ULS Sunny Pines Registration

Child #1 Registration

Fill out the form carefully
SEEDLINGS Attendance Requirements:
- A minimum of 4 weeks.
- 3 registration options:
  *Select ONE option only. Options may not be combined.
  - Tues/Thurs
  - Mon/Wed/Fri
  - Mon-Fri
- SEEDLINGS IS NOW CLOSED!
SPROUTS & SAPLINGS Attendance Requirements:
- A minimum of 4 weeks.
- A minimum of 2 days within the same week is required. This can be:
  - 2 full days
  - 1 full and 1 half day
  - 2 half days
- SAPLINGS FULL on June 25
Day Swap Policy:
While we aim to be flexible at Sunny Pines, day swap requests will be accepted only through May 1, and only if space is available on the requested day.

*Day Swaps are not guaranteed.

*All registrations are non-refundable.
Child #1 Name*

First NameLast Name
Age/Incoming Grade (26-27)*
Birth Date*

MonthDayYear
Gender*
Allergies, Medications and/or Health Plan*
If none, please type N/A
Tuesdays / ThursdaysMondays / Wednesdays / FridaysMonday-Friday
Will your SEEDLING be attending Half or Full Days?*
Mark the specific dates Child #1 will attend Half AND Full Days (June 8-August 14 *There is no camp July 1-7)*
Select the days of the week your SPROUT or SAPLING will be attending Sunny Pines (minimum of 2 days within the same week)*
Will your SPROUT or SAPLING be attending Half or Full Days?*
Mark the specific dates Child #1 will attend Half AND Full Days (June 8-August 14 *There is no camp July 1-7)*
We provide the following extra services. Please check all you give permission for your child to use.*
Select Shirt Size (SIZE UP!!)*
*T-shirt is included in camp registration.
What are some important routines for your child?*
Please describe in detail
How would you describe the way your child explores and learns about the world around them? (For example: fearless, eager to try everything, or more slow and cautious.)*
What helps eating times go smoothly?*
Please describe in detail
What makes nap/rest time work?*
Please describe in detail
How are you approaching diapering/toilet training?*
Please describe in detail
Are there any custody arrangements we should be aware of?*
Is there anything you would like us to know about your child?*
(i.e. things they enjoy, things they struggle with, things that can help set them up for a successful day, etc.)
YESNO

Child #2 Registration

Fill out the form carefully
SEEDLINGS Attendance Requirements:
- A minimum of 4 weeks.
- 3 registration options:
  *Select ONE option only. Options may not be combined.
  - Tues/Thurs
  - Mon/Wed/Fri
  - Mon-Fri
- SEEDLINGS IS NOW CLOSED!
SPROUTS & SAPLINGS Attendance Requirements:
- A minimum of 4 weeks.
- A minimum of 2 days within the same week is required. This can be:
  - 2 full days
  - 1 full and 1 half day
  - 2 half days
Day Swap Policy:
While we aim to be flexible at Sunny Pines, day swap requests will be accepted only through May 1, and only if space is available on the requested day.

*Day Swaps are not guaranteed.

*All registrations are non-refundable.
Child #2 Name*

First NameLast Name
Age/Incoming Grade (26-27)*
Birth Date*

MonthDayYear
Gender*
Allergies, Medications and/or Health Plan*
If none, please type N/A
Tuesdays / ThursdaysMondays / Wednesdays / FridaysMonday-Friday
Will your SEEDLING be attending Half or Full Days?*
Mark the specific dates Child #2 will attend Half AND Full Days (June 8-August 14 *There is no camp July 1-7)*
Select the days of the week your SPROUT or SAPLING will be attending Sunny Pines (minimum of 2 days within the same week)*
Will your SPROUT or SAPLING be attending Half or Full Days?*
Mark the specific dates Child #2 will attend Half AND Full Days (June 8-August 14 *No camp July 1-7)*
We provide the following extra services. Please check all you'd like your child to receive.*
Select Shirt Size (SIZE UP!!)*
*T-shirt is included in camp registration.
What are some important routines for your child?*
Please describe in detail
How would you describe the way your child explores and learns about the world around them? (For example: fearless, eager to try everything, or more slow and cautious.)*
What helps eating times go smoothly?*
Please describe in detail
What makes nap/rest time work?*
Please describe in detail
How are you approaching diapering/toilet training?*
Please describe in detail
Are there any custody arrangements we should be aware of?*
Is there anything you would like us to know about your second child?*
(i.e. things they enjoy, things they struggle with, things that can help set them up for a successful day, etc.)
YESNO

