Summer Safari 2019 Schedule FormPlease complete the form below for each child who currently attends one of our U-GRO centers. We look forward to spending the summer with you! If you have any immediate questions, please see your Center Director.Parent/Guardian Name* First Last U-GRO Location*--Select--Bent CreekBrethren VillageHACC HarrisburgHACC LancasterHarrisburg EastHempfieldHersheyLebanonMasonic VillageMessiah LifewaysRohrerstownUnion DepositYorkChild Name* First Last Child's Age as of June 10, 2019:*Under 112345Over 52019 Summer Schedule*My child's schedule will NOT change for the summer.My child's schedule will change for the summer.My child will withdraw from school for the summer, returning in the fall, with the understanding that space may not be available at the start of the school year.I am requesting my child's new schedule to begin the week of: Date Format: MM slash DD slash YYYY With the new schedule, I am requesting my child attend the following days: Monday Tuesday Wednesday Thursday Friday*If reducing your full-time schedule, a minimum of 3 days per week is required to guarantee a space in August/September 2019.With the new schedule, I am requesting to drop my child off at the following time: : HH MM AMPM With the new schedule, I am requesting to pick my child up at the following time: : HH MM AMPM My child's last day will be: Date Format: MM slash DD slash YYYY If returning in the fall, our ideal week to begin is: Date Format: MM slash DD slash YYYY Summer Safari T-Shirt Size (Ages 2+)--Select--XXS (18-24 mo)XS (2-4)SM (6-8)MD (10-12)LG (12-14)Child 2: Name First Last Child 2: Age as of June 10, 2019:Under 112345Over 5Child 2: 2019 Summer ScheduleMy child's schedule will NOT change for the summer.My child's schedule will change for the summer.My child will withdraw from school for the summer, returning in the fall, with the understanding that space may not be available at the start of the school year.I am requesting my child's new schedule to begin the week of: Date Format: MM slash DD slash YYYY With the new schedule, I am requesting my child attend the following days: Monday Tuesday Wednesday Thursday Friday*If reducing your full-time schedule, a minimum of 3 days per week is required to guarantee a space in August/September 2019.With the new schedule, I am requesting to drop my child off at the following time: : HH MM AMPM With the new schedule, I am requesting to pick my child up at the following time: : HH MM AMPM My child's last day will be: Date Format: MM slash DD slash YYYY If returning in the fall, our ideal week to begin is: Date Format: MM slash DD slash YYYY Child 2: Summer Safari T-Shirt Size (Ages 2+)--Select--XXS (18-24 mo)XS (2-4)SM (6-8)MD (10-12)LG (12-14)Child 3: Name First Last Child 3: Age as of June 10, 2019:Under 112345Over 5Child 3: 2019 Summer ScheduleMy child's schedule will NOT change for the summer.My child's schedule will change for the summer.My child will withdraw from school for the summer, returning in the fall, with the understanding that space may not be available at the start of the school year.I am requesting my child's new schedule to begin the week of: Date Format: MM slash DD slash YYYY With the new schedule, I am requesting my child attend the following days: Monday Tuesday Wednesday Thursday Friday*If reducing your full-time schedule, a minimum of 3 days per week is required to guarantee a space in August/September 2019.With the new schedule, I am requesting to drop my child off at the following time: : HH MM AMPM With the new schedule, I am requesting to pick my child up at the following time: : HH MM AMPM My child's last day will be: Date Format: MM slash DD slash YYYY If returning in the fall, our ideal week to begin is: Date Format: MM slash DD slash YYYY Child 3: Summer Safari T-Shirt Size (Ages 2+)--Select--XXS (18-24 mo)XS (2-4)SM (6-8)MD (10-12)LG (12-14)Release* I acceptMy child(ren) is/are in excellent health and capable of participation in physical activity. I hereby give my approval for his/her participation in the 2019 Summer Safari at U-GRO. I understand that I will be responsible for any injuries to my child resulting from, or in connection with, camp activities. I hereby release, absolve, and hold harmless U-GRO Learning Centres, Inc., its directors, its officers, and the staff.Field Trip Permission* I acceptI give permission for my child(ren) to be transported by school bus on any field trips taken by the campers. I will provide my child with a packed brown bag lunch and a drink for all trips.
