Middle Tree Unlimited Enrollment















Restroom Policy:
For offices with restrooms outside the office, it is our policy that students in PK-4th grade go to the restroom with an adult and recommend that students in 5th-6th grade are accompanied by someone.

Sign-Out Policy:
It is our policy that students in PK- 4th grade do not sign out without adult supervision and recommend that students in 5th-6th be signed out by an adult or family member.

Do you permit your student to leave Middle Tree premises before signing out for the day? 
By checking this box, you are acknowledging that you are permitting your student the ability to sign her/himself out of Middle Tree's supervision at your student's discretion to go off campus and into the area to get food/snacks. Middle Tree assumes no liability for your student's actions while off campus, and you agree to indemnify, hold harmless, and defend Middle Tree for any actions that result in property damage or injury, up to and including death, while your Student has signed her/himself out of Middle Tree.



Parent/Guardian Information











Middle Tree LIABILITY RELEASE AGREEMENT (hereinafter “Release)

Minor's Legal Name
(hereinafter “Minor”).
Middle Tree and I, the undersigned parent or legal guardian of the Minor, agree that the Activity (activities include any Middle Tree activities both on and off site) may pose risks, including possible illness, injury, as well as similar and dissimilar risks (hereinafter “Risks”). The undersigned is fully aware of the Risks and other hazards inherent in the Activity and is allowing the Minor’s voluntary participation in the Activity and assumes the Risks and all other risks of loss, damage, or injury that may be sustained while participating in the activity. We are also not liable for personal items and school materials assigned to the student. Middle Tree makes no representations or claims as to the condition or safety of the land, structures, transportation, or surroundings that may be involved in the Activity, whether or not owned, leased, operated or maintained by Middle Tree. It is understood that Middle Tree does NOT provide any insurance coverage for the Minor's person or property, and the Minor's parent(s) or guardian(s) acknowledge that they are responsible for the Minor's safety and the Minor's own health care needs, and for the protection of the Minor's property. In exchange for allowing the Minor to participate in these Middle Tree activities, the Minor, by and through the undersigned, the undersigned, and the Minor’s respective heirs, personal representatives and estates agrees to, in perpetuity, release from liability, indemnify and hold harmless Middle Tree and any agent, officer or employee of Middle Tree acting within the scope of their duties for any injury to the Minor's person or damage to the Minor's property. I authorize Middle Tree to take any appropriate action necessary in its judgment, including seeking medical care, if I am not present or reachable in the event of an emergency. The  undersigned acknowledges that as a part of this Release he or she shall be 100% liable for the remuneration of any and all incurred medical expenses resulting from any injury incurred during, or as a result of participation in the Activity. If any term of this agreement or the application to any person or circumstance shall, to any extent, be invalid or unenforceable, the remainder shall not be affected thereby, and each and every remaining term of this agreement shall be valid and enforced to the fullest extent permitted by law. In the event of any need to enforce this agreement, Middle Tree shall be entitled to its attorney fees and costs. This agreement will be governed by California law, County of Los Angeles. I, the undersigned, state that I am the parent or legal guardian of the Minor. I have fully read and understand the above terms and conditions and that they apply to said Minor and to myself, and that no oral representations, statements or inducements apart from the foregoing written agreement have been made to the undersigned. This document is binding on myself, the said Minor, and any person suing on behalf of said Minor.
Parent/Guardian Name

PUBLICITY AUTHORIZATION FORM

Middle Tree regularly produces and distributes instructional or promotional materials, both electronic and printed, to students, families, friends, prospective families, and the Educational Community. These materials may include, but are not limited to student-generated projects and podcasts to be shared with students or experts around the world, media placed on District websites, promotional brochures, etc. Once these materials are distributed they often make their way to the public domain and become generally available to the public for view and use.




Medical Release Form



Emergency Treatment
If Middle Tree staff deem it necessary, your child will be taken by ambulance to the nearest
emergency facility where the attending physician (or dentist) on duty may perform emergency treatment on your child. All costs incurred shall be at the parent’s or guardian’s expense.

Medication at Middle Tree
No Middle Tree staff members administer medications (prescription or over the counter) to
students. However, in case of an emergency, please list the medications your student(s) is/are taking on a continuing basis:
I acknowledge that I have read the Emergency Release Form and that I am aware of Middle Tree’s procedures in the event my child is seriously injured or there is a catastrophic event. I certify that the information I have provided is accurate and current. Should a change in the information I have provided occur, I will immediately inform Middle Tree staff of the change and update this form to ensure that my emergency contacts are available as needed.

EMERGENCY RELEASE FORM (Optional)

Emergency Contact Information:
In the event of an emergency or disaster, your student(s) will only be released to the persons authorized on this form if we are unable to reach you.


As A Member, I Understand That:

ACADEMICS:

➢ Teachers are not responsible for keeping students entertained. When students are at Middle Tree they will be expected to pursue some kind of academic benefit.
➢ If your student does not bring his or her textbook and/or class notes he or she may not be able to receive the necessary help to complete assignments from school.
➢ Students and parents are responsible for keeping track of their own homework assignments, tests, and quizzes.
➢ If your student does not let Middle Tree teachers know about his or her project well in advance of the due date, then your student may not receive the necessary help.
➢ Middle Tree is not responsible for providing school, art or project supplies.
➢ Students with an IEP or a 504 Plan are encouraged to share it with Middle Tree staff before your student begins. Failure to do so will almost certainly prevent us from providing your student with the necessary help.
➢ The more communication Middle Tree staff has with parents the better we are able to assist our students.
➢ Test Preparation lessons are for standardized tests such as the SAT, ACT, SSAT, etc. Preparation for tests over the course of a student’s normal school year can be handled through the regular membership.

LOGISTICS:

➢ A Middle Tree pledge contract cannot be paused or terminated; when pledging to support Middle Tree I am pledging to support a public mission that budgets around the pledges it receives.
➢ All registrations require a nonrefundable $100 registration fee, which covers matriculation and materials costs.
➢ Test Preparation is billed separately from the general membership.
➢ The SEED (Student Enrichment through Educational Development) program is meant for students who need focused attention. Billing is assessed separately from the unlimited membership.
➢ The SHADE program (Summer Hands-on Application Development in Education) is Middle Tree’s summer program and is billed separately from the general membership.
➢ Supplemental curriculum created outside of general hours will be billed separately from the general membership on an hourly basis.
➢ Unlimited program pledges will renew and be continuous until augmented or canceled regardless of the pledge term.
➢ Overlays in the Unlimited Program might not be worked on during each visit depending on students’ workload. Overlays are a minimal focus and practice throughout the month in reflection on the monthly fee.
➢ Appointments and appointment changes must be made 48 hours in advance or they will not be honored. Limited courtesy financial credits may be given but frequent appointment changes will result in the session being canceled or an additional fee per hour will be applied.
➢ If a student cancels an appointment in less than 48 hours from the appointment time or fails to show up for their appointment, the appointment will not be rescheduled and no financial credit will be applied.
➢ Students are expected to show up on time for appointments. Appointments will stop at the prescheduled time regardless of whether or not a student is on time.
➢ If a student is not picked up a half hour after Middle Tree closes and there is no communication with a parent or guardian, a late pick-up fee will be processed and child services will be contacted.
➢ Any student exhibiting signs of being sick or unwell should not come to Middle Tree and risk exposing other students and staff. Students who come into Middle Tree with signs such as coughing, sneezing, or a fever will be sent home and their session will be non-refundable.
➢ Program pledges are non-refundable regardless of student attendance.
➢ Cancellation of any program requires a filled out cancellation form and is subject to a cancellation fee. The cancellation fee amount is dependent on the program being canceled.
➢ All Unlimited memberships can be paused from June 1st to August 31st.

Disclaimer: The $100 registration fee will be automatically populated in the total. 

Please Note: When you click Submit you will be redirected to the payment page.  You will need to change the default quantity for the two tiers not desired to 0 and the desired tier quantity to 1.  

Contact Information