Child #3 Registration

Fill out the form carefully
SEEDLINGS Attendance Requirements:
- A minimum of 4 weeks.
- 3 registration options:
  *Select ONE option only. Options may not be combined.
  - Tues/Thurs
  - Mon/Wed/Fri
  - Mon-Fri
- SEEDLINGS IS NOW CLOSED!
SPROUTS & SAPLINGS Attendance Requirements:
- A minimum of 4 weeks.
- A minimum of 2 days within the same week is required. This can be:
  - 2 full days
  - 1 full and 1 half day
  - 2 half days
Day Swap Policy:
While we aim to be flexible at Sunny Pines, day swap requests will be accepted only through May 1, and only if space is available on the requested day.

*Day Swaps are not guaranteed.

*All registrations are non-refundable.
Child #3 Name*

First NameLast Name
Age/Incoming Grade (26-27)*
Birth Date*

MonthDayYear
Gender*
Allergies, Medications and/or Health Plan*
If none, please type N/A
Tuesdays / ThursdaysMondays / Wednesdays / FridaysMonday-Friday
Will your SEEDLING be attending Half or Full Days?*
Mark the specific dates Child #3 will attend Half AND Full Days (June 8-August 14 *There is no camp July 1-7)*
Select the days of the week your SPROUT or SAPLING will be attending Sunny Pines (minimum of 2 days within the same week)*
Will your SPROUT or SAPLING be attending Half or Full Days?*
Mark the specific dates Child #3 will attend Half AND Full Days (June 8-August 14 *No camp July 1-7)*
We provide the following extra services. Please check all you'd like your child to receive.*
Select Shirt Size (SIZE UP!!)*
*T-shirt is included in camp registration.
What are some important routines for your child?*
Please describe in detail
How would you describe the way your child explores and learns about the world around them? (For example: fearless, eager to try everything, or more slow and cautious.)*
What helps eating times go smoothly?*
Please describe in detail
What makes nap/rest time work?*
Please describe in detail
How are you approaching diapering/toilet training?*
Please describe in detail
Are there any custody arrangements we should be aware of?*
Is there anything you would like us to know about your third child?*
(i.e. things they enjoy, things they struggle with, things that can help set them up for a successful day, etc.)
YESNO

Child #4 Registration

Fill out the form carefully
SEEDLINGS Attendance Requirements:
- A minimum of 4 weeks.
- 3 registration options:
  *Select ONE option only. Options may not be combined.
  - Tues/Thurs
  - Mon/Wed/Fri
  - Mon-Fri
- SEEDLINGS IS NOW CLOSED!
SPROUTS & SAPLINGS Attendance Requirements:
- A minimum of 4 weeks.
- A minimum of 2 days within the same week is required. This can be:
  - 2 full days
  - 1 full and 1 half day
  - 2 half days
Day Swap Policy:
While we aim to be flexible at Sunny Pines, day swap requests will be accepted only through May 1, and only if space is available on the requested day.

*Day Swaps are not guaranteed.

*All registrations are non-refundable.
Child #4 Name*

First NameLast Name
Age/Incoming Grade (26-27)*
Birth Date*

MonthDayYear
Gender*
Allergies, Medications and/or Health Plan*
If none, please type N/A
Tuesdays / ThursdaysMondays / Wednesdays / FridaysMonday-Friday
Will your SEEDLING be attending Half or Full Days?*
Mark the specific dates Child #4 will attend Half AND Full Days (June 8-August 14 *There is no camp July 1-7)*
Select the days of the week your SPROUT or SAPLING will be attending Sunny Pines (minimum of 2 days within the same week)*
Will your SPROUT or SAPLING be attending Half or Full Days?*
Mark the specific dates Child #4 will attend Half AND Full Days (June 8-August 14 *No camp July 1-7)*
We provide the following extra services. Please check all you'd like your child to receive.*
Select Shirt Size (SIZE UP!!)*
*T-shirt is included in camp registration.
What are some important routines for your child?*
Please describe in detail
How would you describe the way your child explores and learns about the world around them? (For example: fearless, eager to try everything, or more slow and cautious.)*
What helps eating times go smoothly?*
Please describe in detail
What makes nap/rest time work?*
Please describe in detail
How are you approaching diapering/toilet training?*
Please describe in detail
Are there any custody arrangements we should be aware of?*
Is there anything you would like us to know about your fourth child?*
(i.e. things they enjoy, things they struggle with, things that can help set them up for a successful day, etc.)

