EmailMe Form - 2021 Onstage - Kids 'N Dance Summer Camps (1wk)

Child's Name *

First Last

Age *

Birthdate *

Grade *

Week we will add you to waitlist *

Additional Camps We Would Like to be WAITLISTED

Week/Camp Name

Are you registering to be a CIT for this camp? *

Yes - I'm registering my child to be a Counselor in Training

No

Email

Phone

### - ### - ####

PAYMENT TERMS

- Cost for the 1 week camp is $390.00 and must be paid in full

Use of Credit *

I do not have a credit to apply.

I believe I have a credit to apply. Please apply the credit and charge my card on file for the balance. If I don't see an email confirming the purchase within a day I know it is important to email you to confirm I am enrolled.

IMPORTANT: If we do not have a current/valid credit card on file we can not enroll you for the camp. Do not consider yourself enrolled unless you have provided payment for the balacce

Refunds *

I agree to the terms listed below

Full refunds before March 1, 2021. No refunds after March 1. If Alameda County Dept of Health mandates camp closures, this program is eligible to be designated Day Care from Community Care Licensing so campers can still attend and no refunds will be provided. If your child is ill we require a doctor's clearance to return, or a documented negative Covid test. In this case, or if your child needs to quarantine due to possible exposure to Covid, a prorated credit will be applied to your account for the days missed. Days missed for reasons other than illness/quarantine (like family vacations) will not be eligible for credit. Again, refunds will not be provided for missed camp days.

CONTACT INFORMATION

Family Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Primary Parent Contact *

First Last

This person is the parent that should be contacted if there is confusion at pick-up time or about billing concerns.

Primary Parent's Phone Numbers - Please list all possible numbers in the order they should be called. *

Primary Parent's Email *

Secondary Parent Contact

First Last

Secondary Parent's Phone Numbers - Please list all possible numbers in the order they should be called. *

Emergency Contacts: Please list at least one name and number as an emergency contact

Alternate Persons for
Pick-up

This is only for emergencies and they should know that they can not enter the building.

Late Pick-Up *

Yes - I give permission to charge my card $1/min after 15 minute window for pick up

- Charges of $1/minute will accrue after the end of camp

MEDICAL / DENTAL INFORMATION

Permission to seek medical
attention *

Yes

In the event of an emergency, as the parent or authorized representative I give my consent for Kids ‘N Dance staff to use their best judgement to secure proper medical or dental treatment for my child if our physician can not be reached. Care will be prescribed by a duly licensed physician, osteopath or dentist for the above named child. This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of the child. I acknowledge that the costs of any medical treatment provided not covered by medical insurance is our sole responsibility

Allergies/Special Needs
List any pertinent health concerns:
- allergies
- medication
- diabetes, asthma, etc.
-PLEASE LIST IF CAMPER HAS EPI PEN

Please list any allergies and actions needed to be taken if exposed to allergen. Use this space to inform us of other medical considerations as well.

OFF SITE WALKING EXCURSION FOR PICNIC LUNCH

Permission to walk one block to the grassy area at Laurel School for eating *

Yes - I give my permission for my child to participate

Campers are strictly supervised to stay on the sidewalk. This allows for safe outdoor socially distant eating. Alternatively, we may have access to a tented/fenced parklet if we get city permission

POLICIES REGARDING REDUCING THE RISK OF COVID-19 TRANSMISSION

Adult Mask Requirement *

Yes - I understand and agree to adhering to this policy

All adults are required to wear a mask during check in

Child Mask Requirement *

Yes - I understand and agree to adhering to this policy

Children will be asked to wear a mask at all times unless they are eating and are socially distant. They should come in their own well fitting 2 layer mask or a Kn95 mask.

Only campers are allowed in the facility and back yard. *

Yes - I understand and agree to adhering to this policy

Unless there is an extenuating circumstances, family members of campers must not enter the facility

Social Distancing Requirement *

Yes - I understand and agree to adhering to this policy

Adults will be asked to adhere to staying 6ft apart from others and model the same expectation for their children.

Drop Off & Pick Up Sign-In Policy *

Yes - I understand and agree to adhering to this policy

- I understand staff will sign my child in on my behalf.
- I will be required to answer questions regarding contact with others and health of those in the immediate family at sign in. TIME MUST BE ALLOTED TO ALLOW FOR THIS TO BE DONE WITHOUT PRESSURE
- Temperatures of children attending will be taken and recorded upon sign in

DROP OFF/ PICK UP
- We start screening for camper arrival at 9:00.
- Campers can start to be picked up in the 15 minute window BEFORE camp ends. We appreciate you making every effort to pick up your child on time.
- Charges of $1/minute will accrue after the 15 minute window of time to pick-up campers.

