Parent Agreement Tuition Agreement Immunization Record Medication ReleaseRegistration Form • January 28th, 2022
Student Last Name First Name Middle Name Nickname Entering Grade (circle grade level desired)N3 PreK K5 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Age Gender Birthdate Home Phone Cell Phone Custodial Parent(s) or Legal Guardian(s) First and Last Name(s) Relationship to Student Marital Status: □ Married □ Single □ Separated □ Divorced □ One Parent Deceased□ Student Living With Parent, Step-Parent or Other If Divorced, Who Has Custody for Decision Making? □ Joint □ Father □ Mother (Copy of Custodial Papers Required) Address City Zip School District Email Address Communication Preference □ Phone □ Email □ Mail Non-Custodial Parent Name (If Applicable) Address Phone Father’s Work Place Father’s Work Phone # Father’s Cell Phone # Mother’s Work Place Mother’s Work Phone # Mother’s Cell Phone # Church Home Pastor Youth Pastor Frequency of Attendance□ Weekly □ Frequently □ Infrequently Member of First Baptist Church of Dunkirk□ Yes □ No Ethnicity Code NYS Reporting Codes: 1 – American
IMMUNIZATION RECORD CUSTODY AGREEMENT (IF APPLICABLE)Registration Form • January 26th, 2016
Household Information Household/Surname (Primary Last Name): Residence Physical Address: PO Box: City: State: Zip: Household Primary Phone: Household Primary Email: Student Information First Name: Middle Name: Last Name: Date Of Birth: Birth City/State: Grade: Ethnicity: (Choose one)Hispanic/Latino Non‐Hispanic Latino Gender:Male Female Race: (Choose one or more)White American Indian/Alaskan Asian Black/African American Hawaiian/Pacific Islander School History Name of previous school attended: City: State: Has this student ever repeated any grade? YES NO If yes, what grade(s): Does this student have Special Placement or Special Education? YES NO If Yes, Please Specify: Individualized Education Program (IEP, this includes Speech): , Gifted IEP (GIEP) or Section 504 Service Agreement FATHER/Guardian/Foster Father Information First Name: Last Name: Address (if different from Household): City, State, Zip Code Home Phone: Cell Phone: Work Phone: Primary Email: Relationship to Student:
Lamb of God Lutheran SchoolRegistration Form • November 28th, 2017
SCHEDULE FRegistration Form • January 26th, 2021
Agreement entered into and concluded pursuant to the Act respecting the sale and distribution of beer and soft drinks in non-returnable containers
Payment in Full Payment Plan (*Payment Plan Agreement must be signed below)Registration Form • January 4th, 2022
SLEEP 2023 REGISTRATION FORMRegistration Form • January 31st, 2023
Contact Information Agreement: By checking the box below, you are agreeing to receive content (i.e. emails, direct mail) from the APSS and exhibitors. 🞎 I consent to share my contact information.
Release AgreementRegistration Form • July 13th, 2023
Street Address, City, State, Zip CodeRegistration Form • June 30th, 2020
This agreement releases Hooks For Heroes & all sponsors from all liability relating to injuries that may occur During the Hooks For Heroes Summer Fluke Slam Fishing Tournament. By signing this agreement, I agree to hold Hooks For Heroes & all sponsors entirely free from any liability, including financial responsibility for injuries or damages incurred, regardless of whether injuries or damages are caused by negligence.
PALM Charter High School’sRegistration Form • March 4th, 2024
Complete the above camper information form and sign back section (release & indemnity agreement). Attach a check or money order with application, Checks may be made out to PALM Charter High School.
Agreement/Registration Form for American Indian Juried Art ShowRegistration Form • February 7th, 2011
CROSS COUNTRY REGISTRATION FORMRegistration Form • May 17th, 2023
Registration begins today and ends September 8th. Each student athlete must submit the registration form by September 8th and the athletic clearance prior to participating in the first meet.
REGISTRATION FORMRegistration Form • May 12th, 2021
In an effort to have all parties involved with overnight activities prepared in the case of a disciplinary event, illness, or exposure to COVID-19, the parent or guardian will be responsible to pick their 4-H’er up if they are notified to do so. By signing the registration form, you are confirming that in the event of an early event dismissal, you will be responsible for providing transportation for your child.
Registration FormRegistration Form • September 15th, 2022
A non-refundable registration fee must accompany this form . The registration fee is $75.00 for the first child and $55.00 for each additional child or Northminster Church Member.
Brittany Place HPRRegistration Form • October 25th, 2023
ContractRegistration Form • May 9th, 2023
In consideration of my participation, I hereby release and covenant not-to-sue Powell Recreation District, Park County School District #1, City of Powell, Park County Fair Grounds, Powell Makerspace, and any of their employees, instructors, agents, or volunteers, from any and all present and future claims resulting from ordinary negligence on the part of Powell Recreation District or others listed for property damage, personal injury, or wrongful death, arising as a result of my engaging in or receiving instruction in SUMMER ACADEMY activities or any activities incidental thereto, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future, that may be made by me, my family, estate, heirs, or assigns.
REGISTRATION FORMRegistration Form • June 7th, 2019
Please fill out this form, read the legal agreement and, if you agree to abide by its terms, sign it in the presence of a notary public who witnesses your signature and affixes his or her notary stamp and seal. Take a photo of your completed notarized form and email it to us. Give the physical copy to the organizers when you meet up with the tour.
