STEM Academy for Young Kids

1665 Oak TREE Road ,Suite#400,Edison NJ 08820

application form

EMERGENCY MEDICAL RELEASE

This is to certify that I voluntarily furnish medical information on the above-designated student to STEM ACADEMY FOR YOUNG KIDS. I hereby request that in the event that emergency medical care for my child. I further give my consent for an emergency medical facility or physician to administer necessary medical treatment to my child if I am unable to be reached or the situation requires immediate attention. I understand that I am responsible for paying all medical bills.

EMERGENCY MEDICAL RELEASE

This is to certify that I voluntarily furnish medical information on the above-designated student to STEM ACADEMY FOR YOUNG KIDS. I hereby request that in the event that emergency medical care for my child. I further give my consent for an emergency medical facility or physician to administer necessary medical treatment to my child if I am unable to be reached or the situation requires immediate attention. I understand that I am responsible for paying all medical bills.

EMERGENCY CONTACT INNFORMATION - Parents notified first, next in priority.
CHILD RELEASE AUTHORIZATION

List names of ANY individuals who are authorized to pick up your child, besides yourself. If anyone else will be picking up your child, please notify the office and use an AUTHORIZATION PICK UP FORM. STEM ACADEMY cannot release your child to anyone not authorized to pick up without written consent. All individuals will need to provide a photo ID when picking up.

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ACKNOWLEDGMENT OF WAIVER AND RELEASE

By signing this form I confirm to pay my tuition fees AND I confirm I realize all risks related to the transportation, activity and environment. I confirm waiving, releasing and discharging STEM Academy For Young Kids and its associates from any and all claims of liability or expenses of any kind and/or nature whatsoever arising out of or relating to my child/ren’s participation in the Enrichment and Care Programs.

Terms of Enrollment
  1. No make ups, credits & refunds.
  2. All deposits/registration fees are non-refundable.
  3. You will be obligated for dates chosen on this form.
  4. We reserve the right to dismiss a camper whose conduct or influence is not the best interest of our camp group for the safety of our campers.
  5. All balances will be charged on June 1, 2017.
  6. Registration fee is $100 per child & non-refundable.
  7. Field Trips are an additional cost.
  8. Bring your own lunch or buy $6 per meal.
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Office Use Only Notes
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