Odyssey Charter School Childcare Program Enrollment Form 2015 ~ 2016Enrollment Form • August 27th, 2015
Welcome to the Before and Aftercare program at Odyssey Charter school. Here we meet the needs of our families by providing convenient, quality childcare for students in Kindergarten through Eighth Grade. Familiar faces, a nurturing environment, a positive attitude, and engaging activities are just a few of the things that make up our successful program.
Enrollment FormEnrollment Form • August 12th, 2009
This contract will only need to completed once (1) per year and will be kept on file at K9 Country Village. Each time your pet(s) board with K9 Country Village, we will ask you to complete a current care and instruc- tion form that will allow you to update any of the above information if necessary.
Peak1 Administration | 7600 Mineral Drive, Suite 450 | Coeur d'Alene, Idaho 83815 healthbridge@mypeak1.com | Phone: 855.814.7565 | Fax: 855.495.3669Enrollment Form • June 2nd, 2014
PARTICIPANT: Please complete all items listed below.Carefully complete all sections. Missing information often results in enrollment delays, which could affect your ability to file claims and receive reimbursement of your qualified healthcare expenses and insurance premiums.Fully complete participant, spouse and dependent information (federally required information) Enter participant contact informationSign and date Hold Harmless AgreementMake a copy of your completed form for your records Return original to your employer’s payroll/benefits office EMPLOYER: Please fully complete this sectionMissing information often results in delays. This could affect your employee’s ability to file claims and receive reimbursement for their expenses and insurance premiums. Please make a copy of this completed form for your records.Enrolling employee is:Active or Separating/retiring on:Specified Participant Effective Date (optional):You may specify the enrolling employee's Participant effective date, no
Enrollment FormEnrollment Form • March 13th, 2018
Does your child have any physical problems, mental health disorders, or developmental disabilities which would limit the child’s participation in the camp programs and activities? Yes No
Caesar Rodney School DistrictEnrollment Form • August 9th, 2016
Odyssey Charter School Childcare Program Enrollment Form 2014 ~ 2015Enrollment Form • June 18th, 2014
Monthly Payments: Payments are due by the 1st of each month. A statement will be issued two weeks pri- or to the due date. Payment can be made by Check, Money Order, or Credit Card. Cash payments will only be accepted in main office during normal school hours.
Kettering Middle School Band 6th Grade Contract/Enrollment FormEnrollment Form • October 10th, 2013
Welcome to the 20132014 school year and the Kettering Middle School Band Program. We are glad to have your student in the bands at Kettering Middle School and hope that he/she attains every desired level of success. One of the unique qualities of a musical ensemble is that its success depends on each member participating to their maximum ability. To make certain each student understands their role as a band member, we are asking that you read and discuss with your son/daughter the following guidelines and complete and return the bottom portion of this contract. We ask that you pay particular attention to the concert dates listed below. Please be sure to fill out all of the information on the contract so that we will have your current contact information in our database for future mailings. We are looking forward to a great year! Please feel free to contact us by email or at 4991550. Please return by Friday, October 11th.
ENROLLMENT FORMEnrollment Form • September 16th, 2019
SCHOOL: ST. MARY CATHOLIC SCHOOL_ CITY: ELGIN DATE: HOME PARISH: ENTERING GRADE: CHILD’S NAME: SEX: CHILD’S SS#: PHONE: ADDRESS: CITY: ZIP: PLACE OF BIRTH: DATE OF BIRTH: SCHOOL LAST ATTENDED: CHILD’S RELIGION: BAPTISM DATE: CHURCH: PENANCE: Y N...Enrollment Form • January 21st, 2023
This form is not intended to constitute nor should it be viewed as creating a “contract” between the School and the student/parent. The School reserves the right to revoke its acceptance of this application, deny enrollment and/or dismiss the student in keeping with applicable School and/or Diocesan policies. Neither this form nor any other written document issued by the School (including by not limited to, the student handbook) should be considered to be a “contract”.
CARQUEST CANADA Stand Alone enrollment formEnrollment Form • May 11th, 2018
ABKA-North Heights Enrollment FormEnrollment Form • October 25th, 2019
❖Emergency Medical Release Form ❖Social Sheet ❖Consent to Use Name and/or Photos ❖Screenings Consent ❖State of Illinois Certificate of Child Health Examination ❖Trinity Day Care Payment Policies ❖ACH Service AgreementEnrollment Form • March 2nd, 2017
To provide a secure, nurturing, and educational environment for children, families and staff. Avoid or eliminate unsafe, inappropriate or disruptive behavior practices elicited by a child.
Office UseEnrollment Form • January 31st, 2013
Is child taking any medication? Yes ____No___ if yes, has a form been completed, Yes___No___ Medicine cannot be administered without proper form.
Enrollment FormEnrollment Form • June 2nd, 2019
In the event that Student needs medical or surgical services which require Parent’s pre-authorization or consent, Parent hereby authorizes, appoints, and empowers the School to act as Parent and furnish such consent on Parent’s behalf. Parent confirms that it is Parent’s desire that Student be furnished with such medical or surgical services as soon as reasonably possible after the need arises. Parent hereby releases and holds the School harmless from any liability which might arise from the giving of such consent. Parent agrees to reimburse the School for any medical expenditures made on Student’s behalf.
Enrollment FormEnrollment Form • June 29th, 2015
A contract between FedEx and the VMTH Clinical Diagnostic Laboratories allows our clients to receive university discounted rates on FedEx Priority Overnight shipping.Enrollment Form • September 11th, 2017
OFFICE USE ONLYEnrollment Form • March 27th, 2013
Last Name: Birth Date: First Name: Place of Birth: Full Middle Name : Grade: Gender: Have you ever been a student in our district? Yes No If yes, last grade School Choice? 504 Plan? Yes No Individualized Educational Plan (IEP)? Yes No Foster Child? Yes No State Ward: Is there a Custody Agreement? YES or NOo Mother Only o Father Only▪ Father has shared custody ▪ Mother has shared custody▪ Father does not have shared custody ▪ Mother does not have shared custodyo Mother – Step Father o Father – Step Mother▪ Father has shared custody ▪ Mother has shared custody▪ Father does not have shared custody ▪ Mother does not have shared custodyo Guardian
ARTHRITIS (TCA) PROGRAMS ENROLLMENT FORM – AGREEMENT 2021Enrollment Form • September 3rd, 2020
The Wyoming Department of Health (WDH) Aging Division (AD), Community Living Section (CLS), in meeting the Department of Health and Human Services 45 CFR Part 75, and Administration for Community Living, Older Americans Act Title III-D, CFDA# 93.043, Disease Prevention and Health Promotion, Evidence-Based Program requirements, collaborates with WDH, Injury Prevention Program to offer subsidies for Senior Center(s) to participate in either or both Matter of Balance (MOB), and Tai Chi for Arthritis (TCA).
ENROLLMENT FORMEnrollment Form • May 16th, 2022
Family Enrollment Form 2015-2016Enrollment Form • March 4th, 2015
*If divorced, separated, or remarried, include child’s other biological parent’s name and address if they would like to receive newsletters, report cards, and other mailings from WCS.
Cost: No Tuition Monday-Friday Hours: 8:30am-11:30am Cost: $165 per week + One time fees Monday- Friday Hours: 8:30am-4:30pmEnrollment Form • August 5th, 2019
Child’s Last Name Child’s First Name Middle Initial DOB Parent Last Name Parent First Name Daytime Phone Number Street Apt # City, State Zip Code Schedule Options Please select only ONE of the following Program Options □ AM Voluntary Pre Kindergarten □ Voluntary Pre Kindergarten + Extended Day . Extended Day Fee and Non-Refundable Deposit Agreement A non-refundable fee of $355 is due when you turn in your registration packet. Please note: All fees are non-refundable. If you choose not to send your child to attend Excell Academy for any reason you will not be refunded. Breaskfast & Lunch costs are not included in the regular weekly fees. If you would like to be considered for reduced priced or free meals you must complete an Application for Educational Benefits. Forms will be available at the front desk in July 2019. The required non-refundable deposit of $305 with your registration packet to hold your child’s space. The deposit is non- refundable and will be applied to your
ENROLLMENT FORMEnrollment Form • June 29th, 2015
Child and Adult Care Food Program Sponsor/Center Name: Child Enrollment Form (Sample) Agreement #:Enrollment Form • May 8th, 2017
This document does not have to be completed for children in Emergency Shelters, Outside School Hours, and/or At-Risk programs. It is recommended to have new CACFP Annual Enrollment Forms completed each year during the Household Eligibility Application renewal period. Review completed enrollment form and enter the effective date in lower right hand section.
NameEnrollment Form • June 26th, 2023
A contract between FedEx and the VMTH Clinical Diagnostic Laboratories allows our clients to receive university discounted rates on FedEx Priority Overnight shipping.Enrollment Form • August 4th, 2020
Frederick County Public Schools Enrollment FormEnrollment Form • March 27th, 2014
Do you have a proof of custody/guardianship? Yes No(Birth certificate/guardianship papers) Do you have current proof of residency? (please circle one)Gas, Electric, Water Bill Signed Lease Agreement Other (PPW permission required) Do you have proof of immunization for your child? Yes No If you answered NO to any or all of the above questions, please see secretary.MD COMAR requires all the above before a child can attend/enroll in school.
FALL PREVENTION: MATTER OF BALANCE (MOB), TAI-CHI FOR ARTHRITIS (TCA), AND BINGOCIZE PROGRAMS ENROLLMENT FORM – AGREEMENT 2021Enrollment Form • April 22nd, 2021
The Wyoming Department of Health (WDH) Aging Division (AD), Community Living Section (CLS), in meeting the Department of Health and Human Services 45 CFR Part 75, and Administration for Community Living, Older Americans Act Title III-D, CFDA# 93.043, Disease Prevention and Health Promotion, Evidence-Based Program requirements, collaborates with WDH, Injury Prevention Program to offer subsidies for Senior Center(s) to participate in either Matter of Balance (MOB), Tai Chi for Arthritis (TCA), and Bingocize Programs.
Child Enrollment Form (Sample) Agreement #: 000-00-000-0Enrollment Form • December 4th, 2018
This document does not have to be completed for children in Emergency Shelters, Outside School Hours, and/or At-Risk programs. It is recommended to have new CACFP Annual Enrollment Forms completed each year during the Household Eligibility Application renewal period. Review completed enrollment form and enter the effective date in lower right hand section.
Enrollment FormEnrollment Form • January 15th, 2019
Child Enrollment Form Agreement #: 300-25-292-0Enrollment Form • October 1st, 2021
Caesar Rodney School DistrictEnrollment Form • April 15th, 2010
Last Name: First Name: Middle Name: Birth Date: Place of Birth: Grade: 🞎Male 🞎Female Ethnic Origin: 🞎American Indian 🞎Black 🞎Asian 🞎Hispanic 🞎White 911 Street Address: Mailing Address: City, State, Zip Code: City, State, Zip Code: Residency Documented By: 🞎Current Utility Bill(s) 🞎Mortgage/Lease Agreement 🞎Other: Home Telephone #: Military Base Housing: 🞎Yes 🞎No
ENROLLMENT FORMEnrollment Form • January 11th, 2021
Surname Initials Title ID Number DOB DD MM YYYY Nick name Full Name(s) RSA Citizen Y N Nationality Immigration Date DD MM YYYY Passport No Alternative ID ID Type Gender M F Ethnic Marital Maiden Mother Tongue Home Language Highest Grade Year Passed
