Summer Program Participant Application

Thank you for purchasing your summer program package. To complete your registration process, please complete the application below for each program participant. You must submit the form multiple times to ensure each student is registered.

Summer Program Student Registration

Who is submitting this application?

Full Name
Full Name
First
Last

Enrollment Info

Student Information

Student Full Name
Student Full Name
First
Last
Student Gender

Parent / Legal Guardian #1

Full Name
Full Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Parent / Legal Guardian #2 (Optional)

Full Name
Full Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Student Release Authorization #1

Full Name
Full Name
First
Last

Student Release Authorization #2

Full Name
Full Name
First
Last

Student Release Authorization #3 (Optional)

Full Name
Full Name
First
Last
Are there any custody issues that we should be aware of?

Student Demographics

Question #1: Is your student enrolled in the Free or Reduced Lunch Program?
Question #2: Is your student designated as an English Learner (EL)?
Question #3: Is your student designated as a Special Education Student with an Individualized Education Plan (IEP)?
Question #4: Does your student have a 504 plan?
Question #5: Does your child have any medical conditions, allergies, or other special needs or problems we should be aware of?

Student Ethnicity Information (Optional)

Waivers & Disclosures

To participate in a Student Hires program, you must review the following waivers.
Student Photo / Video / Work Release Authorization
I hereby authorize Student Hires, its employees, and agents the right and permission to adapt, modify, reproduce, distribute, publicly perform and display, in any form now known or later developed, my child's image, name and voice, as well as writing and other work created by my child. These may be used in photos, videos, publications, social media, advertising, and any other manner without compensation to my child, myself, or other parents or guardians. I hereby acknowledge and authorize that by signing this waiver, I am giving up my rights and the rights of my spouse, children, and wards to sue Student Hires LLC in regards to this matter.
Student Information Release Authorization
As part of my student’s participation in Student Hires programs, the school or school district may share my student’s data to assist Student Hires in understanding my student’s needs and making programming decisions. Student Hires is authorized to administer surveys & assessments to gather student data in its programs.
Pickup Policy Authorization
By signing this waiver, I am agreeing to abide by the Student Hires LLC Late Pick-up Policy. This policy outlines requirements for picking up students on time. If I fail to pick-up my student on time as listed on the Late Pick-up Policy, I acknowledge that I may be fined and that my student may be removed from the program without receiving a refund of fees.
Medical Treatment Authorization
In the event of illness or serious injury, Student Hires is authorized to seek medical help and assistance by contacting emergency services for my student. I acknowledge that Student Hires is not responsible for providing medical coverage for my student. I also acknowledge that a medical personnel may or may not be available during program hours. Student Hires will not be held liable for any injuries incurred while attending our program. I hereby acknowledge and authorize that by signing this waiver, I am giving up my rights and the rights of my spouse, children, and wards to sue Student Hires LLC in regards to this matter.
Luv 2 Play Location Agreement
By signing this waiver, I am giving up my rights and the rights of my spouse and children and wards to sue Luv 2 Play - Chino, CA for any injury, including paralysis or death, caused in whole or in part by the negligence or fault of Luv 2 Play - Chino, CA.
Summer Program Participation Agreement
By signing this waiver, I am giving up my rights and the rights of my spouse and children and wards to sue Student Hires LLC for any injury, including paralysis or death, caused in whole or in part by the negligence or fault of Student Hires LLC.

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