Deformable Registration of Pre-Operative MR, Pre-Resection ...
PRE-REGISTRATION 21-22 SCHOOL YEAR
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For More Information: Call: Prime Time Sports Camp at (310) 838-7872 or Email: [email protected] Prime Time After School Program at Elysian Heights ES • Daily Homework Support • Sports Camp • Art Academy • S.T.E.A.M. Team • Around the World • 8:1 Staffing Ratio • Flexible Attendance • Seasonal Showcases PROGRAM HIGHLIGHTS PRE-REGISTRATION 2021-22 SCHOOL YEAR *Includes 15 minute sign out window FOR STUDENTS K-5th Grade $395 per month Monday through Friday Dismissal until 5:30pm* Use of the school premises has been granted pursuant to the provisions of Sections 17400, et seq., of the Education Code of the State of California to (Prime Time Sports Camp) from the Board of Education of the Los Angeles Unified School District. LA Unified and the Board of Education does not sponsor or take responsibility, nor does it endorse any of the activities, statements or opinions which may be expressed at this meeting/activity.
Transcript of PRE-REGISTRATION 21-22 SCHOOL YEAR
20th
For More Information:Call: Prime Time Sports Camp at (310) 838-7872 or
Email: [email protected]
Prime Time After School Programat Elysian Heights ES
• Daily Homework Support
• Sports Camp
• Art Academy• S.T.E.A.M. Team
• Around the World
• 8:1 Staffing Ratio
• Flexible Attendance
• Seasonal Showcases
PROGRAM HIGHLIGHTS
PRE-REGISTRATION2021-22 SCHOOL YEAR
*Includes 15 minute sign out window
FOR STUDENTSK-5thGrade$395 per monthMonday through FridayDismissal until 5:30pm*
Use of the school premises has been granted pursuant to the provisions of Sections 17400, et seq., of the Education Code of the State of California to (Prime Time Sports Camp) from the Board of Education of the Los Angeles Unified School District. LA Unified and the Board of Education does not sponsor or take responsibility, nor does it endorse any of the activities, statements or opinions which may be expressed at this meeting/activity.
Elysian Heights Elementary 2021-2022
EMERGENCYINFORMATION
MedicalInsuranceCo:___________________________________________________Policy#:________________________________________________________
Doesyourchild(ren)haveanyphysicalactivityrestrictions? ___YES___NO
Doesyourchild(ren)haveanyallergiestoanyfoodsormedications? ___YES___NO
Doesyourchild(ren)haveanydietaryrestrictions? ___YES___NO
IfYEStoanyoftheabove,pleasedownloadtheMedicalInformationandClearanceandsubmitwithapplication.Willyourchild(ren)berequiredtotakeanymedicationwhileatPTSC? ___YES___NO
IfYES,pleasedownloadeitherthePrescriptionorNon-PrescriptionMedicationDispensingAgreementandsubmitwithapplication.1. IncaseofanemergencyandIcannotbereached,IauthorizethePrimeTimeSportsCampDirector,orhisdesignee,toobtainwhatevermedical
treatmentheorshedeemsnecessaryforthewelfareofmychild.IunderstandthepotentialrisksinvolvedintheactivitiesprovidedbyPrimeTimeSportsCampandIherebyagreetoassumeallsuchrisks,includingtheriskofinjurytomychild.Iherebyrelease,andagreetoprotect,defend,indemnifyandholdharmlessPrimeTimeSportsCampanditsowners,officers,directorsandstafffromanyandallclaimsarisingoutofinjurytomychild.Ialsoagreetoacceptfullresponsibility,financialorotherwise,fortheconductofmychild.IfurtherunderstandthatmychildmaybedismissedfromtheprogramforconductdeemedimproperbytheDirectorinhissolediscretion.
2. IauthorizetheexchangeofinformationregardingmychildbetweenPrimeTimeSportsCampandElysian HeightsElementarySchool.
3. Iunderstandthatitismysoleresponsibilitytoarrangeforsigningmychildinandoutoftheprogramandforarrangingforhis/herdropoffandpickup.IunderstandandagreethatPrimeTimeSportsCampisnotresponsibleformychildorfortheactionsandbehaviorofmychildintheeventthatmychildleavesthesupervisionoftheprogramduringthehoursoftheprogramwithmeorapersonauthorizedtopickupmychildassetforthabove,regardlessofwhetherornotheorshehasbeensignedintooroutoftheprogram.
4. Allpictures,films,tapes,orotherlikenessesofmychildtakenduringcamphoursarethepropertyofPrimeTimeSportsCampandmaybeusedforanyandallpromotionalmaterials.
5. Iunderstand,authorize,andagreethatanyartprojectsmadebymychildduring,oraspartof,thePrimeTimeSportsCamp(oranylikenesses,replicas,orre-creationsofanysuchartprojectsmadebymychild)maybeused,depicted,ordisplayedbyPrimeTimeSportsCampforanypromotionalorfundraisingpurposesthatPrimeTimeSportsCampmaychooseordeemappropriate.
_________________________________________________________________________ ___________________________________________________SignatureofParentorGuardian Date
PLEASEFAXSIGNEDAPPLICATIONSTOTHEPRIMETIMESPORTSCAMPOFFICEat(310)838-8825orSCAN AND EMAIL TO [email protected]
QUESTIONSCALL(310)838-7872
MINIMUM 25 STUDENTS REQUIRED TO BEGIN PROGRAM
Fall 2021 Grade: _____________ Date of Birth: ____________ / ____________ / ____________
PARENT OR GUARDIAN INFORMATION
Parent Name(s): ______________________________________________________________________________________________________________________________
Address: ______________________________________________________________________________________________________ Apt. #: ______________________
City: ____________________________________ State: ________ Zip: ____________________ Home Phone: (__________) ____________________________
Cell Phone 1: (_________) _______________________________________ (mom/dad) Cell Phone 2: (_________) ____________________________________
Email 1:_________________________________________________________ (mom/dad) Email 2:_____________________________________________________
CREDIT CARD INFORMATION (ALL Major Credit/Debit Cards Accepted)______________________________________EXP. DATE: _________________
Child’s Name: ______________________________________________________________________________________________________________
