Texas State Summer Play and Inquiry Workshop Registration

2024 PLAY AND INQUIRY SUMMER WORKSHOP

Ages 3-8 June 12th – June 29th, 2024 (Monday – Thursday, 8:30am – 11:30am)

Cost: $110 for 1 child, $205 for 2 children, $300 for 3 children

DEPARTMENT OF CURRICULUM & INSTRUCTION CHILD CARE AGREEMENT, ENROLLMENT POLICIES AND AUTHORIZATION INFORMATION

Child's Legal Name *

Child's Preferred Name or Nickname

Child's Age *

Child's Birthday *

Child's Home Address (address, city, state, and zip code) *

Any important information our staff should be aware of for this child? (Health Conditions, Food Allergies etc.)

Do you need to register a second child? *

Child's Legal Name

Child's Preferred Name or Nickname

Child's Age *

Child's Birthday (mm/dd/yyyy)

Child's Home Address (address, city, state, and zip code)

Any important information our staff should be aware of for this child? (Health conditions, food allergies, etc.)

Do you need to register a third child? *

Child's Legal Name

Child's Preferred Name or Nickname

Child's Age *

Child's Birthday (mm/dd/yyyy)

Child's Home Address (address, city, state, and zip code)

Any important information our staff should be aware of for this child? (Health conditions, food allergies, etc.)

Parent and Guardian Information

Primary Contact Email (used only to notify you about the workshop) *

Parent 1/Guardian 1 Name *

Phone number where parent/guardian can be reached while child is in program *

Parent 2/Guardian 2 Name

Phone number where parent/guardian can be reached while child is in program

If parents/guardians cannot be reached in case of emergency, who can we contact? *

Contact Phone Number *

Relationship to child *

In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the Summer Workshop Director(s) to take my child to

Primary Care Physician Name, Address, and Phone Number *

I authorize my child to be released by the Summer Workshop staff only to the following persons: (please include first and last name and phone number)

I hereby give my consent for my child to participate in walking field trips supervised by the Summer Workshop Staff.
I hereby give my consent for my child to be videotaped and/or photographed during his/her participation in the Summer Workshop. I also give my consent for these videotapes and/or photographs to be used in education classes or professional development opportunities as examples of play-based curriculum.
I understand that my child will be as closely supervised in all activities as is possible. I further acknowledge that Texas State University-San Marcos, its employees and students will not be held responsible for accidents or injuries of any kind. I further acknowledge that Texas State University-San Marcos is not providing any insurance coverage of any kind. If I wish my child to be covered, I will provide the coverage myself.
It is recommended that parents who do not have insurance coverage for their child should secure insurance for the duration of this program.

I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND HAVE PROVIDED THE INFORMATION REQUESTED. I AGREE TO THE POLICIES STATED AND WILLINGLY SIGN MY NAME.

Please type your name, initials, and date below. This will serve as your electronic signature.

Name *

Initials *

Date *

How are you paying? *

Online Payment

This option will become available once you click submit

Check

Please make all checks out to "Texas State University" and mail checks to the following address: Play & Inquiry Workshop – Curriculum & Instruction Dept. Texas State University - ED 3055 – Diane Osborne 601 University Drive San Marcos, TX 78666

Cash

Please contact the Department of Curriculum and Instruction to arrange this payment method. 512-245-3680

If you happen to see this, do not fill this field.