Enrollment Form

Mercyhurst Early Learning Innovation Academy is starting at Northwestern and Springfield Elementary!

The program is open to children eligible to attend Kindergarten through 5th Grade in the Fall of 2024.

Regular programming will begin this Fall and will be available Mondays through Thursdays from 3:30 PM to 5:30 PM.

On Fridays from 3:30 PM to 5:30 PM, the program will alternate locations between Northwestern and Springfield and is open to all enrolled students.

Please note that students from BOTH schools are welcome to attend Friday programming at either location but transportation on these days will be the responsibility of the parent/guardian.

Please read the following legal waiver and release from liability contract below. You must agree to it before you may access the enrollment form.

WAIVER AND RELEASE FROM LIABILITY CONTRACT

In consideration of the minor identified in the enrollment form being allowed to participate in the activities provided by or in conjunction with the Mercyhurst University Early Learning Innovation Academy (“MELIA”), and any related events and activities, and further intending to be legally bound, the undersigned/authorizing guardian:

Agrees that, prior to allowing the minor to participate, they have the right to inspect the facilities and equipment to be used, if any, and if they believe anything is unsafe, they will immediately so advise the supervisor in charge of such facilities and equipment and refuse to participate.
Acknowledges and fully understands that the minor may engage in activities that involve risk of injury, which might result not only from their own actions or inactions, but also from the actions, inactions or negligence of others, or the condition of the premises or of any equipment used. The undersigned/authorizing guardian further acknowledges that there may be other risks not known to MELIA or not reasonably foreseeable at this time.
Assumes all the foregoing risks and accepts personal responsibility for the damages following such injury, in the event it occurs.
Releases, waives, discharges and covenants not to sue MELIA, Mercyhurst University, any of their affiliate entities, or any of their respective directors, officers, shareholders, agents, or employees; other participants; or the owners of the premises and/or equipment used to conduct MELIA, to all of whom the benefits of this waiver and release from liability shall inure, from demands, losses or damages on account of injury, including damage to property, caused or alleged to be caused in whole or in part by negligence of the releases or otherwise.

BY CLICKING "I AGREE TO THE WAIVER" BELOW, YOU ARE AFFIRMING THAT YOU HAVE READ THE ABOVE WAIVER AND RELEASE FROM LIABILITY, UNDERSTAND THAT YOU HAVE GIVEN UP RIGHTS BY SIGNING IT, AND AGREE YOU ARE SIGNING IT VOLUNTARILY. YOU REPRESENT THAT YOU ARE THE PARENT OR GUARDIAN OF THE MINOR, AND ACKNOWLEDGE AND AGREE TO THE ABOVE ON BEHALF OF THE MINOR PARTICIPANT, IN YOUR INDIVIDUAL CAPACITY, AND IN YOUR CAPACITY AS PARENT OR GUARDIAN OF THE MINOR PARTICIPANT.

I, the undersigned/authorizing guardian give my permission for:

My child to participate in MELIA
My child to participate in MELIA field trips throughout the School Year
My child to be photographed, recorded, and have their work showcased in the MELIA Newsletter, reports, and other publicity
MELIA to exchange information regarding my child with the Pennsylvania Department of Education and/or the School District for program evaluation and statistical purposes. This information may include: test scores, grades, behavior reports, and attendance.

Student Enrollment Form

WAIVER AND RELEASE FROM LIABILITY CONTRACT