EM-Registration Form-SUMMER2022-Coral Park ES-SE Site

EM Registration Form-Coral Park Site

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*** SUMMER ENRICHMENT REGISTRATION FOR THIS SITE IS PENDING (APPLICATIONS NOT ACCEPTED YET) ***

WEEKLY PRICE: $90 + Enrichment Trip Fee (Optional)

Select The Student's Actual School:

Select Student's Grade:

Enter Student's Last Name:

Enter Student's First Name:

Enter Student's Date Of Birth:

Student T-Shirt Size:

Siblings In Program:

If "Yes", Name Of Sibling(s):

Enter Guardian 1's Last Name:

Enter Guardian 1's First Name:

Enter Guardian 1's Email Address:

Enter Guardian 1's Cellphone Number:

Enter Guardian 1's Work Number:

Enter Guardian 2's Last Name:

Enter Guardian 2's First Name:

Enter Guardian 2's Email Address:

Enter Guardian 2's Cellphone Number:

Enter Guardian 2's Work Number:

Select Dismissal Method From EM:

List Names & Numbers Of Those Authorized To Pickup The Student:

Acknowledgement 1:

I acknowledge that Enrichment Masters is not a childcare provider and as such does not provide, store, or administer medications for any participant

Acknowledgement 2:

I acknowledge that Enrichment Masters does not provide snacks or lunches for participants and any food or beverages consumed by participants are provided by (whether purchased or prepared) the participant's guardian

Acknowledgement 3:

I acknowledge that Enrichment Masters does not provide medical staff/aides (e.g. nurses, mental health specialists) for student participants. As such, any participants who require such accommodations are encouraged to be registered into a program that is equipped with the necessary support that enables the participant to have a successful and enjoyable experience

Electronic Signature:

By checking this box, I acknowledge that I have read the terms above as well as those listed in the Parent Terms of Agreement and agree to adhere to the terms

Parent Terms Of Agreement

Enrichment Masters is provided by VF Business Group, Inc., WEECorp, and Son Extended, Inc.

Address: 6919 W. Broward Blvd. Ste. 263, Plantation, FL 33317; Phone: 954-641-8774

Disclaimers

Parental Terms

Terms and Conditions