2018-19 School Year Registration Form

To register for Urban Adventure Squad's 2018-19 School-year Programs, please complete this form and choose your programs. This form is required for all new and returning families (one per child); we cannot register students without it.

CANCELLATION POLICY
Please choose your programs carefully; UAS cannot offer refunds within two weeks of the program day. Our programs require a high degree of research, planning, logistics, and care. We use registration numbers and fees to hire/confirm staff, and to develop and research program curricula. For the same reason, we cannot accommodate last-minute or walk-in registrations unless a child has been accepted from a waitlist.

If UAS must cancel a program due to circumstances beyond our control, such as inclement weather or a program location that is forced to close for the day, we will offer credit for future program days.

A minimum of 10 confirmed registrations at least one to two weeks ahead of a program is required in order to run it. If UAS is forced to cancel a program due to under-enrollment, we will offer refunds or credit days.

HOME AND SCHOOL INFORMATION (* indicates required field)

* Indicates required field

Name of Squad member *

First

Last

Name of parent or legal guardian *

First

Last

Phone number of parent or legal guardian *

Email of parent or legal guardian *

Confirm email of parent or legal guardian *

Squad member date of birth *

School *

If you chose "Other," enter school *

Grade in 2018-19 school year *

If you chose "Other," pls specify *

If your student is in grade 6, 7, or 8, are you interested in the UAS Middle School Leadership Program? (www.urbanadventuresquad.org/middleschool) *

Yes No

Address *

Line 1

Line 2

City

State

Zip Code

Country

ALLERGY INFORMATION

My child has allergies *

Yes (please specify allergies) No

List allergies here *

CURRENT MEDICATIONS (if none, leave blank)

We cannot administer medications, but we need this information in case of an emergency. Please list your child's medications here. *

Please use the box below to share any information that will help us understand the best ways to give your child a comfortable, enriching experience. This is optional, and can include information about behavior, learning challenges, special interests, or an IEP or 504 plan. *

WAIVER OF LIABILITY AND AUTHORIZATION FOR MEDICAL TREATMENT

I realize that no environment is risk-free despite a high degree of supervision, and I undertake to discuss with my child the importance of abiding by all Urban Learning and Teaching Center/Urban Adventure Squad (henceforth known as "ULTC/UAS") rules on conduct and safety. I understand that there are certain unavoidable risks associated with participating in ULTC/UAS programs. I acknowledge these risks and agree to let my child participate in all ULTC/UAS activities for the dates my child is registered.

Because ULTC/UAS programs are based on adventures, including outdoors (e.g., city streets, hiking trails, along bodies of water) and on buses/trains, I understand that if my child behaves in a way that risks my child's safety or the safety of any other children or adults affiliated with the ULTC/UAS program, I may be contacted by ULTC/UAS to pick up my child, and that my child may be barred from participating in future ULTC/UAS activities.

By typing my name below and clicking the "Submit" button, I hereby release Urban Learning and Teaching Center/Urban Adventure Squad and its trustees, officers, directors, and agents from all liability or claims, of whatever nature, arising from my child’s participation in ULTC/UAS programs. I further agree to indemnify and hold harmless Urban Learning and Teaching Center/Urban Adventure Squad and its officers, directors, and agents from any damage, including attorney’s fees, that may result from participation in ULTC/UAS programs.

If my child becomes seriously ill or injured while participating in a ULTC/UAS program, I authorize ULTC/UAS staff to call emergency medical services (911) as needed and/or take my child to a hospital, urgent care center, or physician for treatment. I accept responsibility for any expenses incurred in the medical treatment of my child, including any expenses that are not covered by my health insurance policy, or in the event that my child is not covered by a health insurance policy.

Name of parent or legal guardian *

First

Last

Today's date *

OPTIONAL PHOTO RELEASE

By checking "Yes" below, you authorize UAS to use your child's image for external outreach purposes. Default policy: we do not show faces or use names unless you opt in below. We do collect images, video, and audio for internal use and to share with registered families. *

Yes

EMERGENCY CONTACT INFORMATION
Please provide the best contact information for who we should contact in case of an emergency. At least one contact below should be a parent or legal guardian who will be reachable during the program.

Contact 1/Name *

First

Last

Contact 1/Phone *

Contact 1/Email *

Contact 2/Name *

First

Last

Contact 2/Phone *

Contact 2/Email *

Contact 3/Name *

First

Last

Contact 3/Phone *

Contact 3/Email *

Do UAS programs allow you to put in work hours?

Choose one *

How important is aftercare in your decision to enroll in UAS programs? (Choose the statement that best reflects your current opinion; we understand that this may change) *

I would like to be contacted about potential opportunities to be a guest educator, volunteer, or chaperone for a UAS program. *

Yes No, thanks Not at this time, but please try me again in the future

PROGRAM REGISTRATION: CHOOSE YOUR PROGRAMS
Please choose carefully; UAS cannot offer refunds within two weeks of a program day.

Select program(s) *

5/10, Lincoln's Cottage, $70/$50 per sibling 5/28, Temple Micah, $70/$50 per sibling 5/31, Lincoln's Cottage, $70/$50 per sibling

Submit

2018-19 School-YearRegistration FormREQUIRED FOR ALL NEW AND RETURNING STUDENTS

2018-19 School-Year
Registration Form
REQUIRED FOR ALL NEW AND RETURNING STUDENTS