Monday Care

MONDAY CARE & HOLIDAY BREAKS

Full-day care is open to all students of any district and is available from 6:45 am to 6:00 pm each day. Full Day rate of $25/day.

NOW ACCEPTING: State Pay & Government Subsidy!

UPCOMING DATES

December 1st

December 8th

January 5th

January 12th

January 19th

January 26th

February 2nd

February 9th

February 16th

February 23rd

March 2nd

March 9th

March 16th

March 23rd

March 30th

April 6th

April 13th

April 20th

April 27th

May 4th

May 11th

HOLIDAY BREAKS

November 26th

December 29th

December 30th

January 2nd

March 6th

March 13th

March 27th

April 3rd

April 17th

REGISTER TODAY!

Student's Name(Required)

First Last

Student's Birthdate(Required)

MM slash DD slash YYYY

Child's Gender(Required)

Child's Age(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian Information

Parent/Guardian Name(Required)

First Last

Email(Required)

Cell Phone(Required)

Work Phone(Required)

Employer(Required)

Employer Address(Required)

Expected Work Schedule(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

If different than child above

Parent/ Guardian #2

Parent/Guardian Name

First Last

Cell Phone

Work Phone

Employer

Employer Address

Expected Work Schedule

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

If different than child above

Emergency Contact Information

Emergency Contact #1(Required)

First Last

Phone(Required)

Relationship to Child(Required)

Address(Required)

Emergency Contact #2(Required)

First Last

Phone(Required)

Relationship to Child(Required)

Address(Required)

Enrollment Information

Childcare is Needed for:(Required)

Monday's only when Lockwood R1 is out of school

All Days Lockwood R1 is out of school (This includes Mondays, Fridays & Holiday Breaks)

All Monday's

Only Select Dates (I will Select Below)

Dates I need:

December 29th

December 30th

January 2nd

March 6th

March 13th

March 27th

April 3rd

April 17th

OTHER

Additional Dates Needed:

Pick Up Authorization

Who may pick up your child besides parent guardian(s) listed above?(Required)

Note: Please include emergency contacts if applicable. Students will not be released to anyone other than those on this list. Photo identification may be required from anyone other than a parent guardian

Health Record

Does your child have any food allergies(Required)

YES

List all medications or modified diets currently being administered to your child.(Required)

Please write N/A if there are none.

Please list any chronic illnesses, history of hospitalization or anything else the staff would need to know to properly care for your child(Required)

Please write N/A if there are none.

Health Statement(Required)

My child is in good health, is able to participate in group care, has no special health or medical requirements

My child is able to participate in group care but has special health or medical requirements as listed below.

Immunization Record

Every camper is required to have an updated immunization record on file in order to receive care. You may provide this later if you do not currently have it available.

Max. file size: 50 MB.

Authorization for Emergency Care(Required)

In the event of an emergency, Mission to Learn Academy LLC has my permission to seek emergency medical attention for my child as needed.

Credit/Debit Card Agreement(Required)

Quantum Athletics policy requires that all clients have a credit or debit card on file for payment purposes. Your Credit/Debit Card information will be secure and can only be charged under the terms you specify below.

By providing us with your Credit/Debit Card Information, you authorize Quantum to automatically charge your card on a weekly basis if another payment is not secured unless full payment is provided. Cards will be run each Friday morning for the following week. Parents will be immediately notified if the card on file cannot adequately charge fees. Payment must be completed by 5 p.m. on Friday to secure the child's spot for the following week.

If the Credit/Debit Card information on file changes for any reason, you must notify Quantum as soon as possible. We will maintain a clear record of all payments and charges. An email receipt will be sent to you as soon as the payment goes through.

I HAVE READ AND UNDERSTAND THE CREDIT/DEBIT CARD ON FILE AGREEMENT AND AUTHORIZE QUANTUM ATHLETICS TO CHARGE MY CREDIT/DEBIT CARD THE FEES LISTED ABOVE BASED ON MY SELECTION.

