Vacation Adventures Registration Form Name of child* First Last Age* Grade* HiddenGender* Male Female Would your child like to be a Teen Leader (TL)? Indicate below which sessions they are interested in. Note that there is a separate application process, and you will be billed only if applicant is accepted. February Vacation Adventures April Vacation Adventures The Teen Leadership Program is for young people who are too young to have a job, but are interested in spending a week assisting our course teachers in the field, mentoring younger children, helping out with the activities for the day, supervising recess or play at the park. TLCs will be given special assignments by their directing teacher and be responsible for various odd jobs that make the course run smoothly. Interest in science, animals, inventing and building with art materials, and using technology (Mac based) to create presentations — a plus. TLCs should have had previous experience working successfully with younger children, be able to work as a member of a team and have a basic understanding of how children learn through active exploration. 1-2 applicants will be accepted for each course. Teen Leaders must commit to the full program, the per-day option is not available. Please refer to the TLC section on our website for more information. HiddenPlease Register my child for the upcoming February Vacation Day Program at The Phoenix School. Full Week - February (T-F) Single Day - February Please register my child for the following single day(s) for February.* Tuesday (2/21) Wednesday (2/22) Thursday (2/23) Friday (2/24) Please review your choices, you have selected 4 individual days in one vacation week @ $240.00. For the 4-day vacation week, you should select the "Full Week" option @ $205.00 Please register my child for the following extended day(s) (3pm-5pm) for February. Tuesday (2/21)-3pm-5pm Wednesday (2/22)-3pm-5pm Thursday (2/23)-3pm-5pm Friday (2/24)-3pm-5pm Please Register my child for the upcoming April Vacation Day Program at The Phoenix School. Full Week - April (T-F) Single Day - April Please register my child for the following single day(s) for April* Tuesday (4/19) Wednesday (4/20) Thursday (4/21) Friday (4/22) Please register my child for the following extended day(s) (3pm-5pm) for April. Tuesday (4/19)-3pm-5pm Wednesday (4/20)-3pm-5pm Thursday (4/21)-3pm-5pm Friday (4/22)-3pm-5pm Please review your choices, you have selected 4 individual days in one vacation week @ $240.00. For the 4-day vacation week, you should select the "Full Week" option @ $205.00 How did you hear about Vacation Adventures at The Phoenix School?* Facebook/Social Media Direct Mail Homeschool Group Email From a Friend Other Other: Please indicate What School or Homeschool Groups are you connected with?* Guardian's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Preferred Phone Number*Alternate Phone Number2nd Guardian's Name (if applicable) First Last Your Child's Allergies and other Medical Conditions*Please list all allergies, including food, environmental and pharmaceutical. List any medical conditions or limitations. if none, please list "none". I give permission to The Phoenix School to take, use, publish, and reproduce photos, slides, or videos of my child for its records and/or publications.* Yes No Please indicate if we may use your child's photo. The following waiver must be signed to complete registration: Permission is granted for my child to participate in all planned Phoenix School activities; understanding that competent leadership and supervision will be provided. I understand that programs that do not meet the minimum enrollment may be cancelled or changed Digital Signature - Permission to participate* Authorization for Medical and/or Surgical Treatment and for Release of Information Every effort is made to contact and inform the parents or guardians in case of a medical emergency, serious injury, or illness when immediate medical or surgical intervention is deemed necessary. On isolated occasions the parents or guardian cannot be reached. Accordingly, they are requested to sign the following statement: In the event of illness or accident involving our/my son/daughter, we/I hereby give permission to The Phoenix School, its officials, and the treating physicians, surgeons, and dentists, to secure and furnish medical, dental, or surgical care and treatment for him/her and to give, administer, and render any treatment or aid, including anesthetics or surgery, as is necessary to protect, preserve, and safeguard the life and health of our/my son/daughter. We/I further authorize The Phoenix School to release information to facilitate the medical or surgical care of our/my son/daughter, as is necessary for the completion of a claim for health insurance. I give permission to the Vacation Adventures instructor to share information relevant to my child’s health condition with appropriate school personnel when needed to meet my/our child’s health and safety need.Digital Signature - Permission to Treat and/or to Release Medical Information as per the above Authorization Form* Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Δ Search for: Recent Posts “If it’s easy or you’re too comfortable, you’re not growing.” Launch Zone: Summer Adventures Purpose Driven Curriculum Is your child getting bored at school? 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