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Sumner Skate Zone
Registration $40 or $60 Family Weekly
(official use only)
Five Days: $65.00
Three Days: $55.00
Two Days: $40.00
Full Time: ____Monday thru
I hereby enroll in Sumner Skate Zoneís AfterSchool Program. I agree to pay the above tuition along with a
$40 registrationfee. I understand that no refund what so ever will be made to me if I fail to
appear. I understand
the After School Program fees are due the Friday before
the week my child(ren) attend or there will be a $20 late
fee for any payments
made after Monday of the week of attendance.
Parentís Signature: ____________________________
STATEMENT OF COOPERATION AND
am in good health and know of no physical or mental defects that would endangermy own well
being or that of other students. I understand that there arecertain physical risk associated with engaging
in roller skating and relinquish
all rights to claim or recover damages for personal injury in connection
my activities at Sumner Skate Zone. These activities include those activities
performed at the
facility, off the facility, and in transport to and from the
facility. Permission is hereby given for my
child(ren) to participate in all of
the facilities activities, including but not limited to skating, games and
playtime. This release of legal rights is not only binding upon me, but upon my
survivors and representatives
as well. This release operates in favor of Sumner
Skate Zone and its employees. I knowingly and
voluntarily give up my legal
rights against all of the persons and entities.
understand that attendance at Sumner Skate Zone After School Program is a
I/we agree to timely pay our
financial obligation to the Program. I understand the After School Program
we agree to abide by the policies and rules established by the
facility and as stated on the rules
sheet. We agree to cooperate with the staff
in a supportive manner.
are due the Friday before the week
my child(ren) attend. There will be a
$20.00 late fee for any
payments made after Monday of the week of attendance.
Print name of parent or guardian Date
MEDICAL RELEASE/EMERGENCY CONTACT
After School Program
Home phone: _____________Cell
Alternate phone: ____________________________________
__________________Work phone: ____________
Studentís physician: _________________Phone:_____________
For treatment of: _____________________________________
List any other health problem
or physical limitations: __________
List all Allergies:____________________________________
Please list those individuals you hereby allow to pick-up
your child(ren) if the parent/guardian
can not be reached. Your child will not
be released to anyone who is not on the list.
I hereby give permission for the owners and employees of
Sumner Skate Zone to obtain
treatment for my child ___________________________ in
the event of an emergency.
Parent/guardian signature:_________________________ Date:
I, _______________, give
____________________, permission to
(Parentís name) (Schoolís Name)
child/children____________________________, go on
transportation provided by SumnerSkate Zone After School program.
_____________________ __________ _______________
- Sumner Skate Zoneís After School Program
will operate Monday
thru Friday from the time we pick them up from school
- All students must be picked up between
6:00 and 6:15.
- A $5.00 late fee will be charged per
child picked up after 6:16p.m
with an additional $5.00 per every 15 minutes
- There will be a $20.00 charge on all
- Parents must sign out their child(ren)
when they are picked up.
- Only those persons listed on the
Emergency contact list will be
allowed to pick up the child(ren) unless
the parent or Legal guardian
make a written or verbal request, in person
or to the program director.
That person must present a valid I.D before we
will dismiss the child
- It is the parentís/legal guardianís
responsibility to notify Sumner
Skate Zone if the child(ren) does not
attend school that day or is
going on vacation. This is extremely important
so we know they
were not in school and therefore will not be attending the
and do not need to be picked up.
- During homework time ALL students must
do work. If they are
finished their homework they can read.
- A two week notice must be given in
writing if you plan on removing
your child for the program.
- Sumner Skate Zone is not responsiblefor any personal items left
anywhere on the premises.
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