Guardian Signature Sample Clauses

Guardian Signature. There is a $275 registration fee per child for securing a spot at Xxxxxx Xxxx Catholic Parish School. This is a non-refundable deposit. Please make check payable to Xxxxxx Xxxx Parish.
Sample 1
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Guardian Signature. As a user of the Lavaca Public Schools’ computer network, I hereby agree to comply with the stated rules-communicating over the network in a responsible fashion while honoring all relevant laws and restrictions. Student Signature: Student Electronic Device & Internet Use Agreement found on page 30-33 AGREE DO NOT AGREE Please initial the items to indicate that you “agree” or “do not agree” to each item listed and sign below. To allow publication of directory information to all public sources. This would permit the release of directory information for active and inactive students to the Military, postsecondary institutions, potential employers and all public sources such as newspapers. Student’s name and/or picture to be used in yearbook, website, photo, video, district social media or newspaper. Student to access the xxxxxxxxxxxxx.xxx email account at LHS The Student Handbook is available on our district website for your convenience. You may access the handbook by going to the district home page at xxxxx://xxx.xxxxxxxxxxxxx.xxx. Select your child’s school, Student Information, and the handbook icon. Please read through the handbook with your student so that you both are familiar with our policies. Your signature, as well as your student’s signature, is required on this form to indicate that you have been given access to the handbook. If you do not have access to the internet, or for any reason need a printed copy of the handbook, please call a school office (numbers below). A copy will be sent home with your student that day. Lavaca Elementary School 479)-674-5613 Lavaca Middle School 000-000-0000 Lavaca High School 000-000-0000 This certifies that we (parent/guardian and student) have received instructions to access the student handbook including but not limited to the discipline, attendance, computer use, and chemical screen testing policies as well as Parent Involvement Summaries, Smart Core Curriculum, and Graduation requirements of Lavaca Public Schools as outlined by Act 104 of the 1983 1st Extraordinary Session of the General Assembly of the State of the State of Arkansas and polices of the Lavaca Board of Education. The law states this form must be signed by parent and student and returned to the school to be kept in the principal’s office. Parent Signature Student Signature Date Xxxxx Xxxxxx, Secretary Xxxxxx Xxx Xxxxxx Xxxx Xxxxx Xxxxxx, President Xxxxxx Xxxxxxxx Mr. Xxxxx Xxxx Xx. Xxx Xxxxx Xx. Xxxxx Xxxxxxx Xxx. Xxxxxxx Xxxx Superintendent Elem...
Sample 1
Guardian Signature. Assignment of Benefits/Financial Agreement I hereby give authorization for payment of insurance benefits to be made directly to the Advanced Pain Institute and my assisting physicians for services rendered. I understand that I am financially responsible for all charges, whether or not they are covered by insurance. In the event of default, I agree to pay all costs of collections and reasonable attorney’s fees. I hereby authorize this healthcare provider to release all information necessary to secure the payment of benefits.
Sample 1
Guardian Signature. I agree that a photocopy of this agreement shall be as valid as the original. Patient/Guardian Signature Witness Signature
Sample 1
Guardian Signature. Website Consent Do we have your consent for us to put your child’s picture on our website (xxxxxxxxxxxxxx.xxx/xxxxxxxxx) and our Facebook page? We will be showing pictures of our activities each month. Their names and addresses would not be listed. Yes □ No □ Parent/Guardian Signature: Agreements
Sample 1
Guardian Signature. This agreement was ratified by the St Xxxxx School Board in 2016.
Sample 1
Guardian Signature. Date: / / ▪ Children attending Pre School can choose to attend until the day before their sixth birthday as long as they are NOT enrolled at any school. I wish for my child to attend Methven Pre School until date. I am signing to say that they are not enrolled at any school while attending this centre. Parent/Guardian signature: Statutory Holidays: This enrolment agreement is inclusive of school term breaks. Methven Pre School is closed for all of the following statutory holidays and for two weeks over the Christmas/New Year period, (dates advised annually) Waitangi Day Good Friday Easter Monday Anzac Day Queen’s Birthday Labour Day Canterbury Anniversary Day Christmas Day Boxing Day New Year’s Day 2nd January Parent Declaration: I have read and understand the terms and conditions of enrolment as set out above. I declare that all the above information is true and correct to the best of my knowledge and understand that Methven Pre School will accept children whose parents/caregivers undertake to abide by the policies and procedures of the centre and Ministry of Education Licensing Criteria. Parent/Guardian Signature: Date: / / Date: / / Service Provider Signature: On behalf of Methven Pre School Learning and Child Care Centre, I declare that this form has been checked and all relevant sections have been completed. Service declaration: ANY CHANGES TO THIS FORM MUST BE SIGNED & DATED BY PARENT/GUARDIAN
Sample 1
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Guardian Signature. (Please sign after reviewing that the above homework is complete and all homework pages have been initialed) o Instructor Signature: o The student has completed all assignments required. A certificate of completion can be granted. Homework Assignment #1
Sample 1

Related to Guardian Signature

  • Witness Signature 4. PARENT/GUARDIAN CONSENT: (for applicants under 18 years) – I hereby certify and decree that all the information contained in the declarations above is true and accurate Print Name:................................................................... Signature …………………………………………....……... Relationship to applicant ……………………………… Phone Contact ……………………................................... Address …………………………………………………………………….....................................................................

  • Contract Signature If the Original Form of Contract is not returned to the Contract Officer (as identified in Section 4) duly completed, signed and dated on behalf of the Supplier within 30 days of the date of signature on behalf of DFID, DFID will be entitled, at its sole discretion, to declare this Contract void. No payment will be made to the Supplier under this Contract until a copy of the Form of Contract, signed on behalf of the Supplier, is returned to the Contract Officer.

  • Employee Signature Employee ID: Telephone No: Employee Address: Work Location:

  • Signature Signature For the participant For the institution Xxxxxx Xxxxx prof. Ing. arch. Xxxxxx Xxxxxxx, PhD. Vice-xxxxxx for International Relations and Public Relations, based on the procuration Annex I

  • Legal Signature This Agreement may be executed and delivered by any party herein by sending a facsimile of the signature or by a legally recognized digital or electronic signature. Such legal signature shall be binding on the party so executing it upon receipt of signature by the other party.

  • Preparer’s Signature The person completing the DBE commitment form on behalf of the consultant’s firm must sign their name.

  • EMPLOYEE SIGNATURES Signature: Phone # / Personal E-mail: Signature: Phone # / Personal E-mail: Signature: Phone # / Personal E-mail:

  • Student Signature By signing this contract, Resident agrees to pay the contract amount (room, board and association fees) in accordance with Addendum B: Rate and Payment Schedule. Resident may pay the full amount due prior to the due date, at the Resident’s election.