Credit/Debit Card Agreement(Required)

Quantum Athletics policy requires that all clients have a credit or debit card on file for payment purposes. Your Credit/Debit Card information will be secure and can only be charged under the terms you specify below. By providing us with your Credit/Debit Card Information, you authorize Quantum to automatically charge your card on a weekly basis if another payment is not secured unless full payment is provided. Cards will be run each Friday morning for the following week. Parents will be immediately notified if the card on file cannot adequately charge fees. Payment must be completed by 5 p.m. on Friday to secure the child's spot for the following week. If the Credit/Debit Card information on file changes for any reason, you must notify Quantum as soon as possible. We will maintain a clear record of all payments and charges. An email receipt will be sent to you as soon as the payment goes through.

Policy Agreement & Waiver(Required)

1. I give permission for my child to participate in Kids Camp activities such as group led enrichment, movies, outdoor play, etc. at Quantum Athletics.

2. I give permission for my child to be included in pictures or other publicity connected with the camp, including Instagram, Facebook and other social media platforms.

3. I understand that full payment must be made by 5 p.m. the Friday prior to the start of the week for my child to participate.

4. If my child is not picked up by the designated time, a $35 fee will apply for each occurrance. A parent may upgrade from half-day to full-day if space is available.

5. I understands field trips will be offered throughout Kids Camp.

6. I am aware of the nature of this activity and I hereby assume responsibility for the participant listed above to participate. I acknowledge that, while not common, any activity that involves height and motion (such as bounce houses, tumbling and stunting) involves risk of injury ranging from minor (bruises and sprains) to more serious and catastrophic injuries. I will not hold Quantum Athletics LLC or its employees responsible in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of Quantum Athletics prior to participation in any program. If, at any point, I have a question or a concern regarding the safety of my child or the intent of the program, I will contact the owner, manager or instructor immediately. I also allow the participants listed to be photographed and videotaped for publicity and advertising purposes only.

I HAVE READ AND UNDERSTAND ALL POLICIES

Policy Agreement & Waiver

1. I give permission for my child to participate in Kids Camp activities such as group led enrichment, movies, outdoor play, etc. at Quantum Athletics. 2. I give permission for my child to be included in pictures or other publicity connected with the camp, including Instagram, Facebook and other social media platforms. 3. I understand that full payment must be made by 5 p.m. the Friday prior to the start of the week for my child to participate. 4. If my child is not picked up by the designated time, a $35 fee will apply for each occurrance. A parent may upgrade from half-day to full-day if space is available. 5. I understands field trips will be offered throughout Kids Camp. 6. I am aware of the nature of this activity and I hereby assume responsibility for the participant listed above to participate. I acknowledge that, while not common, any activity that involves height and motion (such as bounce houses, tumbling and stunting) involves risk of injury ranging from minor (bruises and sprains) to more serious and catastrophic injuries. I will not hold Quantum Athletics LLC or its employees responsible in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of Quantum Athletics prior to participation in any program. If, at any point, I have a question or a concern regarding the safety of my child or the intent of the program, I will contact the owner, manager or instructor immediately. I also allow the participants listed to be photographed and videotaped for publicity and advertising purposes only.

Transportation & Field Trip Waiver(Required)

Students will be transported on the Quantum Bus to and from field trips, Immanuel Lutheran, Round Grove Pick Up, & Greenfield Schools. Students are required to wear seatbelts and follow bus rules at all times. Parents will be notified and have the option to decline field trips and transportation for field trips at any time. Students who do not follow the bus rules will receive a warning followed by a parent notification. Those who continue to have problems will be removed from the bus and will need to provide their own transportation. For a full list of bus procedures and rules, please contact the Kids Camp director.

I grant permission for my child to attend Field Trips at Quantum Athletics LLC anytime during the 24-25 school year.

I HAVE READ AND AGREE TO THE TRANSPORTATION WAIVER

Transportation & Field Trip Waiver(Required)

Students will be transported on the Quantum Bus to and from field trips, Immanuel Lutheran, Round Grove Pick Up, & Greenfield Schools. Students are required to wear seatbelts and follow bus rules at all times. Parents will be notified and have the option to decline field trips and transportation for field trips at any time. Students who do not follow the bus rules will receive a warning followed by a parent notification. Those who continue to have problems will be removed from the bus and will need to provide their own transportation. For a full list of bus procedures and rules, please contact the Kids Camp director. I grant permission for my child to attend Field Trips at Quantum Athletics LLC anytime during the 24-25 school year.

Card Information

Name on Card(Required)

First Last

Card Number(Required)

Expiration Date(Required)

CCV Code(Required)