Register Online – Monthly

The Adventure Club
* Required

Child Information

First Name *
Last Name *
Nickname
Date of Birth *
/ /
Gender *
Male
Female
Primary Phone *
Child's Home Address *
City *
State *
Zip *
Siblings Attending TAC (Names/Grades)
First Name
Last Name
Grade
First Name
Last Name
Grade
First Name
Last Name
Grade
 
*Select the school where your child attends. *Please also provide grade, start date and the days when your child will attend TAC
Merrillville: Fieler Iddings Miller Salk Wood

Enrollment Time Period:*

Full School year (August-May)   Mid-School year (January-May)

Grade *
Start Date *
/ /
* Check all that apply. If these days change, notify your TAC Site. See parent handbook/website for phone numbers.
  Mon Tues Wed Thurs Fri Days will vary
AM
PM

Parent/Guardian

* Is Parent/Guardian Employed by School? No   Yes   If yes, what position:   Which school:
Primary Parent First Name *
Last Name *
Relation to Child *
Primary Phone *
Secondary Phone
Home Address *
City *
State *
Zip *
Email (Home) *
Driver's License Number *
Driver's License State *
Employer Name and Address
Email (Work)
Work Phone/Extension
Secondary Parent First Name
Last Name
Relation to Child
Primary Phone
Secondary Phone
Home Address
City
State
Zip
Email (Home)
Driver's License Number
Driver's License State
Employer Name and Address
Email (Work)
Work Phone/Extension
* Yes Paperless Billing   No Paperless Billing
If yes, you will receive a monthly invoice via email. If no, it is your responsibility to pick up monthly invoices at your TAC site. All payments are due monthly. Late fees of $5 per week are assessed if you do not pay by Friday at 6:00 pm.
* Provide 2 personal questions and answers for new pick-up authorization.
Question Answer
Question Answer

Emergency Contacts/Authorized Pick-Up Persons

Please notify your TAC Site whenever an emergency contact/authorized pick up person will pick-up your child.
First Name *
Last Name *
Relationship to Child *
Primary Phone *
Secondary Phone
First Name
Last Name
Relationship to Child
Primary Phone
Secondary Phone
First Name
Last Name
Relationship to Child
Primary Phone
Secondary Phone
First Name
Last Name
Relationship to Child
Primary Phone
Secondary Phone
  • You are authorizing the people listed above to pick-up your child from TAC.
  • TAC requires all authorized people including parents/guardians to show a government issued photo ID at the time of pick-up.
  • Identification questions listed on Page 1 will be used to confirm identity when calling in additional pick-up authorizations.
  • In the case of an emergency when the TAC's staff cannot reach you, we will call the persons designated above.

Court Ordered Denied Pick-Up

The following individuals are prohibited from picking up my child(ren) and/or having contact with my child(ren) by court order.
TAC must have a copy of the court order on file in order to deny pick-up.
First Name
Last Name
Relationship to Child
Phone #
First Name
Last Name
Relationship to Child
Phone #
Enrollment Agreement
Child's Health Information

Health Issues & Allergies *

None
Health Issue/Allergy Effect/Reaction Life Threatening? Special Instructions Including
Inhaler/Epi-Pen Usage
Diabetes Yes  No
Epilepsy Yes  No
Seizures Yes  No
Vision Yes  No
Hearing Yes  No
Food Yes  No
Respiratory/Asthma Yes  No
Bee Sting Yes  No
Other Yes  No
TAC does not administer medication with the exception of asthma inhalers and/or Epi-Pens. Ask for Medical Release Form

Medical Information

Physician's Name * Phone Number *
Dentist's Name Phone Number
Preferred Hospital/Clinic for Emergency Care

Medical Policies *

  1. If any changes regarding health issues or medical information occur, I agree to provide new information promptly.

  2. If my child is ill, I agree to pick up my child no later than one (1) hour after being contacted.

  3. I understand that each of the TAC Sites has staff certified by the American Heart Association in CPR and First Aid in order to handle minor injuries. If any injury appears serious of indeterminate, the staff will immediately call 911 as well as the parent/guardian or emergency contact numbers. I understand that the Adventure Club is standing in “local parentis” (in place of parents) and I/we hereby authorize The Adventure Club to exercise the duties and authority arising therefrom. I/we understand that The Adventure Club is acting on behalf of the parents with regard to my child, as such, I/we hereby grant permission for The Adventure Club staff to take whatever steps necessary to obtain medical care for my child.
I have read and agree with all TAC's Medical Policies.
Parent/Guardian Signature   Date   July 21, 2019
By checking the box above and entering your name here you are electronically agreeing and signing the TAC's Medical Policies.
Enrollment Agreement
Financial Responsibility

Program Hours

School Corporations AM
6:30 am – School Start
PM
School End – 6:00 pm
Summer (TBD)
6:30 am – 6:00 pm
Holiday Breaks (TBD)
6:30 am – 6:00 pm
Merrillville

When school is dismissed, students in the elementary schools and Wilbur Wright Middle School report to TAC in their building. If the program is not offered at your school, students are bussed from their elementary (Tri-Creek) or middle schools (LC Schools only) to their respective TAC locations where parents pick them up by 6:00 pm.

