Child and Family Information

Child's Developmental Information

Goals and Additional Information

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By submitting this form, I understand I am requesting a tour for my child and family. Submitting this form does not enroll my child in school or guarantee enrollment.

After the Tour and Trial Day, if all parties agree Lupine Lane is a best fit for my child and family, LL will send a private link to enroll my child. Enrollment is not secure until the enrollment form is successfully submitted.

If all spaces are filled, I will be sent a waitlist form. My space on the waitlist is determined by the time and date stamp when the form is successfully submitted.

I, the Releasor, being of lawful age, in consideration of the enrolled child being permitted to participate in activities run and/or operated by the Releasee (Lupine Lane) WAIVE, RELEASE, and DISCHARGE the Releasee, her heirs, executors, administrators, legal representatives and assigns from all liability for or by reason of any damage, loss or injury to person and property, even injury resulting in the death of the child of the Releasor, which has been or may be sustained in consequence of the child of the Releasor's participation in the activity described above, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Releasee. I hereby acknowledge and agree that I have carefully read this Waiver and Release agreement, that I fully understand same, and that I am freely and voluntarily executing same. By clicking “I agree” below this release I will be forever prevented from suing or otherwise claiming against the Releasee for any property loss or personal injury that my child may sustain while participating in or preparing for the above noted activity. I have been given the opportunity to seek independent legal advice prior to signing this Waiver and Release agreement. I understand that my child(ren) would not be permitted to participate in the above noted activity unless I signed this Waiver and Release agreement. I understand that this Waiver and Release agreement is binding on me, my spouse, my heirs, my executors, administrators, personal representatives and assigns. I acknowledge that my child(ren) does/do not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent them from participating in the above mentioned activity, and, if required, will obtain a medical examination and clearance. I hereby grant the rights and permissions of photographs taken at Lupine Lane events and classes to Lupine Lane, LLC.

If you have opted into our Tuition Continuance plan we will begin to automatically debit the agreed upon monthly tuition charge for summer camp on the first of each month beginning on June 1st and ending on August 1st. Your signature below acknowledges the payment process and that you have read and agree to the camp policies on transfers and cancellations.

I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I AM AWARE THAT CLICKING "I AGREE" I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEE(S).


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