Opportunity Academy Registration

Parent or Guardian Information
Primary Parent/Guardian Name*

First NameLast Name
Relationship to Student*
Current Employer
T-Shirt Size*
Preferred Language of Communication*
How Did You Hear About Us?*
FacebookInstagramTikTokX (Twitter)YouTubeDiscordTwitchWhatsAppOther
Primary Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Parent/Guardian Email*
example@example.com
Primary Parent/Guardian Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Alternative Emergency Contact*
Please enter a valid cell phone number.Format: (000) 000-0000.
By signing below, you agree to allow ORS to contact you via phone call, text message, and email provided by you below in either mass or personal communication. Furthermore, you agree to allow ORS to collect your updated contact information and use it to contact you as necessary to uphold grant requirements. All information provided to ORS below is confidential and will only be used by ORS.
Parent Signature (Communication Release)*

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Transportation
Student Name

First NameLast Name
YesNo
You can get dropped off, drive yourself, or be picked up by an ORS bus from your high school. Our ORS buses are provided through our partnership with Goldstar Transportation.
June 9-13June 16-20
Bus Pick-Up Location:
Bus Drop-Off Location:
Drive MyselfDropped-off & Picked-up
CAR INFORMATION

Individuals Authorized to Pick Up Student from Campus

These individuals will be required to present ID verification at pick-up & students are required to sign-out before leaving the college campus.
Please provide the FULL name of those authorized to pick-up student from the college campus:

Medical Release Form
Student Name*

First NameLast Name
Student Date of Birth *

MonthDayYear
Date
Student Social Security Number
Emergency Contact Name*
Emergency Contact Phone Number*
Primary Care Physician Name *
"N/A" if not applicable
Primary Care Physician Phone Number
"N/A" if not applicable
YesNo
Insurance Provider Name
e.g., Blue Cross Blue Shield, Medicaid, etc.
Policy Holder’s Name
Usually a parent or guardian
Policy Number / Member ID
Group Number
Health Statement

Please list any and all physical conditions that your child may have that might affect or be affected by participation in this program and about which the Upward Bound staff should know.
Present medical problems or conditions:*
"N/A" if not applicable
Medications taken regularly:*
"N/A" if not applicable
Allergies (including allergies to food, medications, etc.):*
"N/A" if not applicable
Limitations on physical activities:*
"N/A" if not applicable
Medical Release

In the event that my child or dependent (listed above) is injured or ill while under the care of the ORS Summer Programs, I hereby give permission to ORS employees, to provide first aid and to take the appropriate measures, including contacting the Emergency Medical Service (EMS) system and arranging for transportation to the nearest emergency medical facility.

In the event of an illness or injury, I give permission to the Director or authorized representative to make decisions regarding treatment as deemed appropriate by a medical doctor, hospital or their authorized staff.

I further acknowledge that the Director will make all reasonable efforts to contact me in the event of illness or injury of my child, but if medical care becomes essential, ORS employees will not under any circumstance refuse medical treatment. I also understand that I am responsible for all charges in connection with the care and treatment rendered to my child during this period.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

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Date Signed*

MonthDayYear
Date

Waiver of Liability Form
Assumption Of Risk, Waiver of Liability, And Indemnification Agreement 2024-2025

Please Read This Document Carefully. By Signing It, You Are Giving Up Legal Rights.

This Assumption of Risk, Waiver of Liability, and Indemnification Agreement ("Agreement") is entered into on the date noted below by the Adult Participant as identified by signature below. and if any minor(s) is/are named below. the Adult Participant on behalf of and as parent or legal guardian for such Child Participant(s) as identified below in favor of Opportunity Resources Services ("ORS") Collectively and severally. Adult Participant and Child Participant (if any their heirs, successors, and assigns are hereinafter referred to as the "Participant." In consideration of ORS permitting Participant to participate in the Activities, as defined below, Participant agrees as follows:

1. RISK AND ASSUMPTION OF RISK. ORS offers participants the opportunity to participate in programs in the timeframe from June 9 - 20 2025, including field trips, adventures, and classes.

Participant understands that the activities may involve serious risks. Participant acknowledges there are inherent risks and injuries in participating in the activities, including, but not limited to, bodily injuries, physical or mental incapacitation, disability, or death. Even though ORS takes careful precautions to minimize the risk and frequency of accidents during activities by having safety rules and procedures, and even though ORS reminds Participants to decline to participate in any activity which they feel may not be safe for them at the time for whatever reason, it is impossible to eliminate all risk and possibility of injury.

