After-School Fall 2022 Enrollment Form


Redcap’s Corner
(Hobgoblin Hobbies, LLC)
3850 Lancaster Avenue
Philadelphia, PA 19104

STUDENT

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PARENT/GUARDIAN #1

 

 

PARENT/GUARDIAN #2

 

ADDITIONAL EMERGENCY CONTACT

 

Completion of all remaining sections of Form is required, except for Photography Release.

PROGRAM, FEE, AND RULES

Program will be run by Hobgoblin Hobbies, LLC d/b/a Redcap’s Corner (“Redcap’s Corner”), from Monday to Thursday, 4:00 pm to 6:00 pm, for the dates selected by parents/guardians of student, and for the corresponding fee (as described in program brochure). Fee does not guarantee inclusion of any materials.

Student is to be dropped off no earlier than 3:40 pm, and picked up no later than 6:10 pm every day; in the event of student not being picked up by 6:10 pm, Redcap’s Corner reserves the right to charge penalty and/or, in the case of repeated late pickups, termination of program participation without refund. Student is expected to behave appropriately; no threatening or abusive conduct will be tolerated. In the event of any unacceptable behavior, Redcap’s Corner reserves the right to require pick up of student before 6:10 pm and/or to termination of program participation without refund. Students of Samuel Powel School or Science Leadership Academy Middle School can be picked up from 3610 Warren Street in Philadelphia, PA by a staff-member and escorted to the program site, if authorized below.

If insufficient numbers of students sign up for a selected session, Redcap’s Corner has the right to cancel the session – in such event, Redcap’s Corner shall notify parents/guardians of affected students who did sign up for that session, and refund all monies already paid.

Registration fees shall be payable by credit card online at www.redcapscorner.com, by check or money order payable to “Hobgoblin Hobbies, LLC”, or by cash or credit card in-store, and must be received at time of this signing. Please contact benn@redcapscorner.com if you have any questions.

STUDENT INFORMATION

The pick-up authorization is mandatory, and Redcap’s Corner will not release your child into the care of anyone who isn’t listed (unless you check the box authorizing the child to leave without an adult).  Redcap’s Corner does not have a nurse or other medical personnel on program staff.  By completing this form, you are representing that you are not aware of any medical condition that would prevent student from participating in the program. Redcap’s Corner will not supervise the administration of medication to, or take recordings of, any children for whom the respective section is not completed.

PICK-UP AUTHORIZATION

I authorize the following people to pick up my child from the program.

MEDICAL INFORMATION

My child has the following medical condition(s), of which program staff should be aware.

I authorize my child to self-administer the following medication(s) during the program session.

I understand that a nurse will not be present during this program. Therefore, it is my responsibility to inform the adult supervisor of any changes in my child’s health status.

PHOTOGRAPHY RELEASE (OPTIONAL)

RELEASE

I, the undersigned parent or guardian of hereby grant permission for my child to participate in all of the activities, including those occurring off of property owned or controlled by Redcap’s Corner, scheduled for the program. My permission extends to all activities listed on this form or which may occur during the course of the program. I have chosen to arrange my child’s transportation to and from the program, and thus, I acknowledge that Redcap’s Corner, its employees, agents, and trustees, have no liability arising out of and from the transportation of my child to and from these activities.

I further understand that all of the terms, conditions, and information contained in this as submitted by me on behalf of my child, including the assumption of the risks of program activities, medical authorization, promotional authorization and such related releases of liability shall apply during my child’s participation in the activities occurring off of property owned or controlled by Redcap’s Corner scheduled for the program.

This statement shall serve as a release and assumption of risk for my child. I authorize Redcap’s Corner to obtain emergency care (if needed) for my child in my absence.

I HAVE CAREFULLY READ ALL OF THE INFORMATION ON THIS FORM AND VOLUNTARILY AGREE TO ALL TERMS AND CONDITIONS. I AM THE LEGAL GUARDIAN OF THE STUDENT AND UNDERSTAND THAT THE INFORMATION, TERMS, AND CONDITIONS CONTAINED ON THIS FORM SHALL SERVE AS A RELEASE AND ASSUMPTION OF LIABILITY FOR MY HEIRS, EXECUTORS, AND ADMINISTRATORS.

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Signature Certificate
Document name: After-School Fall 2022 Enrollment Form
lock iconUnique Document ID: f5c803b2b0bbb6761584642af957534dec0afb74
Timestamp Audit
August 10, 2022 2:38 PM ESTAfter-School Fall 2022 Enrollment Form Uploaded by Benjamin Roe - benn@redcapscorner.com IP 74.109.29.76