THE DOTTED LINE of GEORGIA INC.

   TDL SUMMER PROGRAM

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General Information programs include swimming, field trips, outdoor programming, and many more fun-filled activities. We encourage positive thinking, creativity, friendships and fitness while making lasting memories.

 

Fees: $25 per day, $90 per week or $320 per month

 

Mon - Fri during the hours of 8am to 4pm

 

Main Contact Person

 

Last Name ___________________________________ First Name ________________________________________

 

Date of Birth _____________   Male ______  Female ______  Are you a Cobb or Fulton County Resident  Yes /  No

 

Street Address ____________________________________________________________________________________

 

City ______________________________ST ________ Zip ______________ Home Phone _____________________

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E-mail Address _________________________Work Phone ________________ Cell Phone _________________

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Participant #1

1st Participant   Name ____________________________________________________________________________                    

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Date of Birth ____________  T-Shirt Size (Please Circle)  Youth S  M  L  Adult  S  M  L  XL

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2nd Participant  Name ____________________________________________________________________________            

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Date of Birth _____________ T-Shirt Size (Please Circle) Youth  S  M  L  Adult  S  M  L  XL

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MAKE CHECKS PAYABLE TO “The Dotted Line of Georgia Inc.”  TOTAL AMOUNT DUE $ _____________

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Please indicate any special needs or allergies the participant may have:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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                            HOLD HARMLESS AGREEMENT PERMISSION TO PROVIDE EMERGENCY MEDICAL TREATMENT

 

I authorize the staff of The Dotted Line of Georgia, Inc. to organize any required medical or first aid procedure or take the undersigned student to the hospital emergency room for treatment. I understand that every effort will be made to notify the parent or individual indicated as emergency contact beforehand by telephone. The undersigned hereby forever releases, discharges and covenants to hold harmless The Dotted Line of Georgia, Inc. and all parties affiliated with The Dotted Line of Georgia, Inc., the heirs, administrators, executors, successors and assignees from any and all claims, demands, damages, costs, expenses, loss of services, actions and cause of action belonging to the undersigned or arising out of any act or occurrence in connection with and particularly on account of all personal injury, disability, property damage, loss of damages of any kind sustained or that may hereafter be sustained arising out of the matters described herein.

 

This Release and Hold Harmless Agreement shall constitute a full and complete release of any and all claims.

 

 

 

Print Name ____________________________________________

 

Signature____________________________________________________________     Date ___________

 

 

There is a $50 NON-REFUNDABLE FEE payment done BY CASH APP: $TheDottedLine1

 

 

                                                           PLEASE EMAIL APPLICATION BACK TO: THEDOTTEDLINEGA@GMAIL.COM