Participant further acknowledges, understands, appreciates, and agrees that participation may result in possible exposure to and illness from infectious diseases, including, but not limited to, MRSA. Influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.

By signing below, Participant acknowledges the risks of the activities and knowingly and freely assumes all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assumes full responsibility for Participant's voluntary participation and exposure.

2. RELEASE OF LIABILITY IN FULL APPRECIATION OF THE FOREGOING RISKS, AND CONSIDERATION FOR THE RIGHT TO VOLUNTARILY PARTICIPATE IN THE IN ACTIVITIES, PARTICIPANT HEREBY EXPRESSLY RELEASES AND AGREES NOT TO SUE ORS, ITS DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AND CONTRACTORS ("PROTECTED PARTIES") FROM ANY AND ALL LIABILITY, CLAIMS. DEMANDS. OR CAUSES OF ACTION, INCLUDING NEGLIGENCE CLAIMS, PERSONAL INJURY CLAIMS, AND MENTAL ANGUISH CLAIMS, ARISING OUT OF ANY DAMAGE, LOSS, PERSONAL INJURY, OR DEATH ARISING FROM OR RELATING TO PARTICIPATION IN THE ACTIVITIES. This release includes, but is not limited to, injuries or accidents, which may occur as a result of the: (a) use or misuse of the facility in any way by anyone; (b) instruction or supervision; or (c) slipping, tripping, or falling while in the facility or on the surrounding premises. This release is valid and effective whether the damage, loss, or death is a result of any act or omission on the part of Protected Parties or from any other cause.

3. INDEMNITY PARTICIPANT FURTHER AGREES TO FULLY DEFEND, INDEMNIFY, AND HOLD HARMLESS PROTECTED PARTIES FROM AND AGAINST ANY AND ALL CLAIMS, LOSSES, DAMAGES, CAUSES OF ACTION. SUITS. AND LIABILITIES OF EVERY KIND, ARISING OUT OF ANY PARTICIPATION IN ACTIVITIES. SUCH INDEMNITY SHALL APPLY WHETHER THE CLAIMS, DAMAGES, LOSSES, CAUSES OF ACTION, SUITS, OR LIABILITY ARISE IN WHOLE OR IN PART FROM THE NEGLIGENCE OR FAULT OF PROTECTED PARTIES.

I have read, understand and fully agree to the terms of this Agreement. I understand and confirm that by accepting this Waiver and Release, said child and I have given up considerable future legal rights. I have accepted this Agreement freely, voluntarily, and under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. By signing below, I am executing a complete and unconditional waiver and release of all liability to the full extent of the law. I understand that ORS is a Texas nonprofit corporation. I expressly agree that the foregoing Release Waiver is intended to be as broad and inclusive as is permitted by the law of the State of Texas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Student Name*

Student First NameStudent Last Name
Student Signature*

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Date*

MonthDayYear
Date
Primary Parent/Guardian Name*

Parent/Guardian First NameParent/Guardian Last Name
Primary Parent/Guardian Signature*

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Date Signed*

MonthDayYear
Date

Payment
Non-Refundable Payment Disclaimer

You can register today by submitting this form but no space will be held or guaranteed until payment is provided. For Credit or Debit Card payments, you will be directed to a payment portal once you submit this form.

By proceeding with this payment, you acknowledge and agree that all payments made through this portal are non-refundable and non-transferable (to other programs). This includes, but is not limited to, fees for services, programs, registrations, or donations.

Refunds or credits will only be issued in cases of duplicate transactions or billing errors, as determined solely at our discretion. If you believe an error has occurred, please contact us within 3 business days of the transaction for resolution.

We offer flexible payment plans to make the program more accessible for families. Reach out to our team to set up a plan that works for you. Please call (817) 241-4141 x114 or email academy@orstx.org.

By submitting payment, you confirm that you have reviewed and understood this policy.
My Products*
prevnext( X )
Non-Refundable Dsposit
Hold a spot and setup a payment plan.

$150.00



Pay in Full
$700.00



Week One Busing
Busing is an additional cost

$60.00



Week Two Busing
Busing is an additional cost

$60.00



Scholarship
Select this option if you have been awarded a scholarship.

$ Free



Total

$0.00
YesNo
To Pay By Check

Checks can be mailed to:

Opportunity Resource Services
214 S. Ridgeway Dr.
Cleburne, TX 76033

Please indicate the name of your student in the memo line.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Student Information

Parent or Guardian Information

Transportation

Individuals Authorized to Pick Up Student from Campus

Medical Release Form

Waiver of Liability Form

Payment