initial application.

  3. A one-week camp deposit is due at the time of registration. All Weekly payments are due by Monday of the current week (no later than 9:00 AM). 

  4. For safety reasons, we must know, in advance, which children are expected to attend on any given day, especially for physical days. If there is any change in my request for camp weeks, the site coordinator must be notified. Additionally, only the child(ren) that are enrolled will be permitted to attend the physical or virtual summer camp

  5. I understand that no refunds will be given for absences. 

  6. I understand that no refunds will be given due to closure or missed days as a result of following Covid-19 safety plan, protocols, health department and CDC guidelines.

  7. I understand that all campers and staff will be required to wear a mask during the summer program. Refusal or inability to wear a mask during physical camp days will result in dismissal from the physical camp program without reduction or refund of payment.

  8. All late payments are subject to a $40.00 weekly late fee.

  9. On physical site days, my child will be subject to Covid-19 screening, including but not limited to screening questions, temperature checks, and will be required to wear personal protective equipment. 

  10. Due to the outbreak of Covid-19 on physical camp days, no parents or guardians will be permitted into the camp facility for any reason. Parents must wear masks or face coverings at the time of drop off and pick up. 

  11. Daily screening must be completed before the time of drop off each day, if screening is not completed camper will not be permitted to stay. 

  12. I am aware that my student must follow the rules and regulations of the physical and virtual summer program and may be terminated from Symone Center for The Arts Summer program if he or she does not comply.


  13. I hereby consent to the taking of photographs, movies, Internet use, and videotapes, of my child Symone Center or its designated representatives. I also grant the right to edit, use, and re-use said products for any and all educational or public service I release any and all rights, title, and interest we or the child may have in said products. Photocopies and facsimiles of this Release and consent shall have the same legal effect as the original.

  14.  Symone Center for The Arts Summer Program is not responsible for any personal items that are lost stolen

       or damaged while attending.


  15. On the physical camp days I consent that in an emergency Symone Center for The Arts may obtain

        medical treatment if necessary. I understand that if medical treatment is deemed necessary I will be

        informed as soon as possible.

  16. I reviewed the application and all the information provided is accurate and true. I agree to all the terms and

      conditions.

  17. I have received a copy of “A Parent’s Guide to Regulated Child Care.”

  18. I understand that if my child is displaying any signs of illness, they will not be able to attend physical camp

       days.​

Health Information 
List any specific medical conditions or behavioral problems? Does your child have any other allergies (food, hay fever, etc)?
Are there any activities in which your child may not participate?
Are there conditions or specific needs that require special attention?

I, 

as parent/guardian, authorize Symone Center for the Arts personnel to 

seek emergency treatment as required and to transport my child to the appropriate medical facility in the event that urgent/emergency care is necessary.

The information listed on this health information form is correct to the best of my knowledge, and the participant described herein has permission to engage in all prescribed program activities, except as noted on this form.


Who is responsible for making payments?

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I hereby, agree to submit summer program payments to the Symone Center for the Arts, Inc. I understand that if I pay late my account will be charged a $40.00 late fee per week/per occurrence. Additionally, non-payment may result in the termination of all services conducted by Symone Center for the Arts, Inc.  I understand that I am enrolling my child for the weeks indicated in the application. I understand that I am responsible for the payment of fees for the 2022 summer program. 

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Thanks for submitting! We look forward to being of service to your family!

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