* 1. Sign Up Information

1. Big Apple Day Program (BADP) is a social skills summer treatment program owned and operated by Manhattan Psychology Group, PC (MPG). If I am receiving financial scholarship, I assert that my annual household income meets the written requirements.

2. I authorize my child’s participation in all BADP activities. As a parent/legal guardian of a minor participant, I recognize and acknowledge that there are certain risks of physical and/or psychological injury associated with participation in BADP, and I agree to assume the full risk for any injuries, damages or loss which may be sustained as a direct or indirect result of my minor child’s participation in BADP as against MPG or its officers, agents, servants and employees, or any other agencies or vendors associated with BADP. Participation includes, but is not limited to, athletic, educational, and therapeutic activities, as well as traveling to/from BADP and using public or chartered transportation. I do hereby fully release and discharge MPG and its officers, agents and employees from any and all claims from injuries, damages or loss that may occur to my minor child or me on account of my minor child’s participation in BADP.

3. I recognize that participation in BADP may require strenuous physical activity and I attest that my child is physically fit for such activity. Further, I agree to notify BADP in writing of any changes in my child’s physical or mental health between the dates of application and the program start date. I give consent to any employee, agent, or other personnel affiliated with BADP to seek medical attention and treatment or other measures deemed necessary or advisable in the discretion or judgment of BADP for my child in the event of an accident, sudden illness, or other condition that occurs while my child is in the care or under the supervision of BADP. I further understand that BADP will make reasonable efforts to notify the child’s parents/legal guardians in the case of an accident, sudden illness or other condition, but authorizes BADP to seek such care or treatment, and for any care or treatment to be administered, even in the event that either parent or legal guardian are not contacted prior to the seeking or rendering of such, care, treatment, or other measures. I release MPG and all BADP staff from and of any liability for such decisions or actions in seeking medical care. I also agree to pay all the costs and fees for the medical care or treatment authorized under this Emergency Medical Authorization. In the event of an accident or sudden illness, I authorize BADP staff to arrange for emergency medical care for my child and release my child’s insurance information as needed.

4. In addition to providing a “camp-like” experience at BADP, I understand that my child will receive treatment towards five major goals: 1) improve his/her social skills, problem-solving skills, and social awareness to get along better with peers; 2) improve classroom behaviors to enhance his/her academic performance and productivity; 3) improve his/her ability to follow-through with instructions, complete tasks, and comply with adult requests; 4) improve his/her self-esteem by developing competencies in academic, sports, and interpersonal domains; and 5) teaching his/her parents how to develop, reinforce, and maintain these positive changes. This treatment will be delivered and monitored via: 1) reward system and individual behavior plans; 2) social skills training; 3) classroom academics & tutoring; 4) art learning projects; 5) problem-solving training; 6) swimming and sports activities; and 7) parent training classes.
5. I understand that BADP utilizes behavior modification principles to teach my child new social skills. This includes positive rewards (e.g., verbal praise, tokens, awards, privileges, field trips) for pro-social target behaviors (e.g., following rules, paying attention, practicing social skills, helping, sharing, ignoring negativity, being a good sport) and negative consequences (e.g., loss of awards/privileges, time-out, not going on field trips, assignment of chores) for inappropriate behaviors (e.g., breaking rules, teasing, stealing, lying, leaving the area without permission, physical aggression, destruction of property, repeated non-compliance). Children may be suspended or terminated from BADP for aggressive behaviors or continued non-compliance with program rules. I understand that I will be contacted to pick up my child from BADP early if he/she is not able to control his/her behavior. Further, I understand that if it is felt by BADP staff, at any time, after due consideration, that my child is not benefiting from BADP or interfering with the learning or safety of other children, BADP reserves the right to suspend or cancel enrollment without refund.

6. I understand that a Parent Education class will be offered one evening per week for the duration of the program where I can learn skills to improve my child’s behavior at home and in public. This is optional but strongly recommended as it will help my child derive maximum benefit from BADP. The exact time and location will be emailed to me prior to the program start date.

7. I understand that BADP reserves the right to cancel any classes, transportation services, or portions of BADP for which there is insufficient registration and to modify the BADP schedule and change faculty assignments as necessary. Once I submit payment for enrollment, I understand that there are no refunds. Once BADP has started, I understand that there are no refunds or make-up days for absences, no matter what the reason, including but not limited to sickness, scheduling conflicts, or Friday field trips. This includes if my child is sent home by BADP staff due to sickness or contagious infection (e.g., lice). If there is insufficient registration, however, there would be a full refund.

8. I understand that I am financially responsible for any damages that my child causes to the facilities, buildings and their contents, program materials, and equipment used by BADP. I understand that I am also financially responsible for any damages that my child causes to someone else’s personal property while attending BADP. I understand that BADP/MPG will not assume financial responsibility for damages done to property or possessions by any child enrolled in the summer program. Unless agreed upon by BADP staff, children should not bring money or items of any significant value to BADP, such as phones, gaming devices or other electronics.

9. I authorize MPG to photograph and/or video record me and my child during his/her participation in BADP, which may be used for promotional purposes. I understand that we will not be identified by name and are not entitled to any compensation for such images. I further understand that visitors may observe BADP.
10. I understand that it is my responsibility to plan for my child to be dropped off and picked up at the set time, as indicated on my pickup/drop off form. If my child is late to be picked up by more than 10 minutes, it can cause disruptions to the entire schedule. Further, I understand that if this happens more than 2 times, there will be a penalty of $50 per incident. I understand that BADP operates out of Solomon Schecter School of Manhattan and that Friday field trips may include museums, beaches, bowling, and other destinations in the greater NYC metro area by way of public or chartered transportation.

11. I understand that food is not provided by BADP and that it is my responsibility to send with my child a cold bag lunch, drink and 2 snacks each day. I understand that BADP is a non-nut free camp. Glass containers should be avoided. I understand that my child should wear comfortable clothing and sneakers daily for sports. BADP staff will notify me by email about Friday field trips and if my child should also bring a swimming suit or other materials.

12. I understand that I am personally financially responsible for paying for my child's participation in BADP. During my post-camp parent feedback session, I will receive a billing receipt that I can submit to my health insurance for out-of-network reimbursement. It is my responsibility to verify my own health insurance benefits. I can request a sample billing receipt to assist in this process.

13. I acknowledge that I have read this Parent Liability Consent and Release Agreement and that it shall benefit and be binding on me, my successors, heirs and assigns.

* 2. Parent information

T