Emergency Dismissal
If school is dismissed early because of hazardous weather conditions or other emergencies, TAC will not be open. It is important that you have a family emergency plan in case of early dismissal because TAC will not notify you.

Delayed Start
In the event of a delayed start to the school day, TAC will be open. Delayed start fees are not included in the before school flat rate fee. Additional rates will begin at the time school normally starts.

Special Permissions

By checking the box's below and entering your name, you are electronically agreeing and signing to each item.
Walking Trips *
I give permission for my child to leave the Site for outdoor fitness and educational purposes, with the understanding that my child will be accompanied by TAC staff and under supervision at all times.
Parent/Guardian Signature

Date
July 21, 2019
Transportation *
I hereby grant permission for my child to participate in and be transported by commercial transportation companies while under staff supervision at all times for field trips and other TAC sponsored activities. I understand that children not attending TAC field trips will remain on-site with TAC staff.
Parent/Guardian Signature

Date
July 21, 2019
Playground/Water Activities *
I give permission for TAC to include my child in supervised playground and water activities. My child has my permission to use all the play equipment and take part in all TAC activities.
Parent/Guardian Signature

Date
July 21, 2019
Parent Handbook *
I have received, read, and agree to abide by the Parent Handbook.
Parent/Guardian Signature

Date
July 21, 2019
Sunscreen Permission (Summer Only)
I understand that TAC is not responsible for any injuries that may result from the sun. I give permission for my child to apply/wear SPF 30 sunscreen that I supply.
Parent/Guardian Signature

Date
July 21, 2019

Parent Release Agreement *

In consideration of the services to be provided by The Adventure Club, Inc., and for other good and valuable consideration, the undersigned, for myself and for my minor child, and any and all family members, heirs, representatives, executors, administrators, and assigns of myself or of my minor child, hereby accepts full responsibility and assumes all risk, for my minor child's use of any and all apparatuses, appliances, facilities, privileges or services, of any nature, which is/are owned, operated or provided by The Adventure Club, Inc. While engaging in any contact, game, function, exercise, competition or any other activity operating, organized, arranged, or sponsored by The Adventure Club, Inc. either on or off their premises, my minor child shall do so at his or her own risk.

I hereby release and hold forever harmless The Adventure Club, Inc., its owners, employees, representatives, and agents (collectively, “the releases”), and each of them, from any and all losses, claims, injuries, damages, or liability of any kind, sustained or incurred by us resulting therefrom, whether caused by the negligence of the releases or otherwise. I specifically agree to indemnify and hold harmless The Adventure Club, Inc., its owners, employees, representatives, and agents as to any loss, cost, claim, injury, damage or liability, sustained or incurred by using the facilities, equipment, or services, of The Adventure Club, Inc., which is caused by an act or omission, whether negligent or otherwise, of an employee, representative, or agent of The Adventure Club, Inc.

I understand/acknowledge that it is my responsibility to ensure that my minor child participates only in those activities for which he/she has the required physical conditioning. My signature below indicates that I have carefully read and freely signed this waiver, and constitutes my full acceptance of this waiver.

I understand that in an effort to prevent any potential conflict of interest, childcare outside TAC hours by TAC staff members is discouraged. However, should I hire TAC staff, it must be outside the TAC premises and with the understanding that such arrangements and payments for services are solely between me and the member. TAC does not sanction the arrangements, and I agree to hold TAC harmless from any such arrangement. If a center staff member chooses to baby-sit for an enrolled child, the Site staff member and I must request and sign a Liability Release Form to be kept in the child's file.

Thank you for enrolling your child at The Adventure Club. It is our mission to provide a before and after school program that is an Enriching, Inspiring, Educating and Exciting place for your child to learn and grow while meeting the childcare needs of our parents, the school and communities we serve.

Thank you for the opportunity to be a part of your child's life.

I have read all the above information on the TAC Parent Release Agreement.
Parent/Guardian Signature   Date   July 21, 2019
By checking the box above and entering your name here you are electronically agreeing and signing the TAC's Parent Release Agreement.

Discipline/Guidance Policy*

It is very important a school ager's development is nurtured through caring and understanding. However, there may be times when our team needs to respond to your child's misdirected behavior. Hitting, kicking, spitting, hostile, intimidation, and threatening behavior is not permitted at The Adventure Club.

  • You are authorizing the people listed above to pick-up your child from TAC.
  • TAC requires all authorized people including parents/guardians to show a government issued photo ID at the time of pick-up.
  • Identification questions listed on Page 1 will be used to confirm identity when calling in additional pick-up authorizations.
  • In the case of an emergency when the TAC's staff cannot reach you, we will call the persons designated above.

