Westport Summer Programs Registration

Child's Namerequired

First Name

Last Name

Date of Birthrequired

Gender

My Child Identifies As

Is your child currently a student at Ridgefield Academy or Landmark Preschool?required

Yes

Current Teacher

I would like to enroll m child in the following program:required

REGISTRATION

Fees are $450/session (Weeks 3: $360). Extended hours are available by request and prior arrangement from 8:30am to 3:00pm at an additional fee of $16/hour.

Before registering, please familiarize yourself with the updated Health & Safety Guidelines and Updated Refund & Withdrawal Policies.

I would like to enroll my child in the following session(s):required

I would like to enroll my child in the following 3s session(s):required

I would like to enroll my child in the following 4s session(s):required

I would like to enroll my child in the following 5s session(s):required

Before Care is offered from 8:30am until 9:00am and After Care is available from 2:00pm until 3:00pm at the rate of $16/hour (by cash or check, payable to Ridgefield Academy). All Before and After Care charges must be paid in full to the Westport main office at time of service.

Will your child need Before/After Care?required

Yes

PARENT INFORMATION

Parent's Namerequired

First Name

Last Name

Primary Email Addressrequired

Street Addressrequired

Cityrequired

Staterequired

Ziprequired

Home/Cell Numberrequired

Secondary Phone

What brought you to our website today?required

If other, please specify

EMERGENCY INFORMATION

Please list an emergency contact other than a parent.

Namerequired

First Name

Last Name

Day Time Phonerequired

PICK UP AUTHORIZATION

The following people are authorized to pick up my child from camp (in addition to parents)

Name

Day Time Phone

Name

Day Time Phone

Name

Day Time Phone

Terms of Servicerequired

I agree to the Terms of Service indicated below:

I understand that Landmark Preschool (Ridgefield Academy, Inc) is a non-profit organization which makes its facilities, programs and activities available to persons only on the condition that they agree to assume complete responsibility for any injury or damage. I acknowledge that Landmark Preschool (Ridgefield Academy, Inc.) programs and activities may involve risk, and assume those risks for my child. Further, in consideration of acceptance of my child into the Landmark Preschool (Ridgefield Academy, Inc) camp and/or its sponsored programs and activities, I release and agree to hold harmless Landmark Preschool (Ridgefield Academy, Inc.) its officers, directors, employees and staff from any claims or damage or loss (including but not limited to physical injury, and property damage) that may occur as a result of my child’s participation in any Landmark Preschool (Ridgefield Academy, Inc.) sponsored program or activity. I hereby give the foregoing release on behalf of myself, my child, and all family members of either of us, and confirm that I authorize to do so. I understand that Landmark Preschool (Ridgefield Academy, Inc.) does not carry medical/accident insurance, and that I am responsible for any and all charges for medical treatment, property damage, or acquiring my own insurance. I acknowledge that participation in Landmark Preschool (Ridgefield Academy, Inc.) sponsored activities is conditional upon compliance with all applicable rules and policies established at Landmark Preschool (Ridgefield Academy, Inc). I further acknowledge that Landmark Preschool (Ridgefield Academy, Inc.) sponsored activities and participants may be photographed, filmed or videotaped from time to time, and hereby consent use of my child’s picture and likeness for Landmark Preschool (Ridgefield Academy, Inc) related promotional purposes without further consideration. Finally, I agree to abide by those rules and guidelines adopted by Landmark Preschool (Ridgefield Academy, Inc) in response to the COVID-19 pandemic and hereby release Landmark Preschool (Ridgefield Academy, Inc) from any claim related to COVID-19.

Upon submission, your card will be charged the full amount for all camps selected. Before registering, please familiarize yourself with the updated COVID Guidelines and Updated Refund & Withdrawal Policies.

Payment Information

Please select a payment typerequired

Card

Billing Addressrequired

Address

City

State/Province

Country

Zip/Postal Code

Cardholder Namerequired

First

Last

Card Numberrequired

Expirationrequired

CVV Numberrequired