Illness Policy *

I understand and agree to adhering to this policy

- If your child is sick, exact symptoms need to be reported immediately.
- Campers showing any signs of illness (congestion, runny nose, sore throat, stomach discomfort, headache) must not attend and need to get clearance from a doctor and / or a negative Covid test to return
- Mid-day illness: Children will have to picked up immediately if they show signs of illness mid-day
- We must be notified immediately if any member of the family or the camper has been diagnosed with Covid

Quarantine Policy *

I understand and agree to adhering to this policy

I will inform you immediately if my chlld has had potential exposure to Covid and will quarantine for the period required by current Alameda County Health Department guidelines

COVID Liability Release *

My signature on this enrollment form shows agreement of the Liability Release as listed below.

Onstage - Kids 'N Dance 'N Theater Arts, LLC (KND) has put in place preventative measures as recommended by the CDC, California and Alameda County Health Departments to reduce the spread of COVID-19. These measures are itemized in our Site Specific Covid Protection Plan and represents the policies and procedures we implement to help prevent the spread of Covid-19 to those in our daycare program and the family members that drop them off.

However, KND cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending KND could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending KND and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at KND may result from the actions, omissions, or negligence of myself and others, including, but not limited to, KND
employees, program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at KND.

On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmlessKND, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of KND,its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in KND programs.

Commitment to Following Safety Protocols *

Yes - I understand and agree to adhering to this policy

- I understand that if any family members refuse to adhere to our protocols after being reminded, they risk the child being dismissed from the program without advanced notice. Documentation of the reminder provided and policies not followed will be provided. No refunds will be provided if asked to leave the program
- Children will be taught safety guidelines for participating in our program. We understand that they will not always remember but must always be willing to follow directions when reminded. If they seem to have difficulty with following directions and we feel it may potentially compromise the health of others in the program, the family will be notified and if not improved dismissal from the program is possible. Under these circumstances, refunds will not be provided.

OTHER HELPFUL INFORMATION

Social/Emotional Needs

- Are there social/emotional needs we should be aware of?
- What methods are used at home to encourage positive cooperative behavior?
- It is helpful for us to know in advance if your child has a diagnosis or habits of behavior that may need guidance in a group setting

Behavior Policy *

I understand the behavior policy and understand that my child may be removed from the program without a refund for severe or repeated violations of the policy.

In the interest of creating a safe and fun for campers, all are required to follow staff directions, act respectfully to staff and other campers, not compromise the emotional and physical safety of others and follow Covid safety protocols. Parents will be informed if a camper has been unable to meet these expectations and a behavior plan will be implemented allowing for no more than 3 violations. If the behavior does not improve Onstage Kids N Dance N Theater Arts has the right to remove the camper from the program with no refund. Severe violations may warrant immediate removal with implementation of a behavior plan.

ALMOST THERE ......

Release of Liability *

Yes

Checking "Yes" indicates you agree to the following: I voluntarily enroll my child with full knowledge that there is risk of personal injury in activities affiliated with KND (including but not limited to playing on gymnastic and play structure equipment). I agree neither I, my heirs, assigns or legal representatives will sue or make any other claims against Kids N Dance/Onstage, its members or employees for any degree of personal injury or property damage/loss, regardless of cause.

Photo Release *

Yes

No

Checking "Yes" indicates you agree to the following: I grant Kids 'N Dance 'N Theater Arts representatives and employees the right to photograph my child in Afterschool Program activities. In addition, I authorize Kids 'N Dance 'N Theater Arts to copyright, use and publish photographs of my child in marketing materials such as brochures and on Facebook.

Questions? Comments? Concerns?

Payment Required to Complete Enrollment *

I understand that I will be directed to a payment screen to compelete my enrollment. Completing this form DOES NOT mean your child is registered for the camp.

DO NOT COMPLETE PAYMENT IF YOU HAVE A CREDIT YOU NEED TO APPLY. If you indicated you have a credit we will process your payment manually.

Current Credit Card Info Needed *

I understand that I should update my card if I have a balance to pay after using my credit. YOu can do this directly on Mind Body

You are not enrolled unil full payment is made

Signature

IMPORTANT

Completing this form DOES NOT mean you have registered for for the camp. ENROLLMENT IS COMPLETE ONLY AFTER PAYMENT IS MADE *

Clear

Your signature indicates agreement to our registration terms It also signifies consent for items indicated in this completed form.

Printed Name *

First and Last Name of person that completed the form and signed above.