(Please Note: This form MUST be submitted before child starts attending.)

 Emergency Contact phone numbers AND person(s) to whom child may be released.
NOTE: It is mandatory to supply Kinder Works with at least 2 names other than parents. Thanks!

In case of emergency, the Director will replace the staff person accompanying the child.  In case of accident or sudden illness, I/We authorize Kinder Works staff to use the medical services of the nearest hospital.  I/We consent to administration of medical care in the child's best interest.

Parental consent is given to Kinder Works staff to administer minor First-Aid procedures in the child's best interest.

I give permission for Kinder Works Camp Staff to take photos of my child for use in the camp displays and program (bulletin boards, wall decor, memory books, gifts, etc.), & to be included in movie productions. *
I give permission for Kinder Works to use my child's photo on the website, our news blog, Facebook, and for promotional and/or training materials. (Personal information will NOT be included.) *

I have read the Kinder Works Dig/Arts Summer Camp Parent Handbook and I/we agree to comply with the policies and procedures within it.

Kinder Works
Central Office: 1090 Pebble Hill Road, Doylestown, PA 18901


TO: All Parents

FROM: April Bass, Executive Director
Kinder Works in Doylestown: 1090 Pebble Hill Road, Doylestown PA 18901
Kinder Works in Montgomeryville: 595 Bethlehem Pike, Bldg. 500 Montgomeryville PA 18936
Kinder Works in Limerick: 36 W. Ridge Pike, Limerick PA 19468

Admissions, the provision of services, and referrals of clients shall be made without regard to race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age, or sex.

Program services shall be made accessible to eligible persons with disabilities through the most practical and economically feasible methods available.

Any individual student/parent (and/or their guardian) who believes he or she has been discriminated against may file a complaint of discrimination with:

Kinder Works
(Please use address above)

Department of Human Services
Bureau of Equal Opportunity
Room 223, Health & Welfare Building
625 Forster Street
Harrisburg, PA 17120

U.S. Dept. of Health and Human Services
Office for Civil Rights
150 South Independence Mall West
Suite 372, Public Ledger Bldg.
Philadelphia, PA 19106-9111
PA Human Relations Commision
Philadelphia Regional Office
Philadelphia Regional Office
110 N. 8th Street, Suite 501
Philadelphia, PA 19107

Commonwealth of PA
DHS Bureau of Equal Opportunity
SE Regional Office
801 Market Street, Suite 5034
Philadelphia, PA 19107