Summer Academy Registration


The information requested below is necessary in order to fulfill our obligation to provide the donors and foundations that support our core College Bound program with general information about the students we serve. Your personal information will remain private and will never be shared. It is important that you respond to each question honestly and completely so that we are able to meet our program goals.

 

At the end of this form, you will be asked to pay either a $50 deposit or the full $250 registration for Summer Academy. 


This year Summer Academy will be at New Heights in Brooklyn from July 8th - August 2nd. Monday through Friday from 8:30 AM - 4:30 PM.


Please do not hesitate to contact our Director of Programs, Greg Louis, at glouis@newheightsnyc.org if you have any questions.





Personal Information


Demographic Information


Edit section title





Parent/Guardian Contact




Emergenct Contact
Please add an emergency contact that is different from the guardian above. 



Summer Academy Information






BY SUBMITTING THIS FORM, I AFFIRM THE FOLLOWING:

I, the undersigned, certify that I am the parent or legal guardian of my child. As such I grant permission New Heights Youth, Inc. regarding the following items:


● I do hereby grant permission for my child to participate fully in all New Heights programming and special events.

● I also grant permission for New Heights Youth, Inc and Bedford Courts I LLC to use the images (photographs, video, interviews, etc.) of my child taken by New Heights staff or volunteers, media representatives, newspapers, and television reporters, photographers, special event staff or public relations personnel. Photographs, videos and interviews will only be used to promote the New Heights Youth Program.

● I agree that my child may participate in online New Heights workouts, workshops and meetings with video (including Zoom), and I agree that New Heights may record my child’s participation in such workouts, workshops and meetings, including her/his name, image and voice for program evaluation purposes, and to promote the New Heights program.

● I give permission for my child to complete all evaluative surveys in order to improve the New Heights program.

● I give permission for my child’s school to release all academic records to New Heights Youth, Inc.

● I give my consent for my child to travel and otherwise participate in all trips with New Heights.

● I give permission for my child to eat meals or snacks in connection with the Program.

● I give my consent to New Heights to seek medical care for my child should he/she need it. I agree to pay all of the costs (or use my insurance, if any) associated with the medical care that my child receives. I understand that New Heights will act in good faith to contact me before and after care is provided.

● I am fully aware that some program activities can be dangerous and may result in serious injury. Knowing and understanding all possible risks and dangers, including those resulting from the COVID-19 pandemic, I hereby expressly and willingly allow my daughter/son’s participation in New Heights’ program activities. In consideration of my daughter/son’s participation, I hereby waive all claims or causes of action against New Heights, its officers, directors, employees, agents, and volunteers from all liability in connection therewith. Furthermore, I give any New Heights parent, faculty, and/or staff and volunteers present at the program permission to seek medical attention for my daughter/son in the event that she/he becomes injured.


Payment Page 

Thanks for Signing up!

 

There is a cost of $250 for Summer Academy. 


You can pay today (in full or a $50 deposit) via debit or credit card through our secure online system. If you pay $50 today, the remaining $200 will be due June 1st. The deposit is non-refundable. If you have any questions please reach out to Adam at aberkowitz@newheightsnyc.org. 

 




Payment Information