In response to these negative behaviors, our team members will not use:

  • Threats or bribes
  • Physical punishment
  • Deprive your child of food or other basic needs
  • Humiliation or isolation

In response to these misbehaviors, our team will:

  • Respect your child
  • Establish clear rules
  • Be consistent in enforcing rules
  • Use positive language to explain desired behavior
  • Speak calmly
  • Give clear choices
  • Redirect your child to a new activity
  • Move your child to a cool down

If your child's behavior is destructive, disruptive, or harmful to himself or other children, we will discuss the issues with you. You will also receive incident reports on these behaviors. If the situation can be resolved, the student may remain enrolled in the program. If we are unable to resolve the issue, you may be required to make other arrangements for your child's before and after school care.

As a parent, you may have some concerns or wish to offer suggestions. Use the lines below so we may modify the above plan with agreed upon suggestions.

Additional techniques to be used with my child:

I (We),have read, understand, and agree to the Discipline/Guidance Policy.

Child's Name
Date of Birth
Parent/Gaurdian Name
Dated:  July 21, 2019

Payment Terms*

Authorization to Bill Credit Card

Name of Student(s)
Name of Student(s)
Name of Student(s)
School
Todays Date:  July 21, 2019
Payment Terms: Check Credit Card
Name on Credit Card
Payment Type: Visa Master Card Other

I hereby authorize The Adventure Club, Inc. to bill my credit card montly prior to the start of new month's service (usually the last week of the month).
Authorizing Signature    (MUST BE THE PERSON WHOSE NAME IS ON THE CARD BEING BILLED)

2018-2019 Contract*


This contract is between The Adventure Club and , the parent(s)/gaurdian(s) of .

This contract covers before and after school services to be provided for the 2018-2019 school year. After school care shall begin on August 15, 2018 and ends June 6, 2019. Below is a summary of charges when applicable. Please read all the policies carefully before signing this contract

  Morning/Afternoon Charges
 
5 Days (AM) $100.00
5 Days (PM) $175.00
5 Days (AM/PM) $275.00


  • Registration
    A Prepayment is due upon registration of first and last month's tuition. Prepayment must be paid prior to child(ren) attending first day.
  • Tuition
    Your monthly tuition will be posted to your account on the first of each month. TUITION IS DUE EACH MONTH BY THE LAST BUSINESS DAY OF THE MONTH PRIOR TO SERVICES BEING PROVIDED. A late fee of $25.00 will be charged to your account if payment is not made by the last business day of the month.

    After the 10th of the month, if tuition has not been paid, your child will not be able to attend the program until full payment (including the late fee of $25.00) is made. You are responsible for all charges on your account. All balances due shall be paid within thirty (30) days. In the event of delinquency, The Adventure Club shall be entitled to collect the delinquent amount and all costs associated with its efforts to collect the delinquency, including reasonable attorney fees.
    • No School Attendance Days/School Breaks
      This contract does not include Spring Break (04/1-04/05), Fall Break (10/26-10/29), and Winter Breaks (12/25-1/4). However, The Adventure Club does provide services during these breaks at the rate of $21/day or $105/week for services provided from 6:30am-6:00pm. There is not a prorated fee available for these days.

      There is no service provided on the following days: Labor Day (9/3); Thanksgiving holiday (11/23), Winter break (12/24 & 12/25), Martin Luther King Day (1/21), President's Day (2/15), Good Friday (4/19), and Memorial Day (5/27).
    • Extended Care Morning and Afternoon Hours
      Extended care hours in the morning are 6:30am until school begins and in the afternoon from the end of school until 6:00pm.
    • Calling Off Child/Changes in Schedule
      Your child(ren) is scheduled to be at TAC every day. If there is a change in plans, it is important that you call off using the following procedures:
      • Call the TAC site and leave a message that your child will not be in attendance.
      • Call the school office and leave a message that your child(ren) will not be in attendance.

      if you do not make the two calls and TAC needs to make a phone call to find out if your child(ren) is safe at home, there will be a $5.00 change fee applied to your account.
    • Early Withdrawal
      If the need arises for you to withdraw your child(ren) from the program, You must submit a change of billing form and two week written notice to the corporate office of The Adventure Club either via US mail (105 East Joliet, Schererville, Indiana 46375) or via email at info@theadventureclub.net
    • Handbook
      It is posted on our website at http://www.theadventureclub.com/pdfs/parent-handbook.pd and it is your responsibility to read our terms and conditions.

      I (We),have read this contract and understand the charges and fees that will be applied to myaccount. I (we) further understand that failure to make tuition payments on time will result in the temporary removal of my child(ren) from the program. Further non-payment will result in the termination of this contract and all charges are due on my account within thirty (30) days.

Parent/Guardian Signature:   Date   July 21, 2019
Child's Name:  
Child's Grade:   School: