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BFA  ART  CAMP REGISTRATION

     Activities 

  • Dance (Zumba for Kids  &  Salsa classes)
  • Art & Craft - Paint Class
  • Sports- (Karate)
  • Splash Zone Recreation
  • Playground
  • Field trips and more ….              

Hours:

7:30 am a 6:00 pm  

*Registration fee $20.00/  T-shirt included !

  • Cost- $70.00/week: Only for BFA STUDENTS.
  • Cost- $100/week: Only for Hialeah Gardens Residents. (With Proof of residency)
  • Cost -$110.00/week:For No BFA students or NO Hialeah Gardens Residents.

I Agree
*Payments are made every Friday of the week in advance.

I Agree
*Field trips will be held every Friday and have an additional cost of $15-$20

I Agree
(2 Snacks Included) We do not have lunch .Each student must bring their lunch wich will be refrigerated until the lunch hour and if necessary we will heat it in the microwave.

$20% OFF for families of 2 or more. 

 SPACE  LIMITED!

Disciplinary Policy For BFA Summer Art Program 

Rules listed in the code of  conduct to the Breuil Fussion Academy Art Program are enforced to ensure a safe , professional and organized program .The following disciplinary procedures are put in place for the program participants. These disciplinary procedures are designed to help each participant learn and grown as a responsible person in a fair and consistent manner. 

Minor  infractions of code of Conduct will have the fallowing consequences that vary with the developmental level and ages of children in care :

First Offense : Verbal reprimand 

Second Offense : Conference with Program Coordinator 

Third Offense : Individual circumstances will be considered and the appropiate consequenses will occur :

1. Written Reprimand 

2. Suspension (1-5 Days )

3.Permanent suspension from program 

Each offense will be writen on a discipliray action form for the parents to sign and review with coordinator .

Such disciplinary polices shall include standards that prohibit children from being subjected to discipline wich is sever ,humiliating , frightening or assosiate with food,rest or toileting. Spanking or any other physical punishment is prohibit by all children care perosonal.In consideration of the nature of the offese , we reserve  the right to implement wichever of the above steps necessary.

I have read the Code of Conduct and Disciplinary Actions for Participants.

I understand and agree to abide by these.

I Agree
     May 25, 2019

Pick Up Authorization 

SIGN IN AND SIGN OUT PROCEDURE 

Parents are to escort their children in and out of camp and sign the appropriate form .This is for the safety of all our campers .

I will infom the people named above that they must present a valid driver's license in order for my child/children to be released in their custody. At BFA we understand that in certain circumstances an individual may not be allowed to pick up your child due to custody agreement or other restictions .If applicable , please identify the name of person that may not take your child home.

I Agree
 

 

Late Pick Up Policy Fee :

For the late fee policy for camp is as follow :

For every minute  Late a $ 1.00 will be assessed. After 6:00 pm 

I Agree
 May 25, 2019

Sunscreen Policy 

The  BFA policy on aplaying sunscreen is as following :Each parent will provide with enough sunscreen to apply to his/her skin personally. When necessary, a BFA staff member of the same sex as the child will assist each child that may be unable to personally apply his/her own sunscreen. When a child needs such assistance , the staff menber will apply SPARY sunscreen on only the exposed parts of the child's skin.Children will be requested to apply sunscreen.

I Agree

MEDIA/ PHOTO/VIDEO 

I , the undersigned, do the hereby grant or deny permission to Breuil Fussion Academy, corp to use the image of my child, as marked by my selection(s) below.Such use include the display , piblication, transmition or otherwise use of photographs, imagines and/or video taken of my child for us in materials include , but may not be limited to, printed materials such as brochures and newsletters, videos and digitals imaginess such as on the Breuil Fussion Academy website .

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Pick Up Authorization

I authorize my child/children to be realized from BFA Camp to the fallowing individuals

Please do not release my child to :
Sunsscreen Permission
DO NOT GIVE PERMISSION
I GIVE THE PERMISSION
MEDIA/PHOTO OR VIDEO RELEASE
DENY PERMISSION TO USE MY CHILD'S IMAGE AT ALL
I GIVE UNRESTRICTED PERMISSION FOR MY CHILD'S IMAGE TO BE USE IN PRINT, VIDEO AND DIGITAL MEDIA.I AGREE THAT THESE IMAGES MAY BE USED BY BREUIL FUSSION ACADEMY,CORP FOR VARIETY OF PURPOSES AND THESE IMAGES MAY BE USED WITHOUT FURTHER NOTIFYING ME .I DO UNDERSTAND THAT THE CHILD'S LAST NAME WILL NOT BE USED IN CONJUNCTION WITH ANY VIDEO OR DIGITAL IMAGES.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Medical Information

Alergies

Food Alergies

Insects Bites/Stings

Other
medical condition
Epilepsy
Seizers
Asthma
Heart
Diabetes

Medical Insurance Company

Policy #

Policy Expiration Date

Emergency Contact( if custodial parent/guardian cannot be reached )

Cell Phone

Click to customize text box label
Emergency Affiant*

Click to customize text box label
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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