Meridian Micro Farm Summer Stewardship Registration

Meridian Micro Farm Summer Stewardship

Student Information Emergency Contact Photo Release Parent Agreement

"*" indicates required fields

Parent Information

Parent's Name:*

First Last

Email address:*

Enter Email Confirm Email

Mailing address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Best Number to Reach You:*

Cell Phone

Home Phone

Work Phone

Cell Phone:*

Cell Phone:

Home Phone:*

Home Phone:

Work Phone:*

Work Phone:

2nd Parent's Name:

First Last

2nd Parent's Email address:*

Enter Email Confirm Email

Student Information & Photo Release

Permission

I/We give permission for photos/videos to be taken of:

I/We do not give permission for photos/videos to be taken of:

If you select “do not” there will be no photos taken or posted of your child, including photos to our password-protected parent site. If you wish to view photos of your child in the classroom, we need permission to take them.

Number of children you are registering:*

Please enter a number from 1 to 3.

Child's Name:*

First Last

Child's Date of Birth:*

2nd Child's Name:*

First Last

2nd Child's Date of Birth:*

3rd Child's Name:*

First Last

3rd Child's Date of Birth:*

while he/she is participating in Meridian Micro Farm activities. I/We understand that photos/video may be published online, in printed materials and/or for other promotional purposes, but only to help document student work and illustrate Meridian Learning programs. I/We hereby waive any ownership rights, as well as any right that I/we may have to inspect or approve the finished product in which a photographic or video image may be used including the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied.

Student Medical Information

Does your child have any allergies? Specific dietary needs/food sensitivities? Medical conditions?*

Is your child currently taking any medications?*

Yes

Please list medications:*

Has your child had recommended immunizations?*

Yes

If not, which ones have yet to be administered?*

Has your child had a recent vision and hearing test?***

Yes

Does your child have any other special needs?*

Does your 2nd child have any allergies? Specific dietary needs/food sensitivities? Medical conditions?*

Is your 2nd child currently taking any medications?*

Yes

Please list 2nd child's medications:*

Has your 2nd child had recommended immunizations?*

Yes

If not, which ones have yet to be administered for 2nd child?*

Has your 2nd child had a recent vision and hearing test?***

Yes

Does your 2nd child have any other special needs?*

Does your 3rd child have any allergies? Specific dietary needs/food sensitivities? Medical conditions?*

Is your 3rd child currently taking any medications?*

Yes

Please list 3rd child's medications:*

Has your 3rd child had recommended immunizations?*

Yes

If not, which ones have yet to be administered for 3rd child?*

Has your 3rd child had a recent vision and hearing test?***

Yes

Does your 3rd child have any other special needs?*

**Current immunizations and vision/hearing tests are strongly recommended. Records may be required for registration.

Person to Contact in Case of Emergency:

Emergency Contact Name:*

First Last

Emergency Contact's Relationship to your child:*

Emergency Contact's Address:*

Street Address Address Line 2 City State ZIP Code

Emergency Contact's Phone Number:*

Preferred Hospital:*

Name of Family Physician:*

First Last

Phone Number for Family Physician:*

In case of emergency, do we have permission to administer CPR and/or authorize an ambulance to transport your child(ren) to a hospital?*

Yes

Emergency Contact Acknowledgement:*

By checking the box, you are agreeing that the information provided for Emergency Contact is accurate.

Parent Agreement

1. Program Administration

Meridian Micro Farm operates as a separate nonprofit entity. Meridian Learning, LLC has been contracted by Meridian Micro Farm to administer program operations, including staffing, tuition management, billing, and enrollment administration. By enrolling, families acknowledge and agree that all tuition payments, billing, and contractual obligations related to this program are administered by Meridian Learning, LLC on behalf of Meridian Micro Farm.

2. Tuition & Enrollment Commitment

Tuition for the Meridian Micro Farm Summer Stewardship Program is a single charge covering summer session. Tuition includes participation in the two-day-per-week Summer Stewardship Program (June–August). Attendance during the summer session may vary based on family schedules; however, tuition remains the same regardless of holidays, absences, or varied summer schedules. Tuition is payable to Meridian Learning LLC, which administers billing and enrollment on behalf of Meridian Micro Farm.

3. Non-Refundability, Withdrawal & Failure to Pay

Families are reserving a space and assuming responsibility for the full summer tuition. Tuition payments are non-refundable. Withdrawal from the program does not release a family from the remaining tuition obligation, regardless of the reason for withdrawal. Meridian Learning is not required to release a family from this obligation unless the student’s reserved space is filled or an exception is granted in writing by Meridian Learning. Verbal agreements do not constitute a release from this contract. Meridian Learning reserves the right to suspend or terminate participation for non-payment. If legal or collection action is required, the family agrees to be responsible for all attorney fees and costs permitted under Ohio law.

4. Waiver, Assumption of Risk & Off-Site Activities

Participation in the Meridian Micro Farm Summer Stewardship Program involves inherent and foreseeable risks, including but not limited to farm-based work, use of tools, equipment and materials; physical labor; outdoor activities, uneven terrain, weather conditions, and community-based or off-site activities. These risks are voluntarily assumed. To the fullest extent permitted by Ohio law, Meridian Micro Farm and Meridian Learning, LLC, along with their respective officers, directors, members, employees, contractors, volunteers, and agents are released and held harmless from claims arising from participation, except in cases of gross negligence or willful misconduct. Permission is granted for participation in all supervised off-site and community-based activities associated with the program. This waiver is binding upon heirs, assigns, and legal representatives

5. Student Behavior, Attendance & Program Fit

Meridian Learning reserves the right to discontinue enrollment if a student’s behavior or needs, following an initial adjustment period, consistently interfere with the learning environment, pose a safety concern, or exceed the program’s capacity to provide appropriate supervision or support. Whenever possible, families are asked to provide at least two (2) hours’ notice if a student will be absent. Tuition is not adjusted for absences. Punctuality is expected. Continued late drop-off or pick-up may result in a review of participation and may result in discontinuation from the program.

6. Parent Communication & Confidentiality

Written communication with guides and staff should occur through the designated communication platform or email during normal business hours. Guides are not expected to respond outside of school hours. Families agree to communicate concerns directly with administration so that issues may be addressed thoughtfully and collaboratively. Meridian Micro Farm is committed to protecting the privacy of participating families and students. Families agree to maintain confidentiality and to treat all students and families with respect.

7. Governing Law & Final Acknowledgment

This agreement shall be governed by and construed in accordance with the laws of the State of Ohio. By signing below, it is acknowledged that:

the information provided is accurate
enrollment represents a summer session tuition obligation
tuition remains due even if participation ends
the waiver and parent agreement have been read and understood
this agreement is entered into voluntarily

Summer Stewardship Tuition:*

Tuition can be paid in either a single payment or in 2 payments.
The 2 payment option is $475.00 today and $475.00 billed via brightwheel due July 6th.

Total for Summer Stewardship to be paid via PayPal:

Preferred Days:*

Monday

Tuesday

Wednesday

Thursday

Friday

Multi-sibling discount:*

Yes

Student Information & Photo Release, Student Medical Information, Emergency Contact, and Parent Agreement Acknowledgement:*

By signing below, you are agreeing that the information provided is accurate and that you have read the Photo Release and Parent Agreement. My signature below indicates that I agree to all of the above provisions regarding my family’s participation in the program.

Parent/Guardian Name:*

First Last

Parent/Guardian Signature*

Parent/Guardian Name:

First Last

Parent/Guardian Signature