ContractRegistration Form • January 7th, 2018
ContractRegistration Form • January 6th, 2018
See reverse for tuition agreement)Registration Form • May 30th, 2022
THE END OF COURSE DATE FOR THE COURSE OPTION. We cannot allow make-ups for students enrolled in Option 2 once we have begun course Option 3. No refunds once classes have begun.
Registration Form (Adults)Registration Form • April 30th, 2021
Region 1 RegistrationRegistration Form • June 6th, 2022
ContractRegistration Form • November 14th, 2011
REGISTRATION FORM Name: ID No: Date of birth: Email: Phone: Current address: City: State: ZIP Code: Current employer: Employer address: Phone: Emergency Contact Name: Phone: CLASS TYPE Annual Agreement – paid monthly Month to Month Individual 2 person Family Date of draft 1st of the month 15th of the month Name ID No: Name ID No: Name ID No: Name ID No: PAYMENT INFORMATION EFT AuthorizationI, , authorize my bank to make my payment by the method indicated below and post it to my account. Checking (attach voided check) Visa Mastercard Discover Acct. no. Routing no. Bank name: Bank address: Bank phone: Credit Card Expiration date: CV Code: Signature Date Enrollment Fee Pro-rate amount Retail Tax TOTAL Default and Late PaymentShould you default on any payment obligation as call for in this agreement, the entire remaining balance shall be deemed due and payable upon demand, and you agree to pay allowable interest, and all cost of collection, including, but not limited to, coll
Hold Harmless Indemnity AgreementRegistration Form • December 21st, 2019
ContractRegistration Form • January 28th, 2009
ELIXR TEEN FIT PROGRAM REGISTRATION FORM The program set out in this agreement is between the student or parent/guardian if student is under the age of eighteen years (identified on the front of this agreement) and Elixr Health Clubs (Elixr) situated on the premises stated above. Elixr Health Clubs is the trading name of Elixr Easts Holdings P/L - ABN: 84 111 634 747 Student Name: First Name: Surname: Address: Street:Suburb: State: Postcode: Date of Birth: Age: Sex: Height(cm):Student Asthma Bronchitis Autism SPD Motor Sensory Disorder Epilepsy Medical ClearanceMedical History: Diabetes Heart Disease ADHD APD Behavioural Condition Other: Parent / First Name: Surname:Guardian :Details Contact Number: Email: Emergency: Contact Name: Contact Number: Member of Elixr: Yes No Member Tag Number: Member Full Name: PRE-EXERCISE QUESTIONNAIREThis section is to be completed by a parent/guardian who is responsible for the medical care of the young person. Does your child have, or previously had:
AMHERST REGISTRATION REQUIREMENT CHECKLISTRegistration Form • November 29th, 2022
Any Documentation Pertaining To Prior Education (Transcripts/Final Report Cards/Assessment Results/Gifted Documentation/WEPS/WAPS)
ContractRegistration Form • January 7th, 2016
Etchells Great lakes RegattaRegistration Form • June 12th, 2009
R E G I S T R A T I O N F O R MRegistration Form • May 11th, 2017
Cordillo CourtsRegistration Form • May 17th, 2018
Northleach C of E Primary School Breakfast Club and After School Club PackRegistration Form • September 18th, 2019
Thimble Fingers Sewing StudioRegistration Form • April 10th, 2014
We, the undersigned, understand that the Thimble Fingers instructor(s) and their assistants will teach and enforce practical safety in all sewing classes and will conduct all classes with every effort toward prevention of accidents. We therefore agree to hold the instructor(s) harmless for any accident that may occur to my child while attending sewing classes.
Student agreement:Registration Form • December 4th, 2021
Registration FormRegistration Form • March 30th, 2021
For which session are you registering?Registration Form • November 14th, 2018
Please fill in this form and the attached Non disclosure agreement to register for the ECCO Counter- trade and Offset Academy and send it either by e-mail or by post mail (see addresses at the bottom of every page). You will then receive a proforma invoice for 50 % of the applicable fee (payable im- mediately). The remaining 50 % will have to be paid within 30 days of the course start date.
ContractRegistration Form • December 14th, 2021
REGISTRATION FORM (Part 1)2022 - 2023 PALLISER SWPBP Community Center - 2323 Palliser Dr SW Name of child: REGISTRATIONIn order to complete your registration: 1) Please submit these forms to Seedlings Early Learning: 1) Registration Form (Parts 1 & 2) 2) Media Release Agreement (not required if you already filled it online, or if no changes are required from the current one) 3) Medication Consent Form (If Applicable) 4) Pre-Authorized Debit (PAD ) Agreement for monthly tuition payments authorization The above forms can be submitted via email to seedlingsregistry@gmail.com or by mail to 18 Cougarstone Terrace SW T3H 4Z8 Note: Pre-Authorized Debit (PAD) Agreement Form should be sent by mail to 18 Cougarstone Terrace SW T3H 4Z8 2) Registration payment including: ANNUAL REGISTRATION FEE (Existing families must pay every New School year) $ 95.00(one fee per family even when there is more than one child)DEPOSIT FEE- Equivalent to last month’s tuition fee. Please refer to the fee schedule
