Child's Name: Giovonni Montgomery Child's School: Eads
Birth Date: May 28, 2016 Nickname: Gio Gender: Male Address: 310 Belmont Place City: Munster State: IN Zip: 46321 Phone: 3124781344
Grade: 5th Grade Start Date: September 21, 2026 Siblings Attending TAC: Kimalla Montgomery Enrollment Time Period: Full School Year (August - May) AM Attendance: Days Will Vary PM Attendance: Days Will Vary Allergies: NONE Life Threatening?: No
Describe Effects: Special Instructions: Physician's Name: Preethi Venepallli Physician's Phone: 2194405334 Dentist Name: Na Dentist Phone: 0000000000 Preferred Hospital: Community hospital
Primary Parent Name: Jessica Montgomery Relationship: Mother Email: jessicadidrovo@gmail.com Primary Phone: 3124781344 Secondary Phone: 3124781344 Home Address: 310 Belmont Place City: Munster State: Indiana
Zip: 46321 Employer Name: Powers Health community hospital Employer Address: 801 Mcarthur Blvd Work Phone: 2197033906/td> Work Email: jessicadidrovo@gmail.com Employed By School?: No What Position?: School Name:
Secondary Parent Name: Relationship: Email: Primary Phone: Secondary Phone: Home Address: City: Munster State: IL
Zip: Employer Name: Employer Address: 801 Mcarthur Blvd Work Email: Work Phone: Employed By School?: What Position?: School Name:
Denied Pickup Name 1: Relationship: Primary Phone: Denied Pickup Name 2: Relationship: Primary Phone:
Emergency Pickup Name 1: Mayra Idrovo Relationship: Aunt Primary Phone: 2193859238 Secondary Phone: 2193859238
Emergency Pickup Name 2: Relationship: Primary Phone: Secondary Phone:
Emergency Pickup Name 3: Relationship: Primary Phone: Secondary Phone:
Emergency Pickup Question 1: What is the name of my pet? Answer 1: Milo
Emergency Pickup Question 2: What is my mother’s maiden name? Answer 2: Campoverde
Paperless Billing?: Yes
Medical Policy

If any changes regarding health issues or medical information occur, I agree to provide new information promptly.
2. If my child is ill, I agree to pick up my child no later than one (1) hour after being contacted.
3. I understand that each of the TAC Sites has staff certified by the American Heart Association in CPR and First Aid in order to handle minor
injuries. If any injury appears serious of indeterminate, the staff will immediately call 911 as well as the parent/guardian or emergency contact numbers. I understand that the Adventure Club is standing in “local parentis” (in place of parents) and I/we hereby authorize The Adventure Club to exercise the duties and authority arising therefrom. I/we understand that The Adventure Club is acting on behalf of the parents with regard to my child, as such, I/we hereby grant permission for The Adventure Club staff to take whatever steps necessary to obtain medical care for my child.

Signature:

Program Hours and Fee Schedule

Munster Hours

6:30 AM until School Start

School End until 6:00 PM

 

Emergency Dismissal

If school is dismissed early because of hazardous weather conditions or other emergencies, TAC will not be open. It is important that you have a family emergency plan in case of early dismissal because TAC will not notify you.

 

Delayed Start

In the event of a delayed start to the school day, TAC will be open. Delayed start fees are not included in the before school flat rate fee.
Additional rates will begin at the time school normally starts.

 

