Summer Camp Registration Form

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Please contact us prior to filling out the form to check for your child's age group availability.

Camper's First and Last Name *

Camper's Date of Birth *

YYYY

Weeks of Attendance *

Week 1: May 31st - June 3rd **this will be a 4-day week to allow for national holiday

Week 2: June 6th - 10th

Week 3: June 13th - 17th

Week 4: June 20th - 24th

Week 5: June 27th - July 1st

Week 6: July 5th - 8th **this will be a 4-day week to allow for national holiday

Week 7: July 11th - 15th

Week 8: July 18th - 22nd

Week 9: July 25th - 29th

Required

Schedule *

8:00 am - 3:00 pm * regular camp schedule

8:00 am -12:00 pm * early dismissal

7:00 am - 6:00 pm * early arrival AND after camp care

Parent / Guardian #1 Full Name *

Parent / Guardian #2 Full Name *

Parent / Guardian E-mail *

Parent / Guardian Phone Number *

Address (street address, city, state, zip code) *

I hereby authorize Tohuí Language Academy to allow my child to leave the facility ONLY with the following persons. Please list name and telephone number(s) for each. Children will only be released to a parent or a person designated by the parent/guardian after verification of ID. *

I hereby give consent for my child to be transported to the nearest health facility and supervised by Tohuí Language Academy’s employees in case of an emergency *

Yes

I give consent for the facility to secure any and all necessary emergency medical care for my child. *

Yes

List any special problems that your child may have, such as allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregivers should be aware of. *

I hereby give permission for images of my child captured at Tohuí Language Academy through video, photo and digital camera, to be used solely for the purposes of the Tohuí Language Academy classroom and promotional materials, and waive any rights of compensation or ownership thereto. *

Yes

I hereby give permission for my child to access internet under the supervision of Tohuí Language Academy’s employees for educational and academic purposes only. *

Yes

Medical Authorization and Disclaimer: I acknowledge that there are known, unknown, and unforeseen risks associated with participating in activities conducted by Tohui Language Academy. I willingly assume the risks associated with participation in activities. I agree to hold Tohui Language Academy harmless for any and all injuries, liabilities or damages resulting from the students participation in such activities. Please initial to acknowledge. *

I understand ALL registration fees are NON REFUNDABLE and need to be paid in full before service starts. *

I understand

Cancellation policy: A 3 week notice before camper's first day will be required for a 100% refund. A 2 week notice before camper's first day will be required for a 50% refund. *

I agree

I understand that teachers at Tohui create a safe and loving environment in the classroom. GOOD BEHAVIOR is expected on all camps and language classes to maximize learning to all students. *

I understand

Your child's registration will be complete when payment has been processed. Current Tohui parents will be sent an invoice and new/returning summer Tohui parents will be asked to bring a check. *

I understand

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