Climate ChangeMakers – Registration Form Step 1 of 3 33% Introducing an after-school enrichment program dedicated to cultivating young minds could be the key to unlocking their potential. By empowering the next generation with knowledge and skills in environmental sustainability, this program nurtures future eco-leaders and enables them to make a lasting impact on our planet’s well-being. Welcome to the next generation of climate change makers! See more details here. Join us in shaping a sustainable future.Student InformationStudent name(Required) First Last NicknameOptional: In case your child prefers to be called a different name.Date of birth(Required) MM slash DD slash YYYY School(Required)Walnut Acres Elementary SchoolWhat's your child's grade and teacher's name?(Required)Pick-up details(Required)Please provide the name of the person who will be picking up the student, their relationship to the student, and indicate if the student is permitted to walk home alone.Medications, allergies, food restrictions or special needs:In case of emergency, call first 911 Guardians Guardian / Parent InformationGuardian name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City ZIP / Postal Code Terms(Required)LIABILITY RELEASE I know and appreciate that risks may arise from my child's participation in any extracurricular program. I hereby assert that my child's participation in the Sustainable Walnut Creek's (SWC) programs is voluntary and that I knowingly assume any natural risks related to program activities. I do hereby release SWC and any persons represented or employed by SWC from liability for any and all claims related to my child's negligence, personal injuries, accidents, illnesses, and property loss arising from participation in SWC's programs. I agree to defend, indemnify, and hold harmless SWC and any persons represented or employed by SWC from and against any and all loss, liability charges, actions, claims, suits, expenses (including attorney's fees), and costs which may arise by reason of participation in SWC programs. REFUND POLICY SWC maintains a strict no-refund policy. All payments made towards SWC's programs are final and non-refundable. This policy applies regardless of the reason for the request including, but not limited to, absence, change in personal circumstances, dissatisfaction with program placement, or discontinuation of the program by the participant. By agreeing to this policy, I acknowledge that I have been informed about this no-refund policy and understand that no exceptions will be made. EXTRA CHARGE FEES In cases where a child is not picked up within 10 minutes after the scheduled end of a class or program session, an extra charge will be incurred. This fee is set to cover additional supervision and operational costs incurred by SWC. A charge of $10 will be applied for every additional 10-minute period beyond the scheduled pick-up time. Repeated late pick-ups may result in further action, including potential exclusion from future SWC programs. FIELD TRIP POLICY By enrolling my child in SWCs programs, I hereby grant permission for their participation in all field trips, acknowledge SWC's provision of supervision and transportation, agree to provide updated emergency contact and health information, and release SWC from liability for any incidents during these trips, except in cases of gross negligence or willful misconduct by SWC or its staff. VIDEO/PHOTO RELEASE I grant SWC permission to use my likeness in a photograph and/or video in any and all of its publications (both electronic and printed) without payment or any other consideration. In addition, I waive my right to royalties or other compensation arising or related to the use of the photos or videos that may be taken during class or events, like Earth Day at Civic Park. I understand and agree that these materials will become the property of SWC and will not be returned. I waive the right to approve or inspect the finished product, including written or electronic copy, wherein my child's likeness appears. This includes any alterations or editing made to the materials. I acknowledge that SWC will use photos and videos for advertising (both electronic and printed) and promotion, and that these WILL NEVER be given or sold to a third party. I agree to the terms. PaymentClimate ChangeMakersCalling all Planet Protectors! Come take action and become an Eco-Entrepreneur. Develop leadership skills as you engage in fun hands-on projects aimed at making Walnut Acres more environmentally friendly. By the end of this 12-week program, you will not only gain a deeper understanding of climate change and its impact but also learn to think like an entrepreneur, working in teams to ideate, create, and present a project. All materials provided. Mondays, 2:50-3:50 pm, from Jan 22 to Apr 29, 2024. Price: Credit CardCard Details Cardholder Name