Participant Attendance and Health Information

Acceptance and Health Information Form

Student Information

Student's Name(Required)

First Last

Current Grade(Required)

School Year 2023-2024

I will be attending Summer Laureate University for Youth (SLUFY)(Required)

This is a yes or no question.

Carpool (if interested and not previously indicated)

Health Information

Primary physician or Clinic(Required)

Primary physician/Clinic Phone(Required)

Preferred Hospital in Little Rock Area(Required)

Other Special Needs/Comments not given on application

Student and Guardian Acknowledgements

Health Information Policy(Required)

I, the guardian, understand that certain health information will be listed on the back of the child's nametag in order to provide information to the faculty and staff that they may need quickly in order to properly care for the child in case of an emergency.

Disclaimer of need to list information on the student name tag.

Behavior Policy(Required)

We, the guardian and student, understand that any inappropriate behavior will result in an immediate parent conference and possible dismissal of your child from the program. Also, a child in the possession of any inappropriate weapons, tools, medications, or toys, and/or a child who verbalizes any type of harmful threat to staff, teachers, or other participants will be taken seriously and may be removed from SLUFY.

Payment Due Dates(Required)

I, the guardian, understand that full payment must be made by or before June 1. After that date we will have to release seats that are not paid for.

Refunds(Required)

I, the guardian, understand that on July 1, tuition, like the deposit, becomes non-refundable except in cases of serious illness or family emergency; partial refunds are permitted only under those circumstances. Should you choose to withdraw your child during the program, no refund will be given. All refunds will be processed after the Summer Laureate program has concluded.

Signature

Typing your name in this box constitutes your signature. Thank you.

Phone

This field is for validation purposes and should be left unchanged.

About the Camp

Participant Attendance and Health Information

Acceptance and Health Information Form

Student Information

Health Information

Student and Guardian Acknowledgements

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