Summer Camp Consent Forms

  • 2026 Summer Camp Intake Form

    June 15th - July 24th

  • Child's Information

  • Choose a location for your child to attend 2026 Summer Camp*
  • Child's Date of Birth*
     - -
  • Child's Gender*
  • Select 2 electives you would like your child to participate in:*
  • Select the elective(s) you would like your child to participate in:*
  • Is your child proficient in English?*
  • Other language(s) spoken in your home?*
  • Child's Ethnicity*
  • Child's Race*
  • Does your child have an Individual Education Plan, also known as an IEP*
  • Doe your child receive special education services in school?
  • Does your child have a disability? A disability can be physical, mental and/or learning.*

  • We want to get to know your child better so that we can provide the best possible experience in our programs. Please tell us more about your child...

  • What are the main ways in which your child communicates? (Mark all that apply)*
  • What, if any, help does your child receive at this time? (Mark all that apply)*
  • What conditions does your child have that are expected to last for a year or more? (Mark all that apply)*
  • Do any of the conditions make it harder for your child to do things that other children of the same age can do?*
  • To support your child’s successful participation in this program, in what areas might s/he need extra assistance?*

  • Parent/Guardian Information


    Please note that The Children’s Trust may contact you vial postal mail, email and/or text to ask about your satisfaction with these services, and to make you aware of other Trust-funded programs, initiatives and events you may be interested in. 

    If you are interested in other services funded by The Children’s Trust, please call 211 or visit www.thechildrenstrust.org.

  • Format: (000) 000-0000.
  • Is this a cell/mobile phone?*
  • What is the highest level of education you’ve completed?*

  • Emergency Contact Information

  • Format: (000) 000-0000.

  • Parental Consent

  • Please indicate how your child will be signed out of Program each day:*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • I hereby release and waive, and further agree to indemnify, hold harmless or reimburse Ten North Group formerly Opa Locka CDC from and against any and all claims, demands, damages, actions, causes of action, suits in equity of whatever kind or nature, which I, any other parent or guardian, any sibling, the child named above, or any other party may have or claim to have, known or unknown, directly or indirectly, for any losses, without limitation in time or amount, damages or injuries, whether caused by the negligence of Ten North Group formerly Opa Locka CDC or otherwise, arising out of, during, or in connection with my child’s participation in the Summer Camp, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any.*

  • Thank you for your interest in the Art of Transformation Aftercare Program! We’re excited about the opportunity to serve families in our community through engaging, creative, and supportive aftercare services.

    Please note that in order to move forward with your application, we require consent to the following release and waiver: “I hereby release and waive, and further agree to indemnify, hold harmless or reimburse Ten North Group, formerly Opa-locka CDC, from and against any and all claims, demands, damages, actions, causes of action, suits in equity of whatever kind or nature, which I, any other parent or guardian, any sibling, the child named above, or any other party may have or claim to have, known or unknown, directly or indirectly, for any losses, without limitation in time or amount, damages or injuries, whether caused by the negligence of Ten North Group, formerly Opa-locka CDC, or otherwise, arising out of, during, or in connection with my child’s participation in the Aftercare, the travel to and therefrom, and the rendering of emergency medical procedures or treatment, if any.”

    Since consent was not provided, we’re unable to proceed with your application at this time.

    If you have any questions or would like to revisit your application, we’d be happy to help. Thank you again for considering the Art of Transformation Aftercare Program!

  • I give permission for my child named above to be interviewed, photographed, or videotaped for use in Ten North Group formerly Opa Locka CDC or its funders’ web pages, publications, productions, or for use by the general news media for print or broadcast purposes.

  • SUMMER SCHOOL ~ STUDENT/PARENT COVID-19 CONTRACT

  • While Ten North Group formerly Opa Locka CDC can not guarantee that participants in a Art of Transformation program, their parents/guardians, or others in attendance will not become infected with COVID-19, Ten North Group formerly Opa Locka CDC has adopted the following in an effort to reduce the possibility of infection:

    Because COVID-19 is extremely contagious and is spread mainly from person-to-person contact, for the Art of Transformation program, Ten North Group formerly Opa Locka CDC has put in place preventative measures to reduce the spread of COVID-19 (“Measures”). While participating in any and all Art of Transformation program activities, the student named below (“Student”) will abide by the Measures and follow all COVID-19 directives imposed by Ten North Group formerly Opa Locka CDC, as communicated by Art of Transformation staff and as set forth below.
    Student and his/her parents/guardians will practice “social distancing,” Student will bring sufficient masks each day and wear them during all Art of Transformation progam activities, and Student’s parents/guardians will wear masks whenever visiting the Art of Transformation program location(s).
    In light of the ongoing spread of COVID-19, if, during the dates of the Art of Transformation program, student falls into any one of the below categories, s/he will immediately cease participation and not come to the Art of Transformation program location(s): (a) Student exhibits any of the following symptoms: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea; (b) Student or Student’s parent/guardian believes that Student may have been exposed to a confirmed or suspected case of COVID-19; and/or (c) Student has been diagnosed with COVID-19 and is not yet cleared as non-contagious by state or local public health authorities or the health care provider responsible for his/her treatment.
    Student’s parents/guardians must pick Student up immediately from the Art of Transformation program location(s) or the Artof Transformation program field trip venue if student exhibits any of the symptoms listed in section 3(a) above and/or must be isolated/quarantined.

     

    ASSUMPTION OF THE RISK

    By participating in the Art of Transformation progam, student and his/her parent/guardian acknowledge and understand the following:

    Participation in the Art of Transformation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.
    Student knowingly and freely assumes all such risks related to illness and infectious diseases, such as COVID-19.
    Student hereby knowingly assumes the risk of injury, harm and loss associated with participation in the Art of Transformation.

     

    RELEASE AND WAIVER

    I hereby release, waive and forever discharge any and all liability, claims, and demands of whatever kind or nature against the Art of Transformation, Ten North Group formerly Opa Locka CDC, and/or either of their affiliated partners and sponsors, including in each case, without limitation, their directors, officers, employees, volunteers, and agents (the “Released Parties”), either in law or in equity, to the fullest extent permissible by law, including but not limited to damages or losses caused by the negligence, fault or conduct of any kind on the part of the Released Parties, including but not limited to death, bodily injury, illness, economic loss or out of pocket expenses, or loss or damage to property, which I, my heirs, assignees, next of kin and/or legally appointed or designated representatives, may have or which may hereinafter accrue on my behalf, which arise or may hereafter arise from my participation in/with any Art of Transformation activity.

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  • Clear
  • Date*
     - -
  • Should be Empty: