Summer Adventures Registration Form Step 1 of 2 - Registration 50% Name of child* First Last Age*as of June 2022 Grade*as of Sept 2022 Gender(Optional) HiddenExtra Please Register my child for the upcoming Summer Adventures Program with The Phoenix School. No 1 No 2 ROV Construction, Extended Day (Optional) Price: Please Register my child for the upcoming Summer Adventures Program with The Phoenix School. Spies in the Wild: Full Week, Jun 20 - 24 Spies in the Wild: Individual Days Launch Zone: Full Week, Jun 27 - July 1 Launch Zone: Individual Days World Engineers: Full Week, Aug 22 - 26 World Engineers: Individual Days Prehistoric Paradise: Full Week, Aug 29 - Sept 2 Prehistoric Paradise: Individual Days Spies in the Wild: June 20 - 24, 2022 Price: Spies in the Wild - Individual Days Monday 6/20 Tuesday 6/21 Wednesday 6/22 Thursday 6/23 Friday 6/24 Spies in the Wild - Extended Day (Optional)extended day option 3pm - 5pm - Please note: extended day NOT available for Friday Monday 6/20 Tuesday 6/21 Wednesday 6/22 Thursday 6/23 Launch Zone: June 27 - July 1, 2022 Price: Launch Zone- Individual DaysONLY for less-than-full-week enrollment. Monday 6/21 Tuesday 6/22 Wednesday 6/23 Thursday 6/24 Friday 6/25 Launch Zone - Ext Day Selection (Optional)Extended Day option 3pm - 5pm Please note: extended day NOT available for Friday Monday 6/20 Tuesday 6/21 Wednesday 6/22 Thursday 6/23 World Engineers: August 22-26, 2022 Price: World Engineers - Individual DaysONLY for less-than-full-week enrollment. Monday 8/22 Tuesday 8/23 Wednesday 8/24 Thursday 8/25 Friday 8/26 World Engineers - Ext Day Selection (Optional)Extended Day Option 3pm - 5pm - Please note: extended day NOT available for Friday Monday 8/22 Tuesday 8/23 Wednesday 8/24 Thursday 8/25 HiddenROV Construction - Ext Day Selection (Optional)Extended Day Option 3pm - 5pm Monday 8/24 Tuesday 8/25 Wednesday 8/26 Thursday 8/27 Friday 8/28 Prehistoric Paradise: August 29-September 2, 2022 Price: Prehistoric Paradise - Individual DaysONLY for less-than-full-week enrollment. Monday 8/29 Tuesday 8/30 Wednesday 8/31 Thursday 9/1 Friday 9/2 Prehistoric Paradise - Ext Day Selection (Optional)Extended Day 3pm - 5pm - Please note: extended day NOT available for Friday Monday 8/29 Tuesday 8/30 Wednesday 8/31 Thursday 9/1 How did you hear about Summer Adventures at The Phoenix School?* Facebook/Social Media Direct Mail Homeschool Group Email From a Friend Other Which friend(s) recommended our program? 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.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. Please refer to the TLC section on our website for more information. June 14-18 - Animal Theatrics - TL June 21-25 - Nature Scientists - TL August 23-27 - Adventure Nature - TL August 30-Sept 3 - Animal Architects - TL Other: Please indicate What School or Homeschool Groups are you connected with?* Parent's/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 Parent's/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 Summer Adventures 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 I agree to have the medical and emergency forms completed and sent to The Phoenix School by June 10th or by August 12th. I understand that my child may not attend a Summer Adventures program until the medical and emergency forms are received by The Phoenix School. Refunds will not be given for days missed due to lack of properly completed forms. I agree to pay the balance of my child's tuition by June 10th or August 12th. I understand the $50 Registration Fee for each program is non-refundable and that tuition is not refundable for withdrawal, dismissal, failure to attend, or incomplete attendance. To receive a full or partial tuition refund, cancellations must be made on or before June 10th or August 11th. 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 CardCard Details Cardholder Name List Δ