The Graham Academy Summer Enrichment Program

Every week throughout the summer, The Graham Academy will be hosting an Enrichment Program for all children going into Kindergarten through 6th  grade.   The Program offers a wide range of exciting activities including:

We welcome children of all ability levels, from delayed to gifted. Children with developmental delays will benefit from time spent in the sensory gym, playroom, art bar and music den. CHILDREN MUST BE POTTY TRAINED TO ATTEND.

COSTS: $90 per week

HOURS: 8:30a.m. to 12:00 p.m.  Monday-Friday

Children can be enrolled in the program for multiple weeks.   

Please print out the following forms and return them with your payment.

REFUND POLICY

Cancellations must be received in writing at least 3 weeks prior to the session for a full refund.

 Cancellations that are received in writing at least 2 weeks prior to the session will receive a 50% refund. 

There will be no refunds for cancellations that occur later than 2 weeks prior to the start of the session. 

　 For more information please call 570-283-0641 or email us at grahamacademy@gmail.com

 

 

　ENROLLMENT FORM FOR SUMMER ENRICHMENT PROGRAM

The Graham Academy

469 Miller St,    Luzerne, PA  18709-1501   

570-283-0641

Name of Child/Children ___________________________________________________________________

Name of Parent__________________________________________________________________________

Address ________________________________________ City/Township____________________________

State ________________ Zip______________________ Phone ____________________________________

cell ___________________________ Emergency Contact_________________________________________

Grade(s) Each Child Will Be Attending in the Fall: _________________________________________________

Is any child developmentally delayed? _________If so, what is their approximate developmental age?__________

If the child is language delayed, does the child use spontaneous speech? ________________________________

If so, do they use spontaneous sentences?_______________________________________________________

OTHER INFORMATION ___________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Please check the week your child(ren) will attend and how many children are coming:

__________June 23-27                 ________June 30-July 4                ___________July 7-11           

_________July 14-18                    ________July 21- 25                      ___________July 28-Aug 2

_________Aug 5-9                         ________Aug 11-15

All parents must complete an indemnity form prior to enrollment.  Please print out this forms below and return.

　

　

 

 

　CONTRACT, WAIVER AND RELEASE OF INDEMNIFICATION FOR THE GRAHAM ACADEMY, 469 Miller St, Luzerne, PA, 18709-1501 570-283-0641

CONTRACT, WAIVER, RELEASE AND INDEMNIFICATION

I acknowledge that by enrolling my child(ren) in the Graham Academy Summer Enrichment Program I am agreeing to indemnify and hold The Graham Academy, Christina Ouellete, CEO, and their employees harmless from all claims, damages, losses, injuries, and expenses arising out of or resulting from my or my child’s participation in the Summer Enrichment Program..

I further agree to release, acquit and covenant not to sue The Graham Academy, Christina Ouellete, CEO or any of their employees for all actions, causes of action, claims or damages, damages in law or remedies in equity of whatever kind, arising out of or resulting from participation in activities associated with the Graham Academy Summer Enrichment Program. I assume full responsibility for myself, my family, my minor children, and any other individuals whom I bring with me to the school at 469 Miller St, Luzerne, PA, 18709-1501, for any bodily injury, death, loss of personal property, or expenses as a result of my negligence, the negligence of my family, or the negligence of The Graham Academy, Christina Ouellete, CEO , or their employees.

Should a court of competent jurisdiction declare any paragraph or part of this agreement unenforceable, the remaining parts or paragraphs shall remain in full force and effect. I acknowledge that no guarantees have been made that my child will achieve any specific objectives. I have adequate health, disability and life insurance for my child. I hereby give permission for transportation to any medical facility or hospital and I authorize for any qualified medical personnel to render necessary emergency medical care for my child.

I, ___________________________________________________ (parent name), of my own free will, for my spouse, minor children, my heirs and executors and myself, have read, understand and acknowledge the risks and liabilities for myself, my child(ren) and my family this __________ day of _________________, 2008. This release will remain in effect until revoked in writing. A copy of this release can be used as if it was an original.

Name of Child (ren) __________________________________________________________________________________________________

Street Address______________________________________________________________________________________________________

City______________________________________________ State_______________________Zip__________________________________

Phone____________________________________________________________________ Cell Phone ________________________________

Emergency contact ___________________________________________________________________________________________________

Emergency Phone number____________________________________ Name of Pediatrician__________________________________________

Phone Number of Pediatrician: __________________________________________________________________________________________

Signature_________________________________________________________________________________________________________

 

 

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