FERR's Little Explorers Registration

Simple. Structured. Screen-free. Hands-on learning for ages 5–12

This form registers your child for scheduled instructor-led enrichment sessions. This program is an educational enrichment program and is not a childcare or daycare service.
1. Child Information

(Separate form for each child)
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Age
Grade
Parent/Guardian Full Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Emergency Contact/Full Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
📍 PROGRAM SELECTION
Preferred Week(s)
(Parent drop off/pick up at location)
🩺 MEDICAL & ALLERGY INFORMATION
If, Yes. Allergies, Medical needs, Accommodations, or anything we should know. Please explain:
Is your child permitted to participate in all activities?
If No, please explain:
🚨 AUTHORIZED PICK-UP
List all authorized individuals for pick-up:
📸 PHOTO & MEDIA CONSENT - photographed or recorded for marketing purposes?
⚠️ PROGRAM ACKNOWLEDGMENT (REQUIRED)
🌿 LIABILITY WAIVER (REQUIRED)
🚑 MEDICAL CONSENT
Today's Date

MonthDayYear
Date
✍️ SIGNATURE
💳 PAYMENT AGREEMENT
📲 PAYMENT INSTRUCTIONS (ZELLE)

Please submit your payment via Zelle using the information below:

Info@ferrmarketing.com - FERR Marketing LLC

📝 IMPORTANT:
Please include your child’s full name + session week in the memo
Example: “Sofia Rodriguez – Week 1 Summer Camp”

⏳ Payment Deadline:
Payment must be submitted within 24 hours to secure your child’s spot
Spots are limited and first come, first served
Should be Empty:

Simple. Structured. Screen-free. Hands-on learning for ages 5–12

1. Child Information