Registration
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New Families register here for Ifetayo's Summer Camp Experience! | Returning families, please refer to the link in your email <3 | Don't forget to register for Week 2: https://app.jackrabbitclass.com/regevent.asp?xID=7513874&orgid=553010&%20internal=1
Event:
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End Date/Time:
Fee per Student:
Room:
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Family Information
First Name:
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Last Name:
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Type
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Caregiver
Father
Grandparent
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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Zip:
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Emergency Contact Info (Not Contact #1 or #2)
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
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(format=mm/dd/yyyy)
School:
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Grade Level:
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10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
Kindergarten
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Preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Agree to Media Release Y/N:
Add New Student #2:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
Kindergarten
Pre-K
Preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Agree to Media Release Y/N:
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
Kindergarten
Pre-K
Preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Agree to Media Release Y/N:
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
Kindergarten
Pre-K
Preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Agree to Media Release Y/N:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
Kindergarten
Pre-K
Preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Agree to Media Release Y/N:
Questions/Options:
FOR NEW FAMILIES: Did anyone recommend our camps to you? Please share the name of your referral below:
Has your child previously attended any Ifetayo programs (CAP, Rites of Passage, MGCHP, Camp)? Please indicate the program and year(s)
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**Special Registration: DAY RATE** If you are *NOT* registering for the full week please let us know which days your child will attend camp below (Day rate is $75/day)
**Special Registration: SINGLE WEEK** If you are solely registering for 1 week of camp, from 8/18 - 8/22 select yes.
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Yes
No
Are you interested in Early Drop off (8:00 AM) ($15/day)?
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Yes
No
Are you interested in Late Pick Up (until 4PM) ($15/day)? **NOTE: All pick ups after 3:30PM will automatically be charged the late pick up fee**
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Yes
No
Ifetayo will provide supplementary snacks for all program scholars, however children are expected to arrive with a packed lunch and snacks for the day. Please acknowledge this by clicking yes
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Yes
No
Please list any allergies and/or special needs your child may have (please enter N/A if there are none)
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I grant permission to Ifetayo Cultural Arts Academy and its partners to photograph and/or record my child during camp activities. I authorize the use of these materials for future promotion.
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Yes
No
Additional Information:
Safety Agreement
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I, the undersigned parent or legal guardian of the child named above, hereby give permission for my child to participate in the Ifetayo Cultural Arts Academy summer camp. I understand that participation in camp activities involves inherent risks, including but not limited to physical activity, outdoor play, arts and crafts, and transportation to off-site locations. I acknowledge and accept full responsibility for any injury, accident, illness, or other harm that may occur during the camp period.
I hereby release, indemnify, and hold harmless Ifetayo Cultural Arts Academy, its employees, volunteers, directors, agents, and affiliates from any and all liability for injuries, damages, or losses sustained as a result of participation in the camp, whether arising from negligence or otherwise, to the fullest extent permitted by law.
In the event of an emergency, I authorize camp staff to seek and obtain any necessary medical treatment for my child. I understand that I am responsible for all costs associated with such treatment.
I've read the above and agree.
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