Photo/Video Consent
YES, I consentNO, I do not consent
Signature:*

Parent/Guardian Information

Double-check your details to stay in the loop!
Parent/Guardian Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
List as Emergency Contact?*
Authorized to Pick Up Child(ren)?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YESNO
Parent/Guardian Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
List as Emergency Contact?*
Authorized to Pick Up Child(ren)?*
Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Emergency Contacts

Person(s) to call if parent/guardian(s) cannot be reached in an emergency
YESNO
Additional Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship*
Authorized to Pick Up Child(ren)?*
YESNO
Additional Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship*
Authorized to Pick Up Child(ren)?*

Additional Authorized Pick-Ups

List any additional people authorized to pick up your child(ren). Anyone not previously selected or listed below must be authorized by a parent/guardian via phone or email to pick up your child(ren).
YESNO
Name*

First NameLast Name
Relationship*
YESNO
Name*

First NameLast Name
Relationship*
YESNO
Name*

First NameLast Name
Relationship*

Emergency Medical Treatment Authorization and Child Insurance Statement
Child #1 Name*

First NameLast Name
Child #2 Name*

First NameLast Name
Child #3 Name*

First NameLast Name
Child #4 Name*

First NameLast Name
As the legal parent or guardian of the above named child(ren), and in the event of an injury or illness which requires immediate examination or treatment, in the opinion of University Lake School officials, I authorize University Lake School on my behalf to have my child transported by car or ambulance to the nearest hospital. Necessary emergency treatment may be given by any doctor on call.

The parents of a student who incurs an injury or suffers an illness that requires more than first aid will be notified as soon as practical after the injury occurs. In an emergency, this notification may occur after the student has been transported to and/or treated by a doctor, clinic or hospital.

I understand that the school assumes no financial responsibility for medical care or ambulance conveyance. We further understand that ULS does not carry medical expense insurance for the benefit of any student who may be injured while participating in school activities and that ULS assumes no responsibility for such medical expense. We further understand that a student who does not have health insurance coverage will not be permitted to participate in athletics unless this statement is signed and filed with the Head of University Lake School. We consent to having our son/daughter participate under these conditions and authorize the treatment of injuries and illness incurred by our child in accordance with the procedure described above.
Parent/Guardian Signature*
Parent/Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date
Medications

If your child must take prescription drugs on a continuing basis, please name the drugs and describe the medical condition.
YESNO
Child Name*
Prescription Medication(s)*
Dosage(s)*
YESNO
Child #2 Name*
Prescription Medication(s)*
Dosage(s)*
YESNO
Child #3 Name*
Prescription Medication(s)*
Dosage(s)*
YESNO
Child #4 Name*
Prescription Medication(s)*
Dosage(s)*
The information provided here is accurate. I give University Lake School Permission to treat my child.*

Parent or Guardian's Signature is Required.
Date*

MonthDayYear
Date

Choose Weeks	# of Children
Week 1: June 8-12
Week 2: June 15-19
Week 3: June 22-26
Week 4: June 29-30 & July 8-10
Week 5: July 13-17
Week 6: July 20-24
Week 7: July 27-31
Week 8: August 3-7
Week 9: August 10-14

Choose Weeks	# of Children
Week 1: June 8-12
Week 2: June 15-19
Week 3: June 22-26
Week 4: June 29-30 & July 8-10
Week 5: July 13-17
Week 6: July 20-24
Week 7: July 27-31
Week 8: August 3-7
Week 9: August 10-14

Choose Weeks	# of Children
Week 1: June 8-12
Week 2: June 15-19
Week 3: June 22-26
Week 4: June 29-30 & July 8-10
Week 5: July 13-17
Week 6: July 20-24
Week 7: July 27-31
Week 8: August 3-7
Week 9: August 10-14

Choose Weeks	# of Children
Week 1: June 8-12
Week 2: June 15-19
Week 3: June 22-26
Week 4: June 29-30 & July 8-10
Week 5: July 13-17
Week 6: July 20-24
Week 7: July 27-31
Week 8: August 3-7
Week 9: August 10-14

Choose Weeks	# of Children
Week 1: June 8-12
Week 2: June 15-19
Week 3: June 22-26
Week 4: June 29-30 & July 8-10
Week 5: July 13-17
Week 6: July 20-24
Week 7: July 27-31
Week 8: August 3-7
Week 9: August 10-14

Enter coupon

Child #1 Registration

Child #2 Registration

Child #3 Registration

Child #4 Registration

Photo/Video Consent

Parent/Guardian Information

Additional Emergency Contacts

Additional Authorized Pick-Ups

Emergency Medical Treatment Authorization and Child Insurance Statement

Medications

PAYMENT