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SUMMER CAMP STUDENT REGISTRATION FORM
Student Information
Last Name
First Name
Date of Birth
date_range
Entering Grade(25-26 school year)
Address
Apt
City
State
Zip
Cell Phone Number
phone
Home Phone Number
phone
Student currently enrolled at NFEI?
Parent/Guardian Information
Nameyour full name
Contact Number
phone
Alternate Phone
phone
Name
Contact Number
phone
Alternate Phone
phone
Emergency Contacts
Name
Relationship to child.
Contact Number
phone
Allowed to pick up child?
Name
Relationship to child.
Contact Number
phone
Allowed to pick up child?
Student Allergies
Student Medications
TRAVEL ARRANGEMENT DECLARATION

NFEI's Summer Program acknowledges two forms of transportation for participants.  Please indicate below which form of transportation your child will be using.



Form of Transportation
PARENT/GUARDIAN MEMO OF UNDERSTANDING AND PERMISSION
  • I have enrolled my child in the NFEI Summer Program.
  • I recognize the Program hours of operation.
  • I understand the NFEI Summer Program will follow the school closing calendar and inclement weather policy. All other closings will be notified in advance.
  • I understand that I shall be notified should my child become ill during Program hours, and that it will be necessary to make arrangements to have my child picked up as soon as possible after notification.
  • I understand that as a participant in the Program, my child will have access to a variety of technological equipment. I understand that I am responsible for the cost of replacement/repair of this equipment or material if damaged due to misuse by my child.
  • NFEI Summer Program staff, tutors, and program evaluators have my authorization to obtain and review certain school records needed to help plan appropriate support services and provide date required in the program reports to the Federal Government. All records and information about the students will be kept confidential.
  • I understand that if my child misses (3) unexcused days of the Program, he/she might be withdrawn from the Program.
  • I understand that the NFEI Summer Program administration has the right to dismiss my student from the program due to exhibition of poor behavior or any other violation of the NFEI Student Code of Conduct.
  • NFEI Summer Program activities may include positive youth development workshops, sports, and other physical activities. I understand that a risk of injury exists when students participate in the above mentioned activities.
  • I have read the above statements and give my permission for my child to participate in program activities and NFEI has my authorization to use photographs, reproductions, and any sound recording of my child for promotional purposes.



Parent/Guardian SignaturePlease enter your full name as acknowledgement to the above.

Release Waiver

In consideration for my child’s (children) acceptances, I/we waive and release North Florida Educational Institute (NFEI), and/or its agents, related companies, contractors, employees, insurers, successors and assigns from all claims, demands, causes of action, damages or suits at law and equity of whatsoever kind, including but not limited to claims for personal injury, property damage, medical expenses, loss of services, on account of or in any way related to or growing out of my child’s attendances and/or presence at their facility or use of the facility and/or equipment. This waiver and release is intended to and does release NFEI from any and all liability for damages or injuries on account of or in any way related to or growing out of my negligence, my child’s negligence, the negligence of another students, an employee’s negligence and/or the negligence of third parties, including but not limited to negligence in the construction, maintenance and upkeep of the facility and its equipment, negligence in training, negligence in supervision and/or any other types of negligence not specified. I/we further agree not to institute any claims or legal action against NFEI and/or its agents, related companies, contractors, employees, insurers, successors and assigns for any claim released by this Agreement. I recognize that as the parent/legal guardian of my child I am assuming all risk and responsible of their actions.

While at the facility and/or in attendance, I/we agree to conduct myself/ourselves in a responsible manner and will refrain from engaging in inappropriate conduct, including the use of loud, foul, slanderous language or any intimidating or offensive conduct that would interfere with the peaceful use and enjoyment of others.



Hold Harmless

North Florida Educational Institute (NFEI) strives to provide a safe, clean, and caring environment for all students. However, from time to time accidents happen, including but not limited to; student’s breaking limbs, slip and fall, cuts, bruises, etc.

By signing this Agreement, I agree and understand NFEI, its staff members, teachers, board members, insurance provider, bus drivers, and/or any affiliates cannot be held responsible or liable for any injuries. I also understand and agree that I am responsible for all out of pocket medical bills, ambulance charges, co-pays, and any other expenses regarding my child and/or family member(s). If my insurance company denies or attempts to collect expenses paid out, it is my responsibility to pay these costs. Furthermore, NFEI shall not be held responsible for any actions or injuries caused by another student. This includes summer camp, field trips, bus transportation, van transportation, recess, before school, during school, after school, extended care, as well as all school activities (Basketball, Football, etc.)


Parent/Guardian SignaturePlease enter your full name as acknowledgement to the above.
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