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Section I

MEDICAL RELEASE

Please indicate below any allergies or health concerns/restrictions for your child. If an action plan is in place for allergies, please provide in writing with enrollment paperwork. If none, please write "None"

Should my child become ill or suffer any accident while he/she is in the care of Kearny Christian Academy, the staff shall undertake to contact me immediately. Kearny Christian Academy shall be authorized to secure and to consent to such medical attention, treatment, and services as may be deemed necessary. Any qualified person providing such required medical attention, treatment, and services for my child may accept such consent as if given by me in person. I agree to assume responsibility for medical costs incurred.

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Section II

EMERGENCY CONTACT PERSONS:

Emergency telephone numbers where parent/guardian(s) may be reached during Summer Spectacular hours:

RELEASE & AUTHORIZED PICK-UP PERSONS:

The following person(s) are authorized to pick up my child(ren) from Kearny Christian Academy. KCA staff may ask for identification for any person unfamiliar to them. Any changes or additions to this list must be provided in writing.

Any student that remains after the Summer Spectacular program at 4pm will automatically be enrolled in our After Care Program at a rate of $5 per hour. Any child picked up after 6pm will be charged $1 per minute. Families will receive a separate charge for any Extended Care charges.

EXTENDED CARE:

FIELD TRIP RELEASE:

I understand that special trips are planned for the children away from the school building during the spring spectacular program. I am aware that I will be notified when these trips are to occur and that they will be carefully arranged and supervised by an adult. I am willing to assume the responsibility for Kearny Christian Academy and its staff to take my child on these trips.

TRANSPORTATION RELEASE:

My child has permission to ride in the bus/car/van on field trips that take place during the Summer Spectacular program. 

GENERAL WAIVER:

I further understand and agree to hold Kearny Christian Academy and its sponsor church, City of Hope International Church, and its agents harmless for any liability to my child or any agent thereof because of injury or alleged injury to my child. I understand that should any of the registration information included on this form change, it is my responsibility to update KCA in writing.

By signing this form, I certify that I have read the form, understand what I am signing, and consent to all of the terms of the release form, as well as any other policies that the program may have.

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Section III

LUNCH PROGRAM:

LUNCH is available for purchase through our KCALunch.com website. Upon enrollment into lunch program, parents will receive a Welcome email with login & password information. Lunch orders will need to be placed by 10pm the night before.

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Section IV

PAYMENT

By entering your signatures above and clicking submit, you are consenting to your signatures being applied electronically and agreeing to the terms of this agreement.