Summer Program Registration Form 🌞

Child's Full Name* This field is required.

First Name

Last Name

Age of Student as of June 1* This field is required.

Parent/Guardian Name* This field is required.

First Name

Last Name

Parent Email Address* This field is required.

example@example.com

Parent Phone Number* This field is required.

Please enter a valid phone number.

Emergency Contact Name* This field is required.

First Name

Last Name

Emergency Contact Phone Number* This field is required.

Please enter a valid phone number.

Relationship of Emergency Contact to Child* This field is required.

Does your child have a specific learning difference (ADHD, etc.), or medical condition (asthma, allergy, etc.) we should know about? If so, please explain.* This field is required.

Does your child take a daily prescription medication for a learning differnce or medical condition that will need to be administered between the hours of 8 am and 4pm?* This field is required.

Yes, my child will need to take a prescription medication during Summer Care each day, and I

No, my child does not need a prescription, or I will administer my child's medication at home.

OLHS SUMMER CARE MEDICATION CONSENT FORM **Per Arkansas DHS guidelines, all medications shall be in the original container with a child resistant cap, not have an expired date, and be labeled with the participant’s name.**

FIRST AND LAST NAME OF CHILD

NAME OF MEDICATION

DOSAGE

REASON FOR MEDICATION

DATE(S) and TIME(S) MEDICATION TO BE GIVEN

POSSIBLE SIDE EFFECTS

NAME and PHONE of PRESCRIBING PHYSICIAN

STORAGE INDICATIONS (refrigeration, etc)

I, __________________________________________, (parent or guardian) give permission to authorized staff member(s) to administer medication to my child as indicated above.

All summer care students are required to be fully potty trained, including during rest/nap time. Summer Care is not staffed to care for students that need to be changed and/or cleaned on a regular basis. For clarificatioin, potty trained children: Recognize when they need to go to the restroom. Verbalize to an adult the need to use a restroom with time to get to there before having an accident. Can pull down/up pants and underwear without assistance. Can get on the toilet without assistance. Can wipe themselves after urination/ bowel movement. Flush the toilet. Wash their hands.* This field is required.

I have read and agree to the potty training policy, and agree that my child is fully potty trained.

Children shall be protected from overexposure to the sun. Sunscreen will be applied at home before Summer Care each day. Additional sunscreen may be provided by the parent, and applied by school age children with written parental permission.* This field is required.

I will apply sunscreen to my child before Summer Care each day.

I give my permission for my child to apply his/her own (parent provided) sunscreen at Summer Care each day.

I give Summer Care staff permission to help my child apply (parent provided) sunscreen each day.

All children should come to Summer Care dressed appropriately with socks, and closed-toed tennis shoes that he/she can tie or fasten without assistance. Water shoes are acceptable on water play days. All students 3K, pre-K, and K students should bring a change of clothes to keep on campus.* This field is required.

I acknowlede and accept.

Summer Care drop off is from 8-9 am each day. Summer Care pick up is from 3-4 each day. Any student who is picked up late from Summer Care will be charged an additional late fee of $5 (per student), and a $1 per minute fee (per student).* This field is required.

I acknowledge and accept that if I am late to retrieve my child(ren) from the Summer Care program, I will be charged additional fees as stated above.

Occasionally we will photograph students during summer activities.* This field is required.

I give permission for my child to be photographed for school use.

I do not give permission for my child to be photographed for school use.

I give permission for my child to participate in all OLHS Summer Care activities.* This field is required.

I acknowledge and accept.

I, the parent/guardian of this child, give authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.* This field is required.

I acknowledge and accept.

I release the director, organizers, coaches, staff, or managers of this program for any responsibility in case of accident, illness, or injury during my child's enrollment.* This field is required.

I acknowledge and accept.

We expect all students attending OLHS Summer Care to behave in a respectful and kind manner with both Summer Care staff, and other students. Any behavior deemed inappropriate may result in dismissal. In the event of a dismissal, tuition will not be refunded.* This field is required.

I have read and agree to the discipline policy.

I confirm that all information given in this form is true, complete, and accurate. I confirm that my child and I will follow all rules and guidelines above. * This field is required.

Date

PAYMENT - You will notice that each week will have the same theme. However, each week will have three different options: M-F, Monday, Wednesday, and Friday ONLY, or Tuesday and Thursday ONLY. Please make sure you are selecting the correct number of days each week. Also, please note: field trips will likely be on Fridays or Mondays as we will have enrichment classes (art, music, STEM, etc.) the other days.

Credit Card

First Name

Last Name