Feb/Mar 2022 FREE Life Skills classes Waitlist

Howard County Students ONLY. FREE online Life Skills classes

Due to the overwhelming response, we have closed registration for the Spring Series 1 (February 8, 15, 22, and March 1, 8, 15, 22, 29) and are accepting registrations for the Life Skills Classes Spring Series 2 that will be held May 10, 12, 17, 19, 24, 26, 31 and June 2 from 4:30 p.m. to 6:00 p.m. via Zoom. If you would like to register for Spring Series 2, please complete the form below.

If you have questions or difficulty completing this registration, please email Lifeskills@hcdrugfree.org

Thank you.

Joan Webb Scornaienchi & Rebecca Eng

Executive Director Education Coordinator

HC DrugFree

Question Title

* 1. Please indicate which option below works best for your student.

I would like to have my student added to the waitlist for series 1 (February 8, 15, 22, and March 1, 8, 15, 22, 29 from 5:30-7pm)

I would like to register my student for series 2 (May 10, 12, 17, 19, 24, 26, 31 and June 2 from 4:30-6pm)

I would like my student added to the waitlist for series 1, but if there isn't space, please register them for series 2

I would like to be notified of future class offerings

Other (please specify)

Question Title

* 2. This series is for Howard County students ONLY. Does your student live in Howard County?

Yes

No (please explain below)

Additional Info including if parent lives or works in Howard County and how you heard about these classes:

Student Information

Question Title

* 3. Student's first name

Question Title

* 4. Student last name

Question Title

* 5. Your student is in:

Elementary School

Middle School

High School

Additional Info:

Question Title

* 6. Name of school your student attends:

Question Title

* 7. Your student's grade:

If other, we will consider each request & contact you

Question Title

* 8. Student age

Other (please specify)

Question Title

* 9. Student gender

Male

Female

Don't want to share

Other (please specify)

Question Title

* 10. Student race

American Indian/Alaskan

Asian

Black/African American

Hawaiian/Pacific Islander

White

Additional Information

Question Title

* 11. Is your student hispanic?

Yes

Your student's gmail address will only be used to share Google Docs and other in-class assignments with them during class. We will only contact you with information about classes, not your student. We will not share this information.

Question Title

* 12. Student gmail address

Question Title

* 13. Confirm student gmail address

Parent/Guardian Information

Question Title

* 14. Name of parent/guardian

Question Title

* 15. Phone for parent/guardian

Question Title

* 16. Re-enter phone for parent/guardian

Question Title

* 17. Email for parent/guardian

Question Title

* 18. Re-enter email for parent/guardian

Question Title

* 19. Mailing address

Address

City/Town

ZIP

Emergency Contact Information

Question Title

* 20. Name of another adult serving as emergency contact #2

Question Title

* 21. Phone for adult emergency contact #2

Question Title

* 22. Email for adult emergency contact #2

Question Title

* 23. Does your student have access to a computer/device?

Yes

Question Title

* 24. Does your student have access to a computer/device with both a webcam and microphone? Your student is expected to be on camera and participating during class.

Yes

Comments

Question Title

* 25. Due to high demand for this class, we ask that students expect to attend all classes and fully participate. We realize there may be conflicts, but for now, does your student plan to attend all classes?

Yes

Comments

Question Title

* 26. If you answered "no" above, would you like us to put your student on a waitlist rather than miss classes this session? We may offer another class later in Spring 2022.

Yes

Question Title

* 27. Questions for HC DrugFree's staff:

Question Title

* 28. Additional information for HC DrugFree's staff:

Question Title

* 29. I agree that my student is expected to participate using Zoom and will be on camera.

Having read this waiver and knowing the facts, I, for myself and anyone entitled to act on my behalf, waive and release HC DrugFree and its employees, directors, officers, partners, agents, volunteers and sponsors from and against all claims, demands or causes of actions for accidents, personal injury, bodily injury, death, property damage or other injury or loss or damage of any kind, occurring from any cause arising from or related to or in connection with named participant’s involvement in these Life Skills classes.

Yes