STEAMLife Registration

SteamLife Summer Camp Registration

The following enrollment application and all forms must be read, properly signed and submitted for enrollment in the 2020 STEAMLife Summer Camp at the Potters House Legacy Achievement Center of Excellence. (The PLACE)

Step 1 of 5

Enrollment Contract
Child's Name*
Child 2 Name*
Child 3 Name*
Child 4 Name*
Child 5 Name*
Child 6 Name*
I Agree to ensure that my child/children report (s) to camp daily in compliance with the STEAMLife Summer Program Dress Code.

I understand that STEAMLife Summer Program at the Potters House Legacy Achievement Center of Excellence is not responsible for any lost, stolen, or broken articles that my child brings to the camp.

I understand that it is the policy of the STEAMLife Summer Program at the Potters House Legacy Achievement Center of Excellence that any student that leaves with the group on a bus or van must return with the group on the bus or van.

I understand that it is not permissible for me to transport any child other than my own without the expressed written consent of that child’s parent(s) or guardian (s).

I understand that if I transport my child on a field trip, it is my responsibility to transport my child back to where the group is meeting.

I understand that my child will not be allowed to leave with anyone other than the individual(s) listed as authorized for pick up without expressed written consent turned into the Summer Camp Administrator or Camp Director.

I am aware that I am responsible for providing a substitute lunch in the event my child chooses not to eat the meals that are provided.

The weekly tuition rate is $150 per week/child, and $110 per week/ per additional child thereafter with a maximum of 6 children per registration. Weekly tuition must be paid in full prior to the week your child is attending.

I understand delinquent accounts can result in my child’s inability to participate in the summer camp program. I agree to pay the tuition to STEAMLife Summer at the Potters House Legacy Achievement Center of Excellence in the amount stipulated, by the date and time prescribed. I understand that services may be suspended at the discretion of the organization.

I understand the Attendance Policy states that full tuition is due for weeks that my child is sick or on vacation unless special arrangements have been made in writing with the Director.

I understand that my child(ren) must be picked up by 6:00 p.m. If my child(ren) have not been picked up by 6:30pm, program administration will contact me and the emergency contacts at the numbers listed. If I or anyone listed as authorized to pick up my child(ren) can't be reached, at 7:00pm, Child Protective Services will be contacted and my child will be in remanded in their custody.

I understand that failure or refusal to comply with any of the STEAMLife Summer Camp program policies may result in the immediate withdrawal of my child from the STEAMLife Summer Camp at the Potters House Legacy Achievement Center of Excellence.
Signature
Please acknowledge by consenting below. (You must check the box to consent.)
Consent*
- Checking this box represents your signature and that you acknowledge and consent to the terms of SteamLife Summer Camp enrollment

STEAM Summer Camp Policies
Code of Conduct
- Absolutely no profanity
- Respect for staff and volunteers at all times
- Respect for fellow campers and self (This includes the individual as well as their belongings)
- There will be absolutely no fighting
Discipline
The discipline consequence progression is listed below:
1. First Infraction – Verbal Warning
2. Second Infraction – Visit with a camp administrator and Parent/Guardian contact
3. Third Infraction – Withdrawal from the Summer Camp
Dress Code
- All children must wear appropriate attire
- We strongly recommend closed toe shoes
- No valuable jewelry
- No revealing outfits: too tight fitting or too loose fitting
- No sagging, Belts must be worn when applicable
- No t-shirts bearing distasteful or offensive words, logos, labels, or advertisements
- All shorts must be worn at mid-thigh, no exceptions
Cell Phone/MP3/IPOD/IPAD/Tablets Policy

Students are encouraged to bring personal electronic items such as Cell phone/ IPOD/IPAD/TABLETS as they may be used during instruction times as a part of the lessons. Students are responsible for maintaining possession of their items at all times.

If an electronic device is used during a session when not permitted, it may be confiscated by camp staff and returned by the end of camp.

Personal Items

All personal items that your camper brings to the summer camp needs to be labeled with the child’s First and Last name. No initials.

Students are responsible for maintaining possessions at all times. STEAMLife will not be responsible for lost items
Signature
Please acknowledge by consenting below. (You must check the box to consent.)
Consent*
- Checking this box represents your signature and that you acknowledge and consent to the terms of SteamLife Summer Camp policies

Registration Payment

STEAMLife Summer Camp Payment Form

Select Item(s)

Special Pricing Tiers:

First child : $150/week;
Remaining children : $110/week
Maximum of 6 children per registration

PLEASE NOTE: REGISTRATIONS ARE NON REFUNDABLE

Below, please check the item of your desired weekly sessions and check the box next to the children's names who will be attending.

Summer Camp Registration: Week 1 - June 8th - 12th, 2020 "Work up a Sweat - STEAM in Sports"		$150.00
Summer Camp Registration: Week 2 - June 15th - 19th, 2020 "The Arts in STEAM"		$150.00
Summer Camp Registration: Week 3 - June 22nd - 26th, 2020 "Created To Innovate - Technology in STEAM"		$150.00
Summer Camp Registration: Week 4 - June 29th - July 3rd, 2020 "Fit and Full STEAM Ahead! - Health and Wellness"		$150.00
Summer Camp Registration: Week 5 - July 6th - 10th, 2020 "Fly high with STEAM! - Aviation & Aeronautics"		$150.00
Summer Camp Registration: Week 6 - July 13th - 17th, 2020 "I see STEAM in 3D - 3D Amazement"		$150.00

Review Order

Item Name	Item Price	Quantity	Actions
SubTotal:
Special Offer Codes: Pay 50% of total as deposit. You will be invoiced for the remaining balance. Please Note that your registration is not complete until payment is made in full two weeks prior to the first session start date. If payment is not completed by the due date on the invoice, by checking this box, you agree to have the remaining balance automatically withdrawn from your credit card should your invoice become overdue.
Total:

Contact/Billing

Please Enter Your Contact/Attendee Information Below:

First Name (required)

Last Name (required)

Email Address (required)

Company

Address1 (required)

Address2

City (required)

Country (required)

State (required)

State Other(required)

Zip (required)

Phone

Please Enter Your Billing Information Below:

Same As Contact

Billing First Name (required)

Billing Last Name (required)

Billing Email Address (required)

Billing Company

Billing Address1 (required)

Billing Address2

Billing City (required)

Billing Country (required)

Billing State (required)

Billing State Other(required)

Billing Zip (required)

Billing Phone

Payment Complete*
- Yes
Name
This field is for validation purposes and should be left unchanged.

Name of Medication	Amount Taken	Frequency Taken	Scheduled Time

Name of Medication	Amount Taken	Frequency Taken	Scheduled Time

Name of Medication	Amount Taken	Frequency Taken	Scheduled Time

Name of Medication	Amount Taken	Frequency Taken	Scheduled Time

Name of Medication	Amount Taken	Frequency Taken	Scheduled Time

STEAMLife Registration

SteamLife Summer Camp Registration

Step 1 of 5

Survey Questions

Child or Children's Information

Parent/Guardian Information:

Dismissal & Emergency Contact

Medical/Healthcare Information

Daily Medication

Child 2 Medical Information

Child 3 Medical Information

Child 4 Medical Information

Child 5 Medical Information

Child 6 Medical Information

Enrollment Contract

Signature

STEAM Summer Camp Policies

Code of Conduct

Discipline

Dress Code

Cell Phone/MP3/IPOD/IPAD/Tablets Policy

Personal Items