E-Learning Registration 2020

Enrolling K-8 Students

NOTES:

~~Registration forms must be filled out prior to the participant attending our program.

~~Enrollment is limited. Your child will not officially be enrolled until payment is received. Once you return this form, expect a phone call during our business hours 9:30 a.m. – 5 p.m. to discuss your interest in part-time or full-time status, as well as your personalized schedule. Program availability begins October 19th. If you have a preferred time/day of the week for us to contact you, please indicate that below.

Question Title

* 1. Preferred days/times for us to contact you

Question Title

* 2. Student's Information

Name

Date of Birth (MM/DD/YYYY)

Which grade is the student in?

Question Title

* 3. Parent Contact Information
The parent should be available to answer the phone if staff needs to call during the day.

Name *

Address *

City/Town

ZIP/Postal Code

Email *

Phone Number *

Question Title

* 4. Emergency Contact (if you're not available)

Name

Phone Number

Relationship to Student

Question Title

* 5. Please list all authorized adults (including yourself) who may pick up your child. Please include phone numbers for each adult.

Name/Phone:

Question Title

* 6. What are the student's Medical/Food/Other Allergies?
Staff cannot dispense medications to students; a parent or authorized adult must dispense the medication when needed.
Please include other information that would be helpful to our staff.

Question Title

* 7. Emergency Medical Treatment
"In the event the parent or guardian is not available in an emergency, I hereby grant The Journey Museum and Learning Center permission to secure emergency medical treatment for my child on my behalf at the nearest hospital."

Digital Signature of Parent or Legal Guardian (please type your full name)

Date

Question Title

* 8. E-Learning Expectations, Policies, and Procedures
"My signature indicates that I understand my responsibility for reading and following The Journey Museum and Learning Center E-Learning Expectations, Policies, and Procedures, found online at www.journeymuseum.org/education/e-learning."

Digital Signature of Parent or Legal Guardian (please type your full name)

Date

Question Title

* 9. Photo Release
"I hereby grant The Journey Museum Learning Center my permission to photograph, film, and record my child's image for use in publicity and marketing efforts. This may include but not be limited to use in publications, film and video productions, news coverage, publicity and marketing efforts. All copies of my image photographed, filmed or recorded under this agreement shall constitute the sole property of The Journey Museum and Learning Center, which has my permission to edit, alter, reproduce or use the images in any medium whatsoever without limitation or reservation. This may include possible use on The Journey Museum and Learning Center’s website and Facebook page, but is not limited to those platforms exclusively."
If you do not authorize permission for the Journey Museum and Learning Center to use your child's image, you may leave this section blank.

(child’s name) is under 18 years of age. I consent to this agreement as his or her parent or legal guardian.

Digital Signature of Parent or Legal Guardian (please type your full name)

E-Learning Registration 2020

Enrolling K-8 Students

Question Title

* 1. Preferred days/times for us to contact you

Question Title

* 2. Student's Information

Question Title

* 3. Parent Contact InformationThe parent should be available to answer the phone if staff needs to call during the day.

Question Title

* 4. Emergency Contact (if you're not available)

Question Title

* 5. Please list all authorized adults (including yourself) who may pick up your child. Please include phone numbers for each adult.

Question Title

* 6. What are the student's Medical/Food/Other Allergies?Staff cannot dispense medications to students; a parent or authorized adult must dispense the medication when needed.Please include other information that would be helpful to our staff.

Question Title

* 7. Emergency Medical Treatment"In the event the parent or guardian is not available in an emergency, I hereby grant The Journey Museum and Learning Center permission to secure emergency medical treatment for my child on my behalf at the nearest hospital."

Question Title

* 8. E-Learning Expectations, Policies, and Procedures"My signature indicates that I understand my responsibility for reading and following The Journey Museum and Learning Center E-Learning Expectations, Policies, and Procedures, found online at www.journeymuseum.org/education/e-learning."

Question Title

* 3. Parent Contact Information
The parent should be available to answer the phone if staff needs to call during the day.

* 6. What are the student's Medical/Food/Other Allergies?
Staff cannot dispense medications to students; a parent or authorized adult must dispense the medication when needed.
Please include other information that would be helpful to our staff.

* 7. Emergency Medical Treatment
"In the event the parent or guardian is not available in an emergency, I hereby grant The Journey Museum and Learning Center permission to secure emergency medical treatment for my child on my behalf at the nearest hospital."

* 8. E-Learning Expectations, Policies, and Procedures
"My signature indicates that I understand my responsibility for reading and following The Journey Museum and Learning Center E-Learning Expectations, Policies, and Procedures, found online at www.journeymuseum.org/education/e-learning."