Transcript Slide 1
2015 TPS Summer Camp Registration Camp period 6/1-7/17 (vac. 6/29-7/3) T-Shirts size: Kid( Student's Name 학생이름 ) Youth( Ko한 B-day 생년월일 En영 Age 나이 ) Adult( ) Registration # Sex 성별 Grade 2014Fall After School F M Yes/ no Email Address School 학교 Language Class Address 집주소 부 Parents' Name 부모이름 Father 모 Mother Phone 전화 M Phone 전화 D Phone 전화 H Ko한 En 영 Ko한 En 영 Name 이름 Relationship 관계 School 학교 Korean / ESL Age 나이 R 등록 Siblings 형제관계 Emergency Contact 비상연락처 Name 이름 Relations 관계 Phone 전화 Name 이름 Relations 관계 Phone 전화 Special Needs 특이사항 *학생의 음식에 관한 주의 사항이나 건강이나 특이상황 등을 반드시 적어 주세요. Carpool#________ 1차 납입(등록비) 2차 납입(4/20) Afterschool Cash ($ Cash ($ Cash ($ )/ Check($ )/ Check($ )/ Check($ /# /# /# ) ) ) TPS Summer Camp 2015 Refund Policy(반환금 규칙) Registration Fee is Absolutely Nonrefundable. 등록비는 반환이 되지 않습니다. Only the Tuition Portion is Refundable upon these dates: 아래와 같이 기간에 따라 수업료에 대해서 반환 됩니다 Before May 22 – 90% of Tuition After May 22 to 31 - 80% of Tuition 1st week of Camp – 70% of Tuition After the 1st week of Camp – There is No Refund. ____________________________________________ Child’s Name I understand and acknowledge the refund policy stated above. 서명자는 위의 반환금 규칙을 이해하며 이 규칙을 따르기로 하겠습니다 . ______________________________________ Parent Signature ___________ Date Picture Release Form I give permission for the T.P.S Summer Camp to use my photo in published articles, website, newsletters, flyers, posters, brochures ,News paper advertisement and presentation materials (ie. PowerPoint presentations). Date _____________________ Student’s grade _____________________ Student’s Name_____________________ Signature of Parents_____________________ TPS Summer Camp (TPS 여름 캠프) PARENT’S MEDICAL RELEASE FORM Medical Information Child’s Name: ________________________ Birthdate: ___/___/___ Age:_______ In case of emergency contact:____________________ Phone: _____________________ Allergies: ________________________________________ Special needs, medications, or instruction: _____________________________________ Child’s Physician:_____________________________ Phone: _____________________ Do you have health insurance? Yes_____________ No_____________ Insurance Company: _________________________Policy#:_______________________ Medical Release-“In the event that I cannot be reached in an emergency, I hereby give my permission to the physician or dentist selected by TPS Summer Camp leadership to hospitalize, secure proper treatment as deemed necessary.” Liability Release- Every activity sponsored by TPS Summer Camp is carefully planned and adequately supervised by adults. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, the parent or guardian agrees to assume and accept all risks and hazards inherent in transportation to from the planned activity and in any possible physical injuries that may be sustained as a result of participating in any activity on or off school property. They also agree not to hold this camp or its employees or volunteer assistants liable for damages, loses, or injuries to the person or property undersigned. By signing below I am acknowledging that I understand and I am agreeing to the Medical Release and Liability Release and that I am a parent or guardian with legal custody of the minor listed above. Parent or Guardian: _________________________________________ Date: ___________________