Register Online

Fill out the registration form as completely as possible. Items marked in red are required for online processing. Fill out a Registration Form for each student you want to enroll. Take the second student discount only on the Registration Form for the second student. Please contact us if you have any questions regarding registration.

Parent/Guardian Information

Parent/Guardian	Please enter a name.
Street Address	Please enter an address.
City	Please enter a city.
State	Please enter a state.
Zip Code	Please enter a zip code.

Home Phone	Please enter a home phone number.
Work Phone
Cell Phone
Email Address	Please enter an email. Please enter a valid email address.

Additional Contacts

I authorize these individuals to pick up my child at the end of the day.
These individuals may also be contacted in the event of an emergency, should I be unavailable.

Name	Please enter your additional contact.
Daytime Phone	Please enter your addtional contact's phone.

Name
Daytime Phone

Consent Agreement

	As the parent/guardian of the student being registered for Kids on Campus (KOC), I certify that my child has my permission to attend and participate in all aspects of the program. I allow the Rochester Institute of Technology (RIT) to use photographs and videos of my child (without using last names) for program advertising/promotional purposes, including on the Internet. I consent to hold harmless and release RIT from any and all liability, legal actions or claims which I or my child might have for any damage or injury as a result of being enrolled in the program or from participating in any activity that results in damage or injury or loss or damage of personal property. I understand that if my child does not conform to the behavior expectations and rules of the program, KOC reserves the right to dismiss my child and that there shall be no refunds issued for such dismissal. I further understand that I will be responsible for any personal or property damage caused by my child while at KOC, and that RIT is not responsible for personal belongings lost, damaged, or stolen. I understand that due to demand and scheduling complexities, space in selected workshops is not guaranteed, and that KOC reserves the right to cancel or consolidate workshops. If a workshop is canceled prior to its start, I will receive a refund for all monies paid to KOC for that workshop, or I may enroll my child in another workshop. If I need to withdraw for any other reason, a refund minus a $100.00 processing fee will be granted up to June 1st, 2011. No refunds (except in the above circumstance) will be made after that time. In case my child has an illness or accident during the program, RIT and its representatives have my permission to make suitable arrangements for and to authorize medical care and to act in my stead according to their best judgment in any emergency requiring medical attention. I understand that all medical expenses will be paid by me or by my child's medical insurance plan. I understand that the Health Information must be completely filled out. I understand that I am responsible for advising KOC of all pre-existing medical conditions. I hereby state that, except as disclosed, the child being registered is in good, normal health and has no emotional or behavioral issues that could impact on his/her ability to participate in the program.
	By my electronic signature below, I accept this Agreement. I understand I must also sign a paper copy of this form (one will be provided for you by mail/or be available for your signature upon arrival on the first day). Please confirm this statement.
Please Sign Here	Please confirm this statement.

Payment Information

Refund Policy	If we cancel, full refund. If you need to withdraw, a refund minus a $100 processing fee will be granted up to June 1st. No refunds will be processed after that date.
2nd Child Discount (10%)	Discount to be taken only on second child's registration form.
Total Amount Due $
	(2nd session discount is automatically figured into the total displayed above.)

One or more mandatory pieces of information has been left blank. Please review the form and provide all mandatory information.
A required field has incorrectly formatted information.
Please select a grade and a t-shirt type. Please check off both the student statement and the consent agreement.

Please select at least one session.
Please select a day type and workshop.