CYPHER Program

Registration Form



Please fill out the form below to register.

All visitors and participants are required to show proof of vaccination (vaccination card - hard copy or digital photo or NYS Excelsior Pass), photo ID (driver's license, passport, or school ID), and a green pass via completing the Visitor Symptom Tracker below. Hosting departments or event organizers will be checking for these items upon campus arrival.

Symptom Tracker Link

For information contact: infonc@manhattan.edu 
Website link

Participant's Information

Participant's Full Name*
Date of Birth*

Parent / Legal Guardian Information

Parent's Full Name*
Primary Phone Number
Secondary Phone Number
Address*

Emergency Contact Information

Full Name*
Primary Phone Number
Address

Registration

Select one*
Select one
  Requested
Spring 2022 - Feb 23 - April 27 (10 sessions, every Wednesday)

If registered before December 20th, 2021, your tuition is 100% waived
If registered between December 21, 2021, and January 20th, 2022, the tuition is waived 50%; therefore, you pay $25 for the ten sessions
If registered after January 21, 2022, the tuition is $50 for the ten sessions.

Additional Information

How did you hear about us?*
Please provide additional information on who recommended us (i.e. referral code).

Terms, Conditions, and Release of Liability Agreement

I, the undersigned, hereby acknowledge that I am over the age of 18, that I am the parent and/or legal guardian, and that I have the authority to make agreements on behalf of my son or daughter. I further acknowledge that I have voluntarily chosen to enroll my son or daughter in the Manhattan College Program. I also give consent to my son or daughter's participation in program-related activities.

ACCEPTANCE OF RISKS AND RELEASE FROM LIABILITY

I understand that certain risks are inherent in any hands-on educational activity. I agree that there may be a risk of injury or harm to my son or daughter as a result of program activities, and I knowingly and voluntarily assume all risks of such injury or harm. I hereby waive and release Manhattan College (and its owners, agents, partners, representatives, employees, contractors, and program staff) from any and all claims, injuries, causes, actions, liabilities, demands, losses, legal or equitable, of any kind whatsoever arising out of or in any way related to any loss or damage of property, injury, illness, disease, loss of services, medical bills, charges or otherwise, including death, which may arise out of or in any way be related to my son or daughter's participating in the program, whether occurring inside, on, outside, remotely or off college property, during participation in the program or related activities and for the duration of said activities and whether known or unknown, foreseen or unforeseen, including any and all legal and attorneys' fees and court costs.

SAFETY & CONDUCT

For everyone’s safety, children must follow all staff instructions. I understand that if my son or daughter's actions or attitude are deemed detrimental to other program participants, program staff, the safety of the program, or the general program atmosphere, he or she may be denied service. I agree to accept full responsibility, financially or otherwise, for the conduct of my son or daughter — including paying restitution for damage to college equipment and property, program facilities, and/or personal property of other participants. Manhattan College is not required or expected to protect program participants from theft or damage to property.

MEDICAL AUTHORIZATION & SPECIAL NEEDS
I understand and agree that I am responsible for determining my son or daughter's medical, physical or other qualifications and suitability for participating in the program and its activities (including games and instruction). I agree to disclose to college and program staff any pertinent medical, physical, or other conditions and special needs that may affect my son or daughter's participation in these activities.

PHOTO & VIDEO RELEASE

Some program sessions may be videotaped or photographed. By registering for this program, I grant permission for the use of my son or daughter’s image and voice, which may be captured by video, photo, digital camera, or other media, for college training, promotional materials, and publications, and other marketing purposes.

CANCELLATIONS, REFUND PROCESSING & CHANGES

Manhattan College reserves the right to vary its programs and to reschedule or cancel an event if it is under-subscribed or for any other reason. Manhattan College attempts to give participants reasonable notice if an event is rescheduled or canceled. Please make sure you provide a valid email address and phone number during registration. If Manhattan College cancels events for any reason, you will receive a full refund. If the participant cancels attendance to the program for any reason and provides at least two (1) weeks’ notice of cancellation before the program start day, the participant will also be entitled to a full refund less 10% of the total fee paid. Please keep in mind refund processing usually takes 4 – 6 weeks (this timeframe is dependent upon your financial institution).

GOVERNING LAW, JURISDICTION & MEDIATION

I acknowledge that this Agreement shall be governed in accordance with the laws of the State of New York. I consent to the exclusive jurisdiction and venue of the federal and state courts located in New York in any litigation arising out of or relating to this Agreement.

I agree that any dispute arising out of or relating to this Agreement shall first be attempted to be resolved by non-binding mediation. Mediation shall be held in the state and county in which the camp is held. The mediation provision may be enforced by either party to this Agreement.

I hereby acknowledge that I agree to and will comply with the terms of the mediation provision. Should any part of this Agreement be found invalid or not enforceable by a court of law, then the remaining portion shall continue to be valid and enforceable.

This Agreement constitutes the entire Agreement between Manhattan College and me.

By viewing this document, I acknowledge that I have read and agreed to all the terms set forth in this Agreement.

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Thank you for taking the time to fill out the registration form!