Dream AcadeME 2025 Program Registration Form
On questions for which an answer doesn't apply to your child, please write NA. ONE FORM PER CHILD PLEASE!!!
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Please select the program for which you are registering your child:
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Summer Camp 2025 in Amherst/Milford New Hampshire. Offering camp all summer! June 17 through August 28, 9:30am until 1:30pm.

In order to offer families maximum flexibility this summer, we are offering 3-day, 2-day, & 1-day options each week!

Please choose your schedule from the options below:
3-days Tues, Wed, & Thurs: $150
2-days on Tues & Thurs: $110
1-day on Wed: $60

Please note, weeks are listed by the first day of camp that week. For example, 6/17 is a Tuesday and starts that week for camp.
Pick one box per week you want your child to attend camp.

Payment in full due upon registration.
6/17
6/24
7/1
7/8
7/15
7/29
8/5
8/12
8/19
8/26
T/W/Th
T/Th
Tues only
Wed only
Thurs only
What is your child's first and last name? ONE CHILD PER FORM PLEASE!! *
What is your child's date of birth?
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Select one for your child:
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What is the child's primary address (street, city, state, zip)?

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What is the child's 1st parent/guardian's full name?
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What is the child's 1st parent/guardian's best cell phone? *
What is the child's 1st parent/guardian's best email?
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What is the child's 1st parent/guardian's address, if different from the child's?
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What is the child's 2nd parent/guardian's full name?
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What is the child's 2nd parent/guardian's best cell phone?
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What is the child's 2nd parent/guardian's best email?
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What is the child's 2nd parent/guardian's address, if different from the child's?
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Does your child have any siblings?
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Are there additional family members or friends living at home?
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If yes to siblings, other family members, or friends living at home, please list names and ages.
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What are the pets, type of pet, and the pets' names that live with the child?
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Please provide THREE names AND phone numbers of people other than parents/guardians who are allowed to pick up your child:
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Does your child know how to swim?
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What is your child's primary care Physician (Name, Phone Number, Address, Email)?
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Please list any medications your child is currently taking.
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Does your child have any allergies to medications and/or foods?
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What is your child's previous afterschool classes, camp, or tutoring experiences?
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Is your child currently homeschooled or were they ever homeschooled (homeschooling applies for grades K and up)?
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Is your child or has your child ever been enrolled in a child care center, preschool, or other public or private schools in any grade level?
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If yes, what is the name of the school(s) your child currently attends or formerly attended?
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What is the grade your child attends or formerly attended at this school? 
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Please describe your child in three words.
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Please share what your child enjoys doing.
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What do you admire most about your child?
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Is there any other information to better serve your child?
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FOR TUTORING CLIENTS ONLY! Communicating your child's learning with YOU is one of our top priorities! Each time a Dream AcadeME educator works with your child, you will receive documentation and communication about your child's learning, whether it be on Dojo, email, texts, photos, google drive, or in conversation, we keep you informed. This is an integral part of the parent-teacher relationship and core value because keeping a transparent relationship with you improves our work with your child. 

We charge .25 hours of the tutoring rate to document each session with your child. When you sign this form, you are agreeing to documentation charges for your child's tutoring sessions. This is a great way to track your child's progress and use the documentation for your child's education portfolio.

Thank you for supporting the sustainment of our non-profit organization and the integrity of our program. We are better able to provide quality care and services to you and your children when educators' time is compensated for documentation.

We value each of you and appreciate your partnership!

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Do you accept the following: Dream AcadeME reserves the right as its sole discretion to refuse an application or dismiss a child from any program. *
Do you accept the following: I give Dream AcadeME permission to photograph and/or videotape my child for public relations and/or marketing purposes, as well as for promotional purposes without notification. *
Do you accept the following: I give permission for Dream AcadeME to transport my child for the purpose of field trips. *
Do you accept the following: I give permission for Dream AcadeME to transport my child for the purpose of emergency medical care. *
Do you accept the following: I authorize the program management to act as the agent of the parents in any emergency situation or to administer basic first aid for the health and welfare of the child involved. I am responsible for the expenses involved of the services or physician or hospitalization required. *
Do you accept the following: I give permission for my child to participate in activities related to the program I hereby assume full responsibility for and risk of bodily injury, property damage or loss, regardless of severity, that I or my minor may sustain from my and my minor child’s presence in, upon, or about the facility or while participating or observing the premises or any facilities, or participating in any program affiliated with Dream AcadeME without respect to location. *
Do you accept the following: I, for myself, my spouse, and my minor child, hereby full release, waive, discharge, and covenant, not to sue Dream AcadeME, its operating centers their respective owners, officers, directors, members, volunteers, or employees and each of them from any and all claims for injuries, damages, or loss that I or my minor child may have or which may accumulate to me or my minor child from my and/or my minor child’s presence in, upon, or about the facility or while participating or observing the premises or any facilities, or participating in any program affiliated with Dream AcadeME without respect to location. *
Do you accept the following: I acknowledge that Dream AcadeME and the owners, directors, officers, volunteers, representatives, and agents are not responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity of behalf of Dream AcadeME. *
I understand and accept these guidelines for which I have agreed and checked "Yes" above.
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ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

In consideration of being allowed to participate on behalf of Dream AcadeME and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

Participation includes possible exposure to and illness from infectious diseases, including but not limited to MRSA, influenza, COVID-19, RSV, Norovirus, etc. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Dream AcadeME, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases.

I further acknowledge that Dream AcadeME can not guarantee that I will not become infected with Covid-19 or any other virus or bacteria. I understand that the risk of becoming exposed to and/or infected by COVID-19 or any other virus or bacteria may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, independent contractors, and other clients and their families.

I voluntarily seek services provided by Dream AcadeME and I attest that:

I promise to send my child to Dream AcadeME programs only when my child is NOT experiencing any symptom of illness such as severe/mucus cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or colored excessive mucus coming from nasal passages. I promise that I will keep my child home until 24 hours AFTER symptoms reside. 

Please do not send your child to any of our programs wearing a mask. In general public use, they are not protective against the spread of germs, especially the way children handle them, and they interfere with intellectual, social, and emotional learning.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

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Thank you for registering your child for Dream AcadeME!

There is a one-time $40 registration fee due with the completion of this form.

Payments are due upon receipt of your invoice via Quickbooks. Some classes/camps may require payment in advance or a deposit up front. A $25 late fee occurs when payments are 10 days overdue. If your child needs to cancel, please let the scheduled teacher know as soon as possible. If you cancel less than 24 hours in advance, you will forfeit your session and be charged.

Payments are preferred to be made via Quickbooks, from which you will receive an invoice for the services requested above.

We also accept Venmo:

@Traci-DreamAcadeME - choose the option with NO fees please.

Cash and checks are also accepted.

Please make checks* payable to, Dream AcadeME and mail it to:

Dream AcadeME (attn: Traci Korhonen)

4 Pinewood Drive

Amherst, NH 03031

*bounced checks will be charged a $35 fee in addition to amount of invoice

We look forward to learning and dreaming with your child :-)

With Gratitude,

Dr. Traci Korhonen, Ed.D. & the Dream AcadeME Team

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