Monarch Academy School Registration

Monarch Academy School Registration
Parent/ Guardian #1 Name*
First Last
Parent Email*
Phone*
Start Date*
Date Format: MM slash DD slash YYYY
Please select the days you would like your child to attend school:*
If your child is attending Part Time, please select days:*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Child Information*
Child's Name DOB (mm/dd/yyyy) Healthcard #
Medical Information*
Each child's medical information is strictly for the use of Monarch Academy facilitators and will be kept private and confidential. Please indicate by name if your child(ren) has any of the following in order to help us ensure the safety and comfort of your child(ren) during the academic school year:
- medical condition (including the need to take medication)
- allergies (food, topicals (sunscreen, soap, sanitizer), animals, insect bites, etc.)
- special dietary requirements
Please write 'NONE' if your child(ren) have no such conditions
Emergency Contact Information

The parent/guardian listed above is the first person we will contact if your child has a medical emergency, needs to talk to you, or is late being picked up. Please provide an emergency contact person that will be available during school hours of 8am-5pm to deal with any emergencies or is otherwise needed to pick up your child(ren) from Monarch Academy if we are not able to reach you.
Emergency Contacts Information*
First Name Last Name Phone Relationship to Child
Alternative Person(s) for Picking Up Child(ren)

If you have an alternative person you would like to authorize to pick up your child(ren), please list them below.
Alternative Person #1 for Picking Up Child(ren)*
First Name Last Name Phone Relationship to Child
Alternative Person #2 for Picking Up Child(ren)*
First Name Last Name Phone Relationship to Child
Rules, Release and Indemnity Agreement

1. Daily Park Excursions

In order to maintain a healthy and active experience, children enrolled in the 2023/24 Monarch Academy Academic School Year Program will be brought in groups to either City View Park (800m approximately 10 min walk) or John Budd Cleary Park (900m approximately 11 min walk), weather permitting, under strict supervision from a minimum of two program facilitators. Children must exit the facility using the staircase in an orderly and quiet fashion holding the handrails at all times. Children will walk on sidewalks holding hands in an orderly fashion with a partner selected by the program facilitators. Children will not be allowed to run on the sidewalks that lead to the parks. Children must stay in the designated playground area visible to the program facilitators at all times. Children must use the structures at the park only as intended for use. If there is any breach by any child to the above rules, or there is any horseplay, silliness, or dangerous behavior, the child will receive a warning and will have to sit out the rest of that outing. You will be notified and will be asked to reinforce the rules described above to your child. If the child continues the same behavior on their next scheduled day then you will be notified to pick up your child immediately and the child will be removed from the program.

2. Health and Safety Protocol

You agree that you will not bring your child to school if he/she is experiencing symptoms of Covid-19 or other related communicable diseases.

3. Medical Emergencies

If your child is injured in a way that requires immediate professional medical attention, you will be contacted immediately so that together we can make the necessary decisions and take the necessary steps to best remedy the situation. If we are not able to reach you, however, you must grant us permission here to transport your child to a local doctor or hospital for medical treatment if necessary.

4. Indemnity

The risks associated with an academic school program for children, however minimal, can never be completely mitigated. As a consequence, you freely accept and fully assume all risks and acknowledge the possibility of, and agree to be solely responsible for personal injury, death, disability, property damage or loss resulting from the risks except where such arises as a result of the negligence or willful misconduct of Monarch Academy. You certify that your child(ren) have no pre-existing health or medical condition which could be triggered or exacerbated by participation in the activities or which could be expected to impact your child(ren)'s safety or the safety of others.
1. Daily Park Excursions In order to maintain a healthy and active experience, children enrolled in the 2023/24 Monarch Academy Academic School Year Program will be brought in groups to either City View Park (800m approximately 10 min walk) or John Budd Cleary Park (900m approximately 11 min walk), weather permitting, under strict supervision from a minimum of two program facilitators. Children must exit the facility using the staircase in an orderly and quiet fashion holding the handrails at all times. Children will walk on sidewalks holding hands in an orderly fashion with a partner selected by the program facilitators. Children will not be allowed to run on the sidewalks that lead to the parks. Children must stay in the designated playground area visible to the program facilitators at all times. Children must use the structures at the park only as intended for use. If there is any breach by any child to the above rules, or there is any horseplay, silliness, or dangerous behavior, the child will receive a warning and will have to sit out the rest of that outing. You will be notified and will be asked to reinforce the rules described above to your child. If the child continues the same behavior on their next scheduled day then you will be notified to pick up your child immediately and the child will be removed from the program. 2. Health and Safety Protocol You agree that you will not bring your child to school if he/she is experiencing symptoms of Covid-19 or other related communicable diseases. 3. Medical Emergencies If your child is injured in a way that requires immediate professional medical attention, you will be contacted immediately so that together we can make the necessary decisions and take the necessary steps to best remedy the situation. If we are not able to reach you, however, you must grant us permission here to transport your child to a local doctor or hospital for medical treatment if necessary. 4. Indemnity The risks associated with an academic school program for children, however minimal, can never be completely mitigated. As a consequence, you freely accept and fully assume all risks and acknowledge the possibility of, and agree to be solely responsible for personal injury, death, disability, property damage or loss resulting from the risks except where such arises as a result of the negligence or willful misconduct of Monarch Academy. You certify that your child(ren) have no pre-existing health or medical condition which could be triggered or exacerbated by participation in the activities or which could be expected to impact your child(ren)'s safety or the safety of others.
Consent
I aggree to the terms and conditions of the Rules, Release, and Indemnity Agreement
Parent Signature*
Date
Date Format: MM slash DD slash YYYY

Child's Name	DOB (mm/dd/yyyy)	Healthcard #

First Name	Last Name	Phone	Relationship to Child

First Name	Last Name	Phone	Relationship to Child

First Name	Last Name	Phone	Relationship to Child

Monarch Academy

Monarch Academy School Registration

Emergency Contact Information

Alternative Person(s) for Picking Up Child(ren)

Rules, Release and Indemnity Agreement

@