Summer Up "*" indicates required fieldsSummer Up! Intensive and Day CampReading • Language Arts • Math • Group Reading Therapy • Individual Reading Therapy • Summer Activities and Field TripSummer Up! 2023 (Monday through Friday, July 10th through July 21st) Summer Up! Academic Intensives PLUS Fun Program (A total of $650.00 that includes academic intensives in the morning and day camp afterwards until 4:00 p.m.)Intensives run from 9:00 a.m. to 11:00 a.m. each day. Day camp runs from 9:00 a.m. to 4:00 p.m. each day. There are no refunds due to vacation, illness, or other reasons.Consent I agree that my student will be subject to all the rules pertaining to Summer Up! program and will abide by them.Parent/Guardian eSignature* First Parental Acknowledgement of Summer Up! Rules* I understand that the school cannot refund or pay for repair or replacement of the device(s) my child brings to school, should they be lost, stolen, damaged or broken whilst in Before Care or After Care. The device(s) and any cases or peripherals will be marked with my child’s name. My child understands that inappropriate websites, videos, pictures, video games (rated T, M or A) or any other offending material is not permitted on any device brought to school. In addition, I understand that the instructors may supervise content on device(s) but are not held responsible for material my child may access while in Summer Up! I have discussed the ‘Bring Your Own Device’ Consent with my child and they have signed this agreement. My child will ensure their device is not taken outside, only used during snack time, and not used during classwork or school activities.Parents and Guardians: Please check each box that you acknowledge the terms.Student Acknowledgement of Summer Up! Rules* I will only access my own email, apps or websites to which I belong using my own username and password. I will only use the device for a maximum of 30 minutes or the duration that my guardian has preassigned with my instructor. During ‘No Device’ times, I will ensure my device is turned off and stored safely and securely with my belongings. I will not call out or receive phone calls without prior permission by an instructor. I will use headphones while I am watching a video or while listening to music. I will not lend my device(s) to others or allow others to burrow or use my device(s). I will report any inappropriate material or unpleasant messages I may receive to a trusted adult (instructor or guardian). I understand that the school may check my device and will monitor my internet use whilst my device(s) is/are in Before Care and After Care. I will only use my device with permission from an instructor or during times that they have allowed device use.Parents and Guardians: Please check each box indicating that you have reviewed the rules below and that your student affirms their agreement to abide by the rules listed.Photo Release Form* I give permission for the aforementioned student's photo to be used in print ads or other forms of advertisements used for Trinity School. I DO NOT give permission for the aforementioned student's photo to be used in print ads or other forms of advertisements used for Trinity School.Parent/Guardian 1 InformationName* First Last Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work PhoneMobile PhonePreferred Email* Parent/Guardian 2 InformationName* First Last Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work PhoneMobile PhonePreferred Email* Emergency Contact InformationIf the parents are unreachable in an emergency, contact the following people.Name* First Last Relationship to the Student*Work PhoneMobile PhonePreferred Email* Name* First Last Relationship to the Student*Work PhoneMobile PhonePreferred Email* In case of illness or accident, which hospital or clinic do you want your child to be sent?Clinic or Hospital NameAddress Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student's PhysicianPhysician or Physician Group Name*PhoneAddress Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please list any serious illnesses, operations, or accidents since birth (Please include asthma, etc.)Is your student taking any medication the school should be aware of? Yes NoIf yes, please list all medications the school should be aware of.Consent I agree to the privacy policy.The information requested on this form is confidential and for emergency use only. The undersigned parent(s)/guardian(s) give Trinity School permission, in case of Illness or accident, to take their child to a hospital or clinic. In case of emergency, they give permission for this information to be released to emergency personnel. They also agree that any of the emergency contacts listed on this form may be notified in an emergency, as needed.Parent/Guardian eSignature* First Student InformationStudent Name* First Middle Last Student Nickname First Grade Level 2023-2024Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeSex Male FemaleDate of Birth* MM slash DD slash YYYY Student T-Shirt Size* Youth XS Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult 2XLPayment InformationBilling Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a discount code? Yes NoDiscount CodeHiddenDiscount $0.00 How would you like to make your payment? Bank Account/ACH Debit/Credit CardCard Transaction Fee Price: $0.00 Credit CardAmerican ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Bank Account Transaction Fee Price: Bank Details* Account Number SelectSavingsChecking Account Type Routing Number Bank Name Total Δ Got Questions?Name* First Email* Your Message*CAPTCHAΔ