Trips and Dips Application 2017
           9:00 a.m.-3:30 p.m.
Please complete the application, select the sessions that you want to enroll your child.  Read the Terms and Contractual Agreement on the application, as it constitutes your agreement to the policies of Academy Child Development Center, Inc.  Once you have completed and submitted your child's application, you will receive a Paypal invoice from Academy within 48 hours. 

                Please check all that apply:








*Current children who attend Academy and Trips & Dips Alumni, please submit a brand new emergency form & Medication Authorization Form (if applicable) via email to tripsanddips@gmail.com.
Thank you!
Child's T-Shirt Size
(Please Choose One Size Larger)
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Terms & Contractual Agreement
    As a parent or legal guardian, I am requesting enrollment for my school-age child for the indicated sessions. I agree to abide by the terms as outlined below:
    Completed applications will be considered on a first come basis and must include application, tuition worksheetIncomplete applications will not      be accepted.

Trips & Dips Explorers 9:00 a.m.-3:30 p.m. (K-2nd grades) is $405 for each Session; $324/$272** for Sessions #1 & #3 (closed 6/19/17 & 7/4/17).
Trips & Dips Adventurers 9:00 a.m.-3:30 p.m. (3rd-6th grades) is $405 for each Session; $324/$272** for Sessions #1 & #3 (closed 6/19/17 & 7/4/17).
> Trips & Dips Counselor In Training (CIT) 9:00 a.m.-3:30 p.m. – For students entering 8th-10th grades. Application and recommendations required.  Please       send an email to tripsanddips@gmail.com and our Student Service Learning Coordinator will contact you.
>  Non-refundable application fee is $50 per family.
Trips & Dips by Academy will be closed  June 19, 2017 and July 4, 2017.
> Tuition includes field trips with transportation to our S.T.E.A.M. Labs at DuFief and Cold Spring Elementary Schools, transportation, swimming, materials,          afternoon snack and one t-shirt.
All children must purchase a Trips and Dips Rash Guard to be worn on pool and water park daysNo Exceptions.
> Parent must accompany child at shuttle bus stop until child boards the Academy bus & meet the Academy bus at the designated drop off time.
> If my child arrives late and the group has departed, I will be responsible for making alternative arrangements for my child for the day.            “Students” may not be left at Academy for the day if their group is gone.
Extended Care is available from 7:00 a.m.-9:00 a.m./3:30-6:00 p.m. The weekly cost per child is $40 for the morning and $50 for the afternoon.  
> If my child is dropped off prior to 9:00 a.m. or picked up after 3:30 p.m. and he/she is not enrolled in Extended Care during that session, I will owe the                  Extended Care Fee for the entire session.
> Group size is limited. Incomplete applications will be returned.
> All payments are non-refundable; however a credit may be given towards later sessions if space is available.
> A confirmation letter will be sent.
> We reserve the right to cancel any session due to insufficient enrollment.
> Acceptance is based upon Academy’s ability to meet your family’s needs. Enrollment is on a trial basis. Academy reserves the right to terminate services            for your child if deemed necessary.
> Children are expected to work cooperatively with summer staff and the other children. Anyone with behavior problems will be dismissed without a refund.
> This application constitutes your agreement to the policies (as outlined in the flier and the Academy Family Handbook) & tuition obligations necessary to              enroll  your child in Trips & Dips S.T.E.A.M. Summer 2017 by Academy Child Development Center, Inc. The application gives permission for your child to be    
   transported by Academy, to participate in all activities and your understanding and acceptance of the inherent risks of participation in lively, recreational    activities both indoors  and out.

Registration cut-off is 4:30 pm the Thursday prior to each session’s start date.                   
Trips & Dips Summer 2017 Requested Sessions & Extended Care – please complete all that apply. 
Please complete one form per child.

Please select the Program:
Child's Name:
Date of Birth:
Home School:
Grade in Fall 2017:
Employer1:
Home Phone 1:
Work Phone 1:
Cell Phone 1:
Email Address 1:
Parent/Guardian Name 2:
Employer 2:
Home Phone 2:
Work Phone 2:
Cell Phone 2:
Email Address 2:
Child's Address:
Parent/Guardian1:
Parent/Guardian 2:
Date:
Date:
Child's First and Last Name:
Parent/Guardian Name1: 
Rash Guard/Swimshirt
(Please Choose One Size Larger)
***Rash Guard Shirts are Mandatory***
Summer Location
Academy Primary School​
10107 Darnestown Road
Rockville, Maryland 20850 

S.T.E.A.M.
Male
Female
New Student
Trips and Dips Alumni*
Current Academy Student*
Session #1 6/20-6/23 (*Closed 6/19/17)
Session #2 6/26-6/30
Session #3 7/3-7/7 (*Closed 7/4/17)
Session #4 7/10-7/14
Session #5 7/17-7/21
Session #6 7/24-7/28
Session #7 7/31-8/04
Session #8 8/7-8/11
Session #9 8/14-8/18
#1 Ext.Care AM
#1 Ext. Care PM
#2 Ext. Care AM
#3 Ext. Care AM
#4 Ext. Care AM
#5 Ext. Care AM
#6 Ext. Care AM
#7 Ext. Care AM
#8 Ext. Care AM
#9 Ext. Care AM
#2 Ext. Care PM
#3 Ext. Care PM
#4 Ext. Care PM
#5 Ext. Care PM
#7 Ext. Care PM
#6 Ext. Care PM
#8 Ext. Care PM
#9 Ext. Care PM
I have read and agree to the Terms & Contractual Agreement
Sibling Enrolled
Session #10 8/21-8/25
#10 Ext. Care AM
#10 Ext. Care PM