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Give your child a fun, creative, and enriching Friday at The Discovery Reset Dallas!

Our program offers a safe, supportive space where kids can explore art, STEM activities, and social games while you unwind and recharge. With engaging activities designed to spark imagination and foster growth, your child will leave excited for the next session. Spaces are limited, so secure your spot today and give both you and your child the Friday night reset you deserve!

Thank you for your interest in The Discovery Reset! This registration form helps us ensure a smooth and personalized experience for both your child and you.

Registration Form:

Parent/Guardian Information:

Full Name of Parent/Guardian 1:

Full Name of Parent/Guardian 2 (if applicable):

Primary Contact Number:

Secondary Contact Number (if applicable):

Email Address:

6. Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Child Information:

1. Child’s Full Name:

2. Child’s Date of Birth:

Month

Day

Year

Child's Gender

Male

Female

3. Grade Level/School:

4. Will you be enrolling additional children? If so please provide their names, date of birth, and gender below.

5. Does your child have any allergies or medical conditions we should be aware of? (Please specify) type N/A if not applicable:

6. Medications (if applicable):

7. Does your child have any specific behavioral or emotional needs that our staff should be aware of? (e.g., anxiety, autism spectrum, ADHD, etc.) type N/A if not applicable:

8. Is your child currently receiving any special support (i.e., speech therapy, occupational therapy, etc.)? Type N/A if not applicable:

Program-Specific Information

1. What are your child’s interests or hobbies? (This helps us tailor the activities to your child’s preferences):

2. Does your child have any previous experience with creative activities, such as art, music, or STEM projects?

3. What are your child’s favorite types of activities or games? (e.g., group games, individual projects, quiet activities, etc.):

4. Are there any specific goals or skills you would like your child to work on during the Discovery Reset program? (e.g., social skills, teamwork, focus, creativity, etc.):

Safety and Emergency Information

1. Emergency Contact (Other than parent/guardian) name and phone number:

2. Authorized Pick-Up Persons (Other than parent/guardian) full name, Relationship, and phone number:

*If someone other than the listed authorized pick-up persons will be picking up your child, please provide written permission in advance.

3. Is there anything else our staff should know to ensure your child’s safety and well- being during the program?

Program Policies & Agreements

Drop-Off and Pick-Up Policy

I understand that I am responsible for dropping off and picking up my child at the designated times, and that late pick-up may result in an additional fee.

Yes

Behavioral Expectations

I agree to support the program’s policies regarding behavior, which include respectful interaction with peers and staff, and participation in structured activities

Yes

Medical Authorization

In case of emergency, I grant permission for the program staff to seek medical treatment for my child, should the need arise.

Yes

Photo/Video Consent

I consent to my child being photographed or videotaped for program-related purposes (e.g., promotional materials, social media, etc.).

Yes

Parent Feedback

1. What are your main reasons for enrolling your child in the Discovery Reset program?

2. What do you hope your child will gain from participating in the program?

3. Do you have any additional comments, concerns, or suggestions for improving the program?

Signature and Consent

By signing below, I confirm that the information provided above is accurate and complete to the best of my knowledge. I understand and agree to the terms and conditions in addition to the policies outlined in this form.

Parent/Guardian Name (Printed):

Parent/Guardian Signature:

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Date

Month

Day

Year

Please review and confirm that the information provided is accurate. Once complete, hit SUBMIT below. By submitting your application, you agree to the Terms and Conditions of the program. We look forward to welcoming your child to the Discovery Reset program and providing them with an enriching, fun, and safe environment

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Give your child a fun, creative, and enriching Friday at The Discovery Reset Dallas!

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