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Senior Summer 2024


Please complete the 2024 Summer Program - Enrollment, Emergency Contact, Health Form, and Waiver below by Friday, May 17th.

2024 Summer Program - Enrollment, Emergency Contact, Health Form, and Waiver


Summer 2024 Program Enrollmentrequired

Student Information

Student's Namerequired
First Name
Last Name
Must contain a date in M/D/YYYY format



Parent/Guardian Information

Parent/Guardian 1required
First Name
Last Name
Parent/Guardian 2
First Name
Last Name
Who does the student live with?required
Are the student's parents legally separated or divorced?required
Do both parents have campus visitation , removal rights, and phone access to the student? required
** Please provide documentation (i.e. court order) that specifies limitation of access to the Division Director prior to the start date of the school year. Without documentation, the non-custodial parent will legally have access to their child.



Emergency Contact

In the event of an emergency and EA is unable to reach parent(s), please provide contact information for at least one person other than the parent/guardian.

Primary Emergency Contactrequired
First Name
Last Name
Secondary Emergency Contact
First Name
Last Name




TransportationrequiredPlease check all that appy.
Please check all that appy.
Ride-Share Waiverrequired



Student's Health Information

Please indicate if any of the following applies to your student.
Does the student take any medication? required
If the student needs to take any medication including over the counter medication during school hours or on student trips a medication form with a physician's signature must be on file.
If there are no changes in medication, the student's 2023-2024 school year medication form on file will apply to the summer 2024 program enrollment. If there have been changes to the student's medication, a new physician signed medication form must be submitted prior the start date of the program. 
Medication Formrequired
Student's Doctor
First Name
Last Name
Elgin Academy does not carry accident insurance for it's students and assumes no responsibility for accidents. Each family is expected to carry health/accident insurance for their own children.



Elgin Academy Waiver of Liability and Hold Harmless Agreement

Physician/Hospital Release

If I, as the parent/guardian listed, cannot be contacted immediately in the event of injury or illness, I give my consent for Elgin Academy to take such action as may be deemed necessary, including but not limited to arranging for the transfer to an appropriate facility for medical care and treatment. I also give my consent for Elgin Academy to provide the necessary medical consent to health care providers to take whatever action is deemed appropriate for the care of my child until such time as I am available to communicate with the health care providers concerning my child's condition. I also release Elgin Academy from any and all liability concerning any actions it, through its personnel, takes to ensure appropriate medical care and treatment is provided to my child in the event of an emergency, and recognize that the Elgin Academy is only acting as my agent in regard to providing consent for transportation, care and/or treatment to students in event of a medical emergency. This authority shall remain in effect for the current school year.

Parent/Student Waiver, Release, And Acknowledgment of Risk For Elgin Academy

The undersigned are the parents or legal guardians. The Student is enrolled at Elgin Academy, an Illinois not-for-profit corporation (the “Academy”). As a student at the Academy, the Student will have an opportunity to participate in various functions and extra-co-curricular activities including, without limitation, physical education training, field trips, athletic events, plays, summer programs and school programs (collectively “School Activities”). In consideration of the Academy accepting the enrollment of the Student and/or permitting the Student to participate in School Activities, the undersigned hereby agree as follows:

1.  On behalf of the Student, the undersigned, and our respective heirs and personal representatives, hereby voluntarily release, waive and forever discharge the Academy and its Trustees, administrators, employees, volunteers, and agents (collectively the “Academy Personnel”) from any and all claims or causes of action arising out of the Student’s participation in School Activities or the use by the Student of any facilities, equipment, or vehicles of the Academy or its Personnel; excluding, however, from this Waiver, Release and Acknowledgment of Risk any claim or damage arising out of the intentional neglect or willful and wanton misconduct of the Academy Personnel.

2.  The undersigned acknowledge that participating in School Activities may involve both known and unforeseen risks arising from the School Activity itself or from matters ancillary thereto (such as, by way of example only, transportation to and from such School Activities) which could result in physical injury or death to the Student or damage to the Student’s property. On behalf of the Student, the undersigned hereby knowingly accept and assume such risks and voluntarily and freely choose to incur such risks.

3.  The undersigned certify that they have adequate insurance to cover any injury the Student may suffer while participating in School Activities and acknowledge that the Academy shall not be obligated to pay same.

4.  The undersigned further certifies that the Student has no medical or physical conditions which could interfere with the Student’s safety or health while participating in School Activities except as specifically set forth above. The Academy may rely on this certification without further investigation.

5.  The undersigned acknowledge that they have had sufficient opportunity to read this entire document, that the undersigned have read and understood it, and agree to be bound by its terms.

6.  This Waiver, Release and Acknowledgment of Risk shall be in force commencing with the date hereof and ending on the first to occur of (i) the graduation or withdrawal of the Student from studies at the Academy or (ii) 30 days following delivery to the Academy of our written notice terminating this Waiver, Release, and Acknowledgment of Risk. No such termination shall impair the validity of this Waiver, Release and Acknowledgement of Risk with respect to any matter occurring prior to the date of such termination. In the event that written notice of the termination of this Waiver is received by the Academy, the Student will not be permitted to participate in School Activities.

7.  This Waiver, Release and Acknowledgment of Risk shall be governed and construed under the laws of the State of Illinois.

The student has my permission to: a) use all playground equipment under staff supervision; b) be included in pictures and video connected with Elgin Academy’s program in advertisements and on the school website; c) be recorded during class for remote learning purposes; these recordings will be used for school use only and will not be sold to a third party: d) attend all Elgin Academy field tips.

I agree to abide by all of the policies and procedures outlined in the 2023-2024 handbook.

Electronic Signaturerequired
Parent/Guardian Signaturerequired
First Name
Last Name
Must contain a date in M/D/YYYY format

Summer Calendar

Senior Luncheon
Main Event
Holiday Inn
College Counseling Seminar
Summer Commencement Rehearsal
Summer Commencement

Summer Course Descriptions and Resources

204: English IV

This summer course is intended to prepare students for college-level writing, analysis, reading, and discussion. We will read pairs of texts that illuminate how important issues in our society today have been addressed in different periods of literature and how different tropes and structures in literature serve different literary purposes. 1 credit

Required Resources

542: Statistics 

This course introduces students to a branch of mathematics with many applications in various disciplines beyond mathematics.  Topics include an introduction to statistics, descriptive statistics, probability, discrete probability distributions, normal probability distributions, confidence intervals, hypothesis testing, correlation, and regression.  1 credit

Required Resources