This form is an application and does not guarantee enrollment in SunKids. Caregivers will be contacted if their child is accepted into the program. Payment is due in full to Center for Developing Kids by June 16, 2023, for applicants that have been selected to be in the program. Caregivers using Regional Center funding are responsible for contacting service coordinators to arrange authorizations & funding. I understand that if my child needs a reference form (as described above), the reference form must be received within one week of my child's application. Children's participation may be interrupted if they are not successfully engaged in the program. In these instances, the child will not be able to continue in SunKids. Missed days are not eligible for refunds or makeups. I understand that I am expected to arrive at 3:20 pm in order to pick up my child at 3:30 pm. There is a flat $10 plus $2/minute late fee for pickups after 3:30 pm.
I understand that all CDK Client Policies as detailed on the Client Policies Form apply to participation in the SunKids program.
I, on my behalf and on behalf of my child, fully understand that there is a risk of personal injury to my child in participating in play-based activities and other physically active games through the programs provided by CDK. I am aware that my child is engaging in physically active games and/or therapeutic activities, which could result in injury. I am voluntarily allowing my child to participate in these activities and assume all risks of injury that may result. I personally, and on behalf of my child, agree to hold no individual or corporation responsible or liable for any injuries and associated costs that my child receives on account of these activities, including but not limited to CDK, or it’s officers, employees, agents, aides, therapists, assistants, successors, instructors, insurers, or assigns (hereinafter “Releases”). I further agree to waive any claims or causes of action against and to hold harmless said Releases for any injuries or damages which my child suffers or might suffer as a result of the conduct of any person during or in conjunction with said physically active games or therapeutic play-based activities.
As the authorized representative, I hereby give consent for CDK, to obtain all emergency medical or dental care prescribed by a duly licensed physician (M.D), osteopath (D.O.), or dentist (D.D.S.) for my child. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my child. My signature at the bottom of this form testifies that I am the authorized representative of the child named on this document. Further, I will be responsible for the charges for any medical or dental treatment or hospitalization rendered by reason of this authorization.
