REGISTRATION
Participant’s Last Name: Participant’s First Name:
Birth Date: Age: Grade: Gender: M/F
School: Homeroom Teacher: Room #
Parent/Guardian(s) Name:
Address:
City: State: Zip Code: Email (REQUIRED):_______________________________
Phone: Work (Daytime) Home Cell
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Name Relationship Phone Number
Release
Information
Please provide the names of
the individuals whom your child may be released to at
the end of the day. If a person comes to pick your child up and he/she is not
on this list, your child will not be released.
Name Relationship Phone Number
Name Relationship Phone Number
Name Relationship Phone Number
Name Relationship Phone Number
Emergency Information
Emergency Contact Relationship ________________________
Phone Number (not listed above)
_____________________________________ Cell Phone ________________________
Student’s Additional Needs/Allergies ____________________________________________________________________
*For the safety of your child it is important that you list any
and all allergies or special needs. Please speak with the instructor of
the class about any allergies/special needs listed above so that they may best
accommodate your child.
Transportation
will always drop off
child My child will always
take a Solon Bus*
*For busing, parents must fill out a Transportation Request Form to be kept on file at the Solon
Schools’ Transportation Department. Children WILL NOT be allowed to take the
bus to the Center unless they are registered to attend Arts4Kids that day.
Please make sure you read and understand the Arts4Kids Guidelines. These procedures must be
followed to ensure that your children can attend the program. For the
safety of all SCA students, the Arts4Kids
Guidelines will be adhered to AT ALL TIMES by SCA and your child’s school.
All of the information above is correct.
I have read and understand the Arts4Kids
Guidelines.
Name Date_______________________________________
Arts4Kids Late Fee Policy
Late fees of $20 per one-half hour interval, Monday –
Thursday OR $30 per one-half hour, Friday OR any part thereof will be assessed:
- Monday - Thursday:
Arts4Kids:
- Friday: Arts4Kids:
- Monday - Thursday:
Arts4Kids:
- Friday: Arts4Kids:
It is necessary
for you to pick up your child on time at either
I have read and understand the Arts4Kids Late Fee policy and agree
to abide by this policy
Signature____________________________________________________________________________ Date _____________________
Switching
Fee Policy
If your child tries one
discipline and decides he/she prefers the other, you may switch the day and/or
discipline within the first two weeks of the session if there is space
available. If you are switching days, you must let SCA know by
AUTOPAY PLAN
You may pre-register for future sessions using auto
pay. If you choose to utilize the auto pay program, you must do so during
the very first time you register for Arts4Kids. To enroll in the auto pay
program, you must place a valid credit card on file with SCA. This card will be
charged on the first day of registration for each session (at the time of
registration, 10/12, 12/14, and 3/8.)
Cash: ________ Visa:
________ MC: ________ Disc: ________ Amex: ________ Check
#: ____________
Charge No. for Automatic Payment
_______________________________________________________ Exp*_____________
*If card will
expire during the year, please provide an updated credit card for automatic
payment before current card expires
Auto Pay Approved Signature____________________________________________________________
Date _____________
Received
By: _________________________________________________________________ Date _____________
REFUND AND CREDIT POLICY – Refunds
during the student’s first week of classes will be given in
the amount of 50% of the registration fee. After the student’s first
week of Arts4Kids, there is a no refund policy. A $5 service charge will be assessed on any refund. Refunds are handled
through the City of
RELEASE – In consideration of permission granted to me
for my participation in a Solon Center for the Arts program and other valuable
consideration, I, the undersigned, on behalf of myself, my heirs, executors,
administrators and assigns, do hereby release and discharge the City of Solon,
its Arts Center, its officers, employees, officials, and agents, jointly and
severally from any and all claims, demands, actions, judgments and executions
which may arise out of my participation in a Solon Center for the Arts program. Further, in consideration of
permission granted to me for my participation in a Solon Center for the Arts
program, I hereby agree, on behalf of myself, my heirs, executors,
administrators and assigns, to indemnify any, all or a combination of the
aforesaid, jointly and severally and to hold and save harmless from and against
any and all actions, claims, demands, liabilities, loss, damage or expense of
whatever kind of nature, including attorney’s fees, which may at any time be
incurred by reason of my participation in any Solon Center for the Arts
program.
Signature of participant or
Parent/Guardian if participant is under 18 years of age Date