Summer Registration Form
Fill out a new form for each child. Once we receive your registration form, we will call you for payment and schedule your child's diagnostic assessment.
Summer Program July 5th-August 18th, 2017
Summer Camp Hours: 9:00 am-1:00pm
2 Weeks $350.00
3 Weeks $510.00
4 Weeks $660.00
5 Weeks $820.00
6 Weeks $984.00
61/2 Weeks $1090.00
10% off EARLY REGISTRATION
Please add $20 per field trip
Early Drop Off: 8:00am
$20 per week
Location: PS 18Q Winchester
86-35 235th ct
Queens Village, NY 11427
Date of Birth
Name of School
Please indicate any allergies or health conditions we should be aware of
Select number of weeks between July 5th-August 18th
2 week program
3 week program
4 week program
5 week program
6 week program
6.5 week program
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
I hereby swear that I am the parent or legal guardian of the listed student above, a minor, to participate in Early Scholars Learning Center and all its programs and activities.
I, the undersigned parent or guardian, do hereby authorize emergency medical services be rendered to my child upon consent of an Early Scholars Learning Center staff member. The purpose of this authorization is to permit my child to receive emergency medical attention when needed while involved in the activities connected with Early Scholars Learning Center programs when I or my emergency contact is unavailable to give such consent. I hereby waive and release Early Scholars Learning Center, The New York City Department of Education, Public School 18Q and/or its designees from any and all liability and costs associated with any accidents and emergency care. I further understand that I or my medical insurance carrier will be responsible for any medical expenses arising from said emergency or treatment.
After dismissal, I understand that there is a late pick-up grace period of five minutes. Afterward, a late pick-up fee of $15 for every 15 minutes, or portion thereof, will be assessed. Furthermore, more than two pick-ups after 1:15 p.m. could result in suspension or termination of my child’s enrollment in the program.
We reserve the right to dismiss students for misconduct in cases where the behavior is dangerous and places other students in risk of harm. Parents/Guardians will receive verbal and written warning indicating instances of misconduct prior to dismissal. In such cases, parents will not be refunded for that month/term.
Refunds for services can be provided within 10 days of payment. However, once the 10 day window has passed or after you have received more than one day of service, refunds are not permitted; credit for services can be applied for one calendar year. There are no credits or refunds for missed classes. If Early Scholars cancels a class for any reason, a makeup class will be offered.
I grant Early Scholars Learning Center the right to take and use photos and videos of the student listed above for promotional purposes.
I understand and agree to pay a cash payment of the sum total of $35 for administration fee if any checks written to Early Scholars Learning Center bounces.
NYC HEALTH EXAMINATION FORM LINK
Please copy and paste the following link to a new browser to access the NYC Health Examination Form. All students must provide a completed health form dated after August 16th, 2015.
UPLOAD COMPLETED NYC HEALTH FORM
Should you have a completed health form available, feel free to upload it below.
If not, no need to worry. You can submit the health form later. The completed health form can be emailed to firstname.lastname@example.org, faxed to 718-532-0637 or mailed to our main office at 61-43 186th st. Fresh Meadows, NY 11365
Do Not Fill This Out