UAS Summer 2019 Registration Form

UAS SUMMER 2019 REGISTRATION FORM

Before you fill out the form, you must read through our UAS Summer 2019 policies on cancellation and age range.

Registration is a three-step process:

1. Fill out and submit this registration form and click "Submit." You'll be automatically redirected to a page acknowledging that we have received your form.
2. We'll confirm that we have space in the session(s) you've signed up for, and a member of the UAS staff will send you payment instructions from our general email address, info@urbanadventuresquad.org (please add this address to your contacts). Please be patient. We have a very small staff and this can take a few days.
3. After you have successfully submitted payment, your registration is complete!

* Indicates required field

Name of Squad member *

First

Last

Name of parent or legal guardian *

First

Last

Email of parent or legal guardian *

Confirm email of parent or legal guardian *

Phone number of parent or legal guardian *

Squad member date of birth *

HOME AND SCHOOL INFORMATION (* indicates required field)

School *

If you chose "Other," enter school *

Rising grade (Child's grade in 2019-20 school year) *

If you chose "Other," pls specify *

If your student will be in grades 6, 7, 8 during the 2019-20 school year, 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 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. Our ratios of adults to children are between 1:6 and 1:8, and are designed for safety in the woods, on/along bodies of water, and on public transportation. Children in our programs must be able to manage themselves independently, and are expected to follow our rules of safety and conduct with limited prompting and reminders. *

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.

By typing my name below and clicking the "Submit" button, I acknowledge that I have read through, understand, and agree to the ULTC/UAS policies on cancellation and age range. (www.urbanadventuresquad.org/uas-summer-2019)

Because ULTC/UAS programs are based on adventures, including outdoors and on buses/trains, I understand that if my child is unable to follow the rules of safety and conduct with limited prompting and reminders, and/or 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) *

PROGRAM REGISTRATION: CHOOSE YOUR PROGRAMS
PLEASE CHOOSE CAREFULLY; UAS cannot offer full refunds for weeklong summer programs. Refunds--minus a $100 fee--are available only through April 26, 2019 for weeklong sessions. We cannot offer any refunds after April 26.

Choose Summer Programs *

June 17-21, POP-UP BAKERY at Temple Micah June 24-28, UAS PUBLISHING HOUSE at Temple Micah July 8-12, SURFIN' THE WAVES at Gallaudet July 15-19, BAT WEEK at Gallaudet July 22-26, HIDDEN HISTORY at Christ Lutheran Church July 29-Aug. 2, URBAN PLANNING at Stokes School Aug. 12-16, WALKING THROUGH TIME at Tudor Place Aug. 19-23, UAS PILLOW FIGHT at Temple Micah

Select Aftercare *

July 8-12 at Gallaudet, 4:30-5:30pm, $50 per child July 15-19 at Gallaudet, 4:30-5:30pm, $50 per child July 22-26 at Christ Lutheran Church, 4:30-5:30pm, $50 per child July 29-Aug. 2 at Stokes School, 4:30-5:30pm, $50 per child Aug. 12-16 at Tudor Place, 4:30-5:30pm, $50 per child I do not plan to enroll in aftercare

Submit

UAS SUMMER REGISTRATION﻿ FORM

UAS SUMMER
REGISTRATION FORM