Date REGISTER BY APRIL 17 TO RECEIVE A $50 DISCOUNT …

[Pages:2]2020 SUMMER SCHOOL (LOWER SCHOOL) REGISTRATION

Student's Name: ___________________________________________________________Date:___________________________

D.O.B: ________________Name of School Currently Attending: _____________________Grade Entering in the Fall: __________

I/we understand that a minimum of 5 students are required to run a class. Enrollment in Summer Scholars requires each student to abide by the rules and policies of NSU University School as read in the student handbook. By signature, I/we accept financial responsibility for the Summer Scholars tuition and fees. I/We realize that they are non-refundable and make-up days are unavailable. Initial: _____

The use of my photograph and/or my child's photograph(s) in University School and NSU publications, Web site, and/or advertisements is authorized.

I/we hereby release and hold harmless Nova Southeastern University; its Board and Officers and NSU University School, its officers, trustees, directors, employees, and agents from all liability, including claims and suits at law or in equity, for injury, fatal or otherwise, which result while the student is taking part in all NSU University School summer programs/classes.

Non-University School parents must submit with this registration form the DH/HRS Form 3040(yellow) and the DH/HRS form 680 (blue) signed by a physician for each child. ALL students must submit the Authorization for Medication/Treatment Form.

I/we hereby agree that I/we will be responsible for any loss, damage, or destruction by the student. University school is not responsible for any lost, stolen, or damaged to any personal property that my child brings to the program.

Summer Scholars will be closed on Tuesday, July 4, in observance of Independence Day.

Parent Signature: _______________________________________________Date: ____________________

REGISTER BY APRIL 17th TO RECEIVE A $50 DISCOUNT PER CLASS

June 8-July 3 (4 weeks) 8:45am-11:45am

June 8-July 3 (4 weeks) 8:45am-11:45am

Writing Clinic (Grades 2-5) ....................... $1200

Scholastic Enrichment (Pre-K ? Grade 2) ...$1200

FUN with Fine Motor (Grade JK-2) .......... $1400 11:45am-4:30pm Camp Nova*..............................$200 per week

Learning Center (Grades K-5) ......................$1400

Summer Thrive! (Grades 3-5) ......................$1200 11:45am-4:30pm Camp Nova*............................$200 per week

July 27-July 31 (1 week) 8:45am-11:45am

Back to School Refresher (Grades K-5)......$500

VEX IQ Robotics Boot Camp (Grades 3-5)..$500 11:45am-4:30pm Camp Nova*...............................$200 per week

Mother/Guardian/Co-Parent: Name: __________________________________________ Address: ________________________________________ City:__________________ State: _______Zip Code: ______ Cell #: ___________________Work #: _______________ Email Address: ____________________________________

Father/Guardian/Co-Parent: Name: __________________________________________ Address: ________________________________________ City: __________________ State: _______Zip Code: ______ Cell #: ___________________Work #: _______________ Email Address: ____________________________________

Student Allergies: ___________________________________________________________________________________________ Emergency/Authorization to Release:

Name: __________________________ Relationship: _________________________________Phone: ________________

3375 SW 75 Avenue ? Lower School Building ? Fort Lauderdale, Florida 33314-1400 (954) 262-4528 ? Fax: (954) 262-3224 ? uschool.nova.edu/campnova

Summer Scholars Lower School

Payment Information Child's Name: ______________________________________ Date: _____________ Cash: $______________________________________ Check ? Payable to NSU University School (There is a $25 fee for returned

checks.) Check #:________________________ Amount: $______________________ Credit Card ____ MasterCard ____ Visa ____ American Express

Cardholder Information:

Cardholder's Name: _____________________________________Signature:_________________________ Credit Card #: __________________________________________Expiration Date:______/_______/______

Amount: $ ________________________________________________

3375 SW 75 Avenue ? Lower School Building ? Fort Lauderdale, Florida 33314-1400 (954) 262-4528 ? Fax: (954) 262-3224 ? uschool.nova.edu/campnova

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