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Summer School 23 Registrations
admin
2023-05-09T17:05:56+00:00
Kids Summer School 2023 Registration
Step
1
of
8
12%
Student Information
Student Name
(Required)
First
Last
Gender
(Required)
Male
Female
Grade in Sept 2023
(Required)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Student was register in Kids Academy program 22-23
(Required)
No
Yes
with a prior registration we have your information on file. if you would like to update us on any information please email info@bostoneducation.us.
Birth Date
(Required)
MM slash DD slash YYYY
Primary Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Parent / Guardian Information
Father Name
(Required)
First
Last
Father Phone
(Required)
Father Email
(Required)
Mother Name
(Required)
First
Last
Mother Phone
(Required)
Mother Email
(Required)
Emergency Contact Information
Please list a contact that is not listed on this form, to be used if Parent / Guardian cannot be reached
Emergency Contact Name
(Required)
First
Last
Emergency Contact Phone
(Required)
Emergency Contact Email
(Required)
Relationship to Student
(Required)
Physician Info
Do you have a physician
(Required)
Yes
No
Physician Name
(Required)
First
Last
Physician Phone
(Required)
Any specific condition that we need to know about your kid?
Does your child have a Medical Condition.
(Required)
Yes
No
Medical Info
I hereby state that my son/daughter whose name appears on the first page of this document under ‘Student Information’ has the following medical condition(s) that the BEC staff should be aware of during the school. I hereby state that I have provided the necessary medication to the BEC staff. I instructed them how to give the medication to my child if need arises, and give permission to administer the medication to my child. I hereby state that my son/daughter is otherwise in good physical health condition to participate in the activities provided by BEC, including but not limited to all aspects of running, and folk dance training, basketball, soccer and or competition. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of injury.
Medical Condition 1
Required Medication for Condition 1
Medical Condition 2
Required Medication for Condition 2
Additional Medical Conditions and their Medication
Consent
PERMISSION & TERMS OF AGREEMENT
(Required)
I have read and I agree to the policy.
I hereby give permission for my child, to participate in the Summer School 23 conducted by the Boston Education and Counseling (BEC) with the understanding of the following:
• I understand that the cost of the program will vary in accordance to student and due by June 1, 2022. There will be a 12.5% sibling discount for each student.
• I understand that every effort will be made to provide responsible care by the BEC staff. Students are required to follow the school schedule under the authority of the BEC staff during their attendance at the school. In the case of an accident or injury, where an emergency contact person cannot be reached, I hereby give permission for emergency medical attention to be administrated to my child by the BEC staff.
• It is my responsibility to drop off and pick up my child on time.
Consent
(Required)
I have read and I agree to the policy.
By Submitting the form, I acknowledge the contagious nature of the Coronavirus/COVID-19. I further acknowledge that Boston Education and Counseling has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Boston Education and Counseling cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to mentors, administration, and fellow participants. I voluntarily seek services provided by Boston Education and Counseling and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
I attest that:
* I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days of the meeting day.
* I have not traveled to a highly impacted area within UNITED STATES in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.
* I am following all government recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Boston Education and Counseling harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Boston Education and Counseling. I understand that this release discharges Boston Education and Counseling from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, drawn, medical treatment, or property damage that may arise from, or in connection to, any services received from Boston Education and Counseling. This liability waiver and release extends to the salon together with all owners, partners, and employees. Assumption of Risk and Waiver of Liability: In consideration of the above, I assume all risks associated with the preparation of food products supplied under this Agreement, including matters of health and safety associated thereof. I do hereby release, waiver, discharge, and covenant not to sue Boston Education and Counseling, and their respective Trustees, officers, employees, students and agents from liability from any and all claims including the negligence of said organizations and their respective Trustees, officers, employees and agents, resulting in personal injury, accident, or illness, including death and property loss arising from any and all food products provided under this Agreement. By registering to the Summer Camp hosted by Boston Education and Counseling.
I also consent to and acknowledge that I may be photographed/recorded at all times before, during, and after the event by the Boston Education and Counseling staff for promotional and interorganizational purposes.
Scholarship
Are you in need of a Scholarship?
(Required)
Yes
No
Please type in the scholarship ammount you need
(Required)
Payment
Our price will be
$850
with the minimum requirement of
20 registrations
, therefore an invoice will be emailed to you as soon as we pass 20 registrations.
Registration deadline is June 3rd.
Your registration will be finalized after you pay your invoice.
Thank You
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