Advantage Lancaster - School District of Lancaster

Student Name(Required)

First Last

Student ID Number(Required)

Age(Required)

Grade(Required)

Which school does the student attend during the 2024-2025 year?(Required)

Student Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Custodial Parent/Legal Guardian #1(Required)

First Last

Work phone number #1(Required)

Cellphone number #1(Required)

Email address(Required)

Custodial Parent/Legal Guardian #2

First Last

Work phone number #2

Cellphone number #2

Alternate contact name(Required)

First Last

If parents/guardians cannot be reached

Alternate contact phone number(Required)

List any medical conditions/allergies, dietary restrictions, etc. of which school staff should be aware

Please list any medication that your child is currently taking

Any medication administered on a field trip must follow the School District of Lancaster medication policy. If your child needs medication while on a field trip, you must contact Advantage Lancaster for further instructions.

Insurance(Required)

Yes

If yes, company name(Required)

Policy Number(Required)

School Insurance(Required)

Yes

Please take a moment to let us know your preferences regarding our use of photos and videos of your children:(Required)

Yes. I grant Advantage Lancaster program (staff) permission to use photos and/or video recordings of my child.

No. Please do NOT take or use any photos/video recordings of my child.

From time to time, we take pictures and/or conduct video recordings during the Advantage Lancaster program. We would like your permission to use these pictures and video to promote Advantage Lancaster. We will never reference your child by their whole name or provide any specific information regarding your child.

Advantage Lancaster Parental Waiver and Consent Form(Required)

I agree to the Parental Waiver and Consent Form

I, the undersigned, as the parent or legal guardian of the child named below, do hereby give my full consent and approval for my child to participate in Advantage Lancaster Activities. I understand that there are certain risks of damages and injuries, including death, inherent in such activity, including travel in related activities incidental to my child’s participation, and I am willing to assume these risks on behalf of my child. These risks include, but are not limited to, those hazards associated with weather conditions, travel, equipment and other participants. Further, I agree that on behalf of my child and myself, I do voluntarily elect to accept and solely assume all risks of injury incurred or suffered by my child (a) while involved in the activity, (b) while involved as a team member or observer during the activity, and (c) while on or upon the premises of any and all locations of the activity. I hereby certify that my child is fully capable of participating in the above activity and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation, except as made known to the Advantage Lancaster staff responsible and/or involved with the activity. I further agree on behalf of myself and my child listed below, that I shall hold harmless and fully indemnify the Advantage Lancaster program and its employees and volunteers hereby released from any and all claims, damages, costs including attorney fees, and causes of action which may arise from any cause of action made by me or by, through or on behalf of my child, even if the damages, injuries or death are caused in whole or in part by any of the persons or entities hereby released. I acknowledge (a) that I have read or have had read to me this wavier and consent form in its entirety and (b) that I understand each of the provisions of the waiver and consent form.

Signature Line(Required)

Please type your initials or full name.

Kindergarten Registration is OPEN!

An educational mentorship program offering students a holistic approach to learning

2024-2025 School Year