Summer program registration

Thank you for your interest in our Summer Program 2019.

Please fill out this form to register for the program.

Should you have questions, please contact us or call 415.800.0730.

We look forward to meeting your family!

Child :

Address:

 

 

Mother :

( format must be in xxx-xxx-xxxx )
( format must be in xxx-xxx-xxxx )
( format must be in xxx-xxx-xxxx )

 

 

Father:

( format must be in xxx-xxx-xxxx )
( format must be in xxx-xxx-xxxx )
( format must be in xxx-xxx-xxxx )

 

Permission to have someone else pick up your child.

I hereby give my permission for the following people to pick up my child.

 


Add Another

 

 

Emergency contact names and phone number (if parent is not available):


Add Another

Health:

Registration Camp date's:

Program place: San Francisco Pacific Academy, 3301 Balboa St, San Francisco, CA 94121

Program Time:  8:00 am  -  5:30 pm, Monday– Friday

Program Fee: $480.00

Fees for one t-shirt with logo, all instructional materials, entrance and show tickets, public transportation transfers are included. 

Snacks/Lunch not included.

Yes
Yes

 

 

CONSENTS

RELEASE:   I give permission for my child to take part in all SFPA Summer Program’s activities, including field trips and visiting playgrounds. I agree that, to my knowledge, my child is physically and medically able to participate in these activities. I understand that my child is expected to abide by rules set by the SFPA’s staff and that they take every precaution to ensure the safety of all children during the above said activities. I understand, however, that accidents do occur and agree that I will not hold San Francisco Pacific Academy, its personnel, or the chaperones responsible for any accidental harm that may befall my child. 

Please sign your name below.

PHOTOGRAPHIC RELEASE:    I agree without compensation to permit San Francisco Pacific Academy employees and authorized staff to use photographs of my child for the use and benefit of SFPA in its publications and other institutional development and promotional programs. This release shall continue in force until specifically revoked. 

FEES: The school does not provide any refund or waiver of fees due for dismissals, withdrawals or absences. The school does not prorate or refund fees for the current week.

I understand I need to pick up my child before 5:30pm. I will accept the charge of $1.00 per minute for each additional minute my child is being supervised.  I agree to pay that sum on the following day, prior to the beginning hour of the Program. Otherwise, my child will not be allowed to the Program until I pay the late fee charge in full.   

Please sign your name below.

SCHOOL PROPERTY DAMAGE: 

I assume all financial responsibility for any of my child’s action that cases any and all kinds of damage of the school’s property and building including but not limited to school materials, furniture, equipment, and other.

Please sign your name below.

 


 

Name of either parent/guardian is sufficient to make this rules binding on both parents/guardians.

Thank you!



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