  • AGREEMENT SIGNATURES By signing below, both parties agree to the terms and conditions of this Agreement. Please acknowledge acceptance of this document and terms by returning a signed copy within seven (7) days of issuing. If a signed copy is not returned within seven (7) days and you are attending service, Fighting Chance will deem this to be acceptance of the document. If signed by Xxx XxxXxxxxxxX: Signature of Participant: Date: If signed by Person Responsible: I confirm that this Agreement has been explained to the individual receiving the services and that they agree to the terms. I further confirm that I have authority to sign on their behalf. Signature of Person Responsible: Date: SignaĒure on behalf of FighĒing Chance: Signature of Person(s) responsible: Date: Name: Appendix 1 Key Contact Details Participant’s Name Participant’s Email Participant’s Phone Participant’s Address Person(s) responsible’s Name Person(s) responsible Relationship to Participant Person(s) responsible’s Email Person(s) responsible’s Phone Support Coordinator (where applicable) Support Coordinator’s Name Support Coordinator’s Email Support Coordinator’s Phone Shared Living/Supported Accommodation/Group Home (if applicable) House Manager’s Name House Manager’s Email House Manager’s Phone Additional Contacts (if applicable) Role Contact’s Name Contact’s Email Contact’s Phone Appendix 2 NDIS Claiming Preferences Fighting Chance supports NDIS participants who are NDIA-Managed, Self-Managed or Plan Managed. To invoice and bill you correctly, it is important you keep us updated with your plan management preferences, and let us know ongoing if your status changes. For the purposes of services delivered by Fighting Chance, your NDIS plan is: (please tick) ☐ NDIA-MANAGED You understand that Fighting Chance will claim directly through the NDIA portal if your funding for Fighting Chance is NDIA-managed, so you will not receive any direct request for payment from us. To ensure that you do not get a text from the NDIA to approve each claim weekly, endorse Fighting Chance as a ‘My Provider’ for automatic payment processing. Instructions can be found at xxxxxxxxxxxxx.xxx.xx/xxxx/ or you can contact the Fighting Chance My Provider Endorsement Helpdesk on (00) 0000 0000 or xxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx.xx ☐ (Optional) Please supply me, by email, with monthly Statements of Account to: ☐ SELF-MANAGED ☐ I am self-managed and would like to be invoiced for services once a week. Please email invoices to: Please see Appendix 3 for Self-Management Payment Options. ☐ PLAN-MANAGED Please send invoices to my plan manager: Plan management organisatio Contact Name Email Address Phone number ☐ OTHER FUNDING (eg. self-funded, iCare or other insurance funding) Please email invoices to: Appendix 3 Self-Managed Payment Options Participants who are self-managed have a number of payment options with Fighting Chance: ☐ DIRECT DEPOSIT (preferred option) Payment of Fighting Chance invoices can be made by Electronic Funds Transfer (EFT) through your bank. Fighting Chance’s bank account details are as follows: Bank: Commonwealth Bank of Australia Account Name: Fighting Chance Australia Ltd BSB: 062-438 Account Number: 00000000 To ensure all payments are correctly allocated to your account, please include the full invoice number in the reference field. ☐ CREDIT CARD Payments can be made by credit card by clicking the ‘pay by credit card’ link included on the invoice. Please note that a service fee for this option will be imposed. ☐ PAYPAL Payment of your invoices can also be made via our PayPal account. To make payment via PayPal, please access the following link: xxxxx://xxxxxx.xx/FightingChanceAus?locale.x=en_AU To ensure your payment is correctly allocated, please enter the full invoice number in the reference field. Appendix 4 Non Face to Face Time Breakdown - Jigsaw Standard Non Face-to-Face Supports Delivered to every Jigsaw Participant daily, weekly, annually Writing the Board (i.e. preparing and writing up each person’s individualised program for the following day). Reviewing Trainee records/journal notes/medical or other key information to be able to best support the person during their day. Parent/Guardian/Carer Updates, i.e. emails, phone calls. Pre- and post-shift sta briefings. Zone setup (setting up workstations, boxes, visuals and group training areas) Resource development to support each Trainee to progress towards their employment goals (adapting training resources, creating visual aids and cheat sheets, etc). Research/Coordination to implement support strategies (disability, behavioural and learning strategies). Family reviews and the development of training plans (planning, delivery and follow up). Planning social events and extra curricular training (e.g. TAFE). Standard NDIS Annual Support Review Letter. Standard Ǫuarterly Reports - Upon Request. Complex Non Face-to-Face Supports - Delivered to Jigsaw Participants with High Intensity Support Needs (in addition to supports outlined in Standard) Allied health meetings, phone calls, correspondence. Specialist/additional sta training (internal or external), i.e. BSP implementation training. Creation of additional/detailed social stories/visuals. Data collection requested by behaviour therapists. Incident follow up or crisis meetings (seperate to regular family updates or regular allied health meetings). Development/review/discussion of medication forms/transfer plans/mealtime assistance plans etc. Detailed and regular sta training on individual complex behaviour/medical/transfer/mealtime support plans. Extended daily pre-brief and debrief. Additional Non Face-to-Face Supports - billed separately upon request Detailed NDIS Review Letters One-o engagement or training with Allied Health. Detailed Ǫuarterly Reports.

  • Counterpart Signature This Agreement may be signed in counterpart, and the signed copies will, when attached, constitute an original Agreement.

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