KODU Game Lab
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Student and Emergency Contact Information
Student and Emergency Contact Information, Program Policies, and Photo Release
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Do you have more than one child registered this session?
Child's Name #2
Child's Name #3
Child Date of Birth
Child #2 Date of Birth
Child #3 Date of Birth
Child #2 Grade
Child #2 School
Child #3 Grade
Child #3 School
In case of emergency...
Are there special considerations concerning your child of which our staff should be aware?
All refund requests must be submitted in writing either in person or email.For student withdrawals for summer camp, refunds will be made based on the following schedule: – 7 or more days prior to start of specific camp week: full refund less $25.00 administrative fee – less than 7 days prior to start of specific camp week: 50% refund less $25.00 administrative fee – once specific camp week has started: no refund
Refunds are not issued for missed classes. Montclair Learning Center (MLC) generally does not offer make up classes. However, if the same class is offered on a different time/day and there is space available in the class, one make-up session per semester may be scheduled.
Students and instructors are expected to be respectful and courteous to each other. MLC reserves the right to request a disruptive student to leave camp and not attend any remaining sessions. If a student is asked to leave the program, class fees (less $25 administrative fee) will be refunded for any remaining sessions but not for sessions already attended.
STUDENT LIABILITY WAIVER AND PHOTO RELEASE:
By enrolling in MLC's programs, parent/guardian agrees that neither MLC nor any MLC staff member, shall be liable for any damages or injury to the student, or any other person, on the MLC premise and the parent/guardian agrees to hold MLC harmless from any claims for damages, no matter how caused. By enrolling in a MLC program or activity, parents and guardians authorize MLC and its staff to use, publish, distribute, and copyright photographs, video recordings, or other portraits or likenesses of the student, in which the child may be included in whole or in part, for lawful use on MLC's website, social media properties and printed materials, in both present editions and future editions. MLC will refrain from printing the name of the child in connection with the aforementioned likenesses, unless explicitly authroized by the parent. Parents and guardians who enroll in MLC program(s) release MLC from any claims that may arise regarding the use of the child's image, including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright.
PERMISSION TO PROVIDE EMERGENCY CARE:
I hereby give permission to emergency medical service personnel to order x-rays, routine tests and treatment for my child in the event that I cannot be reached in an emergency.By submitting the form, I understand that I am acknowledging that I have read and understand the terms of the program policies outlined by MLC and will adhere to the terms and policies.
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