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The Symbolic Art Learning Center
Where Cultures Connect
Thank You For Supporting Symbolic Art Programming
The Symbolic Art Learning Center, 2021
Please note that all fields followed by an asterisk must be filled in
*
Indicates required field
Section #1 ~
Child's Information
Name of Child Enrolled
*
First
Last
Only include the first child's name. Siblings must be entered in "Section #2
DATE OF BIRTH
*
Name of School
*
"ANY" SPECIAL NEEDS STAFF NEED TO BE AWARE OF? (N/A) IF NOT APPLICABLE
*
Any allergies? N/A if not applicable
*
Section #2 ~
Sibling's Info
Insert The Name(s) of Sibling(s) "N/A" if Not Applicable
*
If there are no siblings please insert "NA" and move to section #2
Sibling(s) Date of Birth
*
Please enter the name of each sibling being enrolled in camp along with their date of birth
Sibling(s) Allergies or Special Needs? N/A if not applicable
*
Insert the name of the Last Symbolic Art Program Enrolled
*
How Did You Hear About Symbolic Art Learning Center?
*
Section #3
Enrolling Parent/Guardian Info
Parent or Guardian's Name
*
First
Last
The "Enrolling Parent or Guardian" is the only person who can make changes related to child(ren)
Parent or Guardian's Email
*
Alternate Email
*
Alt Phone#
*
Insert The Name & Phone Number To Receive Text Messages
*
Insert Home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Section #4
Emergency Contact Info
1st Emergency Contact's Name N/A if Not Applicable
*
First
Last
[object Object]
Phone# N/A if Not Applicable
*
2nd Emergency Contact's Name N/A if not applicable
*
First
Last
Phone# N/A if Not Applicable
*
Insert Name(s) of anyone other than parent, guardian or emergency contact who may pick up Child(ren)
*
Designated persons who pick up "MUST" be prepared to show an approved I.D. upon request
Symbolic Art Learning Center
2402 N. Tenaya Way
Las Vegas, NV 89128
Hours: 7:00 am - 6:00 pm
SymbolicArtCenter@gmail.com
Symbolic Art Program Notes:
Participants must pack a cold lunch, a water bottle with name written in permanent marker and at least two snacks for AM (9:30 am) & PM (4:00 pm)
Participants should pack personal size hand sanitizer (w/at least 60% alcohol), wet wipes & Kleenex
Participants "
Cannot
" bring the following into the learning center: electronic devices except mobile communication *limited use during the day, stuffed animals, toys or blankets from home
Parents "
Must
" read, sign and return the signature page from the Parent Handbook
Fee Disclosure*
An 'annual' registration fee: $25 is required for each new participant not currently enrolled in other Symbolic Art programs; Symbolic Art Learning Center weekly rates:
*$95 1st Child & $85 Siblings
*Enrollment fees are non-refundable in the case a participant is absent from the program.
Daily/Drop-In
: *
We are Not currently accepting drop ins
~ No Programming Dates: **
Thanksgiving, Christmas Day, New Year's Day, Good Friday, Nevada Day, Independence Day
. A portion of participation fees may to applied to future Symbolic Art seasonal activities, programming or special events at the sole discretion of the Symbolic Art Administrator. Payments may be made in cash, money order or credit card. Payments will only be accepted from adults listed on this form.
A $10 late fee will be assessed for each :15 minutes past 6:00 p.m. (e.g. 6:05 pm / pick up = $10)
Agree & Consent
*
I understand the above and consent
Sign-In & Sign-Out
To protect the safety of our children I understand each child must:
Not enter the learning facility with a cough that cannot be attributed to another health condition
Not enter the learning facility with a condition of shortness of breath that cannot be attributed to another health condition
Not enter the learning facility with any two of the following symptoms: Fever (100.4 F or higher), chills, repeated shaking with chills, muscle pain, headache, sore throat or new loss of taste or smell
Not enter the learning facility if the child had come into close contact (within 6 feet) with someone who has a laboratory confirmed COVID-19 diagnosis in the past 14 days
Participants will be escorted to and from the learning facility by Symbolic Art Staff. Parents/Guardians/Visitors will not be permitted inside the learning facility.
The only person(s) authorized to pick up the child(ren) are those listed on this form; photo ID must be shown.
Agree & Consent
*
I understand the above and consent
Children "will not" be released without proper identification "and" prior written authorization from enrolling parent/guardian. *Authorization via Email is acceptable
AGREE & CONSENT
*
I understand the above and consent
In the case of joint custody disputes - Symbolic Art staff will comply "Only" with "Written" instructions directed by court order on file with Symbolic Art (if applicable)
AGREE & CONSENT
*
I Understand the above and consent
Waiver of Claim*
For ourselves, and/or on behalf of our child named above, our heirs, executors, and administrators, we hereby do expressly and forever waive and hold harmless Symbolic Art Central, Inc dba Symbolic Art and their respective officers, employees, agents or representatives from any and all liability for personal injury or damages, sustained, incurred, arising from and/or connected with travel to, return from any and all classes, activities, tournaments and/or special events, and all activities related to, or in connection with said activity by ourselves or by our child. *Symbolic Art is a community based organization focused on making sports, recreation and artistic expression fun for youth ages 5-12.
During programs or events sponsored Symbolic Art staff may take photos of participants that may be used in professionally designed publications, Symbolic Art websites, social media platforms and other promotional materials.
AGREE & CONSENT
*
I understand the above and consent
Parent Letter*
I have received, read and understand the contents of the
parent letter
AGREE & CONSENT
*
I understand the above and consent
Please Type Your Name to Acknowledge An Acceptance of Symbolic Art Terms & Conditions
Name
*
First
Last
Submit Registration Form
The Learning Center
Programs at TLC
>
Crossfit Combine Fitness
Youth Activities & Events
In The Community
SEASONAL YOUTH CAMPS
