Pay for Enrollment - MJ (Feb 2020)

2

Mar

*** NOTE: This Boot Camp is ONLY OPEN to SB School Students . REGISTRATIONS ARE FIRST COME FIRST SERVE BASIS ONLY ***

Program Dates for children in 1st and 2nd grades (Mondays): **THIS SESSION IS FULL**
Program Dates for children in 3rd to 5th grades (Tuesdays): 03/17, 03/24, 03/31, 04/21, 04/28 & 05/05

LeaderKid Academy “Two Step Process”

Please complete the following Two steps to enroll your child:

1. STEP ONE – AGREE TO ENROLLMENT TERMS and CONSENT and REGISTER: Complete one form per child and electronically sign your agreement to LeaderKid Academy’s Enrollment terms and Consent – Click ‘Submit’ to complete this step.
2. STEP TWO – Select program & PAY FOR ENROLLMENT: Please select the session that you would like to enroll your child for, enter the ‘Full Name’ of the child and teacher, then Click on ‘Pay Now’ to make payment.

If you have any questions, please email: info@leaderkidacademy.org

*** IMPORTANT – WHEN COMPLETING THE FORMS – PLEASE ENTER THE FULL NAME OF THE STUDENT (ACCURATE AND CONSISTENT WITH SCHOOL RECORDS) ACROSS ALL THE FORMS BELOW***

STEP ONE – AGREE TO ENROLLMENT TERMS and CONSENT and REGISTER

Full Name of Student: *

Classroom Teacher: *

Child's GRADE: *

Tell Us More About Your Child:

Please remember to list anything that can help us make your child's learning experience safe and enjoyable (think of medications, allergies, and/or any specific social emotional needs etc. etc.)

Emergency Contact Information:

Parent / Guardian Name: *

Parent / Guardian Email: *

Parent/Guardian Mobile Number: *

Parent/Guardian Home Phone: *

Home Address: *

Dismissal Arrangement: Please Select One: *

Name/s of Adults authorized to pick your child: *

(Proper identification will be required by anyone other than the parent who comes to pick up your child.)

ENROLLMENT TERMS & MEDIA CONSENT

By Completing the enrollment form and by selecting "I Agree" below - you agree to the LeaderKid Academy’s ENROLLMENT TERMS and CONSENT as follows:

1. Please be informed that your child will be photographed and videotaped while participating in the session/camp activities. These pictures/videos will be used by Leaderkid Academy in their training materials, for display on their public website, any print or promotional materials, and/or on social media sites for commercial purposes, and to enhance and build upon programs. No payment will be made for use of these photographs and/or videos. This consent is given in perpetuity and does not require prior approval by you.

LeaderKid Academy will not release or share student names, residential address, email addresses, & phone number without prior written consent from you as parent or guardian.

2. There are no refunds for classes missed by students. In the event of a snow day or instructor illness, a make-up class will be provided.

3. Classes charged in full (unless dropped 5 days prior to the beginning of the session) - All refunds are at the sole discretion of LeaderKid Academy.

4. I understand and agree that while Leaderkid Academy mentors encourage the children to feel important and take ownership of the activities and participation, the participant is responsible for behaving responsibly and being courteous and helpful to each other and to staff. And, participants’ behavioral expectations are clearly explained at the start of the program and reminders are given throughout the sessions in a timely fashion and whenever needed. Any ongoing behavioral issues will be communicated in a confidential manner to the child’s parent/guardian. However, should disruptive behaviors or persistent disregard for the rules continue, then LeaderKid Academy management shall reserve all rights to withdraw the child from the program.

5. I agree to release, hold harmless and indemnify LeaderKid Academy, its agents, representatives, and employees from any and all liability, loss, damages, claims or actions including bodily injury and/or property damage arising out of participation in this activity, in accordance with current state and federal law.

Please select "I Agree" and proceed to the next step.

By selecting "I Agree" your electronic signature serves as your authorization and acceptance to the LeaderKid Academy ENROLLMENT TERMS and CONSENT in its entirety and also serves as a release to LeaderKid Academy and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

Please Type your Full Name

By typing your name here, you are signing the LeaderKid Academy Terms and Consent electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this LeaderKid Academy Terms and Consent form.

Date Signed & Accepted:

STEP TWO – Select Program, Student & PAY FOR ENROLLMENT

REGISTRATIONS OPEN for 3-5 Grades ONLY

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