Fee Schedule and Financial Terms
  • Enrollment fees are non-refundable and non-transferrable. Each school year, parents need to enroll their child by completing an enrollment form, paying the enrollment fee, and providing a copy of their drivers’ licenses. If there is an outstanding balance at the time of any enrollment, all monies must be paid in full.
  • Enrollment applications are required each summer and enrollment fees are additional.
  • Before school rates are a flat fee based on the school corporation. All before care begins at 6:30 am and ends when school starts (8:00 am for LC and 9:00-9:30 am for Munster). If school has a delayed start, there is an additional hourly fee charged. After school care begins when school ends until 6:00 pm. It is an hourly rate with a one hour minimum. One-half hour rates apply after the first hour. For both before and after care, TAC gives discounts to families with 2, 3 and 4 children. Discounts are also given to school employees during school year. See our rate sheet at www.TheAdventureClub.com or call Corporate Office at (219) 865-6283 from 9:00 am – 6:00 pm
  • Invoices are generated every Monday for Lake Central and Wednesday for all other schools for care provided the prior week. Fees are due in full every Friday by 6:00 pm. Payments received by 6:00 pm each Friday will be reflected on the current invoice.
  • A $5 late fee, per week, will be assessed to all accounts not paid in full each Friday.
  • If a tuition balance remains outstanding after one week, a delinquent notice will be issued at the site for pick-up by the parent and a $5 late fee will be assessed to the account each week that tuition remains outstanding ($15 maximum charge). If a tuition balance remains outstanding for two weeks or more, the following will occur: a suspension notice will be issued at the site, a suspension notice and statement will be mailed or emailed to the primary parent, a suspension notice will be mailed via certified mail to the primary parent and school administration, an additional $5 late fee will be assessed, and the student will be suspended and dis-enrolled immediately from the program and unable to return until account is paid in full.
  • TAC provides one weekly invoice and one year-end-statement via email or hard copy to the primary parent. Parents sharing separate financial responsibility are responsible for calculating and submitting one payment as we do not calculate separate bills. Year-end tax statements with the company’s tax identification number will be available after January 31st. A $5 charge will be added to your account for each additional copy of statements.
  • Include your child’s full name and invoice number with all payments. TAC accepts the following forms of payment:
    MasterCard, Visa, Discover, and American Express via PayPal (No fees)
    Pay by phone at (219) 865-6283
    Checks or money orders made payable to TAC (The Adventure Club)
    There is a service charge of $35 for each returned check. NSF checks must be paid by money order or bank check and given to the Site Coordinator. After two NSF checks, fees must be paid by money order or bank check.
    NO CASH PAYMENTS ACCEPTED
  • Parents will have two weeks, from the invoice issue date, to dispute their invoices.
  • TAC Staff must know when to expect your child so you are responsible for submitting your child’s schedule one week in advance. If your child’s schedule changes, you must notify TAC by calling your Site’s answering machine. Failure to report any unscheduled changes either on or off will result in a $5.00 service charge per occurrence. See the Parent Handbook or the TAC website for the phone numbers at each site.
  • Questions regarding billing should be directed to our billing department Monday through Friday from 9:00 am – 6:00 pm at (219) 865-6283 or emailed to info@TheAdventureClub.net.

Program & Fee Signature:

Parent Release

In consideration of the services to be provided by The Adventure Club, Inc., and for other good and valuable consideration, the undersigned, for myself and for my minor child, and any and all family members, heirs, representatives, executors, administrators, and assigns of myself or of my minor child, hereby accepts full responsibility and assumes all risk, for my minor child’s use of any and all apparatuses, appliances, facilities, privileges or services, of any nature, which is/are owned, operated or provided by The Adventure Club, Inc. While engaging in any contact, game, function, exercise, competition or any other activity operating, organized, arranged, or sponsored by The Adventure Club, Inc. either on or off their premises, my minor child shall do so at his or her own risk.

I hereby release and hold forever harmless The Adventure Club, Inc., its owners, employees, representatives, and agents (collectively, “the releases”), and each of them, from any and all losses, claims, injuries, damages, or liability of any kind, sustained or incurred by us resulting therefrom, whether caused by the negligence of the releases or otherwise. I specifically agree to indemnify and hold harmless The Adventure Club, Inc., its owners, employees, representatives, and agents as to any loss, cost, claim, injury, damage or liability, sustained or incurred by using the facilities, equipment, or services, of The Adventure Club, Inc., which is caused by an act or omission, whether negligent or otherwise, of an employee, representative, or agent of The Adventure Club, Inc.

I understand/acknowledge that it is my responsibility to ensure that my minor child participates only in those activities for which he/she has the required physical conditioning. My signature below indicates that I have carefully read and freely signed this waiver, and constitutes my full acceptance of this waiver.

I understand that in an effort to prevent any potential conflict of interest, childcare outside TAC hours by TAC staff members is discouraged. However, should I hire TAC staff, it must be outside the TAC premises and with the understanding that such arrangements and payments for services are solely between me and the member. TAC does not sanction the arrangements, and I agree to hold TAC harmless from any such arrangement. If a center staff member chooses to baby-sit for an enrolled child, the Site staff member and I must request and sign a Liability Release Form to be kept in the child’s file.

I give my full permission and consent to TAC to use and keep my child(ren)'s artwork; photographs or moving pictures they may take or produce at the Club’ or photographs or moving pictures in which my child(ren) may appear.

Thank you for enrolling your child at The Adventure Club. It is our mission to provide a before and after school program that is an Enriching, Inspiring, Educating and Exciting place for your child to learn and grow while meeting the childcare needs of our parents, the school and communities we serve.

Signature:

Parent Handbook

I have received, read, and agree to abide by the Parent Handbook.

Signature:

Walking Trips

I give permission for my child to leave the Site for outdoor fitness and educational purposes, with the understanding that my child will be accompanied by TAC staff and under supervision at all times.

Signature:

Playground / Water

I give permission for TAC to include my child in supervised playground and water activities. My child has my permission to use all the play equipment and take part in all TAC activities.

Signature:

Transportation

I hereby grant permission for my child to participate in and be transported by commercial transportation companies while under staff supervision at all times for field trips and other TAC sponsored activities. I understand that children not attending TAC fieldtrips will remain on-site with TAC staff.

Signature:

Return to List
Return to Schools