Class Registration Signup Form

Last Name of Family *

First Name of Child *

Birth Date *

Month Day Year

Grade *

FOR HIGH SCHOOL ONLY - First Hour Class (For selecting multiple courses (for sem 1 and 2), hold CTRL key while you choose your option. This will allow for 2 choices.)

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FOR HIGH SCHOOL ONLY - Second Hour Class (For selecting multiple courses (for sem 1 and 2 or Wed and Fri), hold CTRL key while you choose your option. This will allow for 2 choices.)

FOR HIGH SCHOOL ONLY - Third Hour Class

FOR HIGH SCHOOL ONLY - Fourth Hour Class

First Name

Birth Date

Month Day Year

Grade

FOR HIGH SCHOOL ONLY - First Hour Class (For selecting multiple courses (for sem 1 and 2), hold CTRL key while you choose your option. This will allow for 2 choices.)

.

FOR HIGH SCHOOL ONLY - Second Hour Class (For selecting multiple courses (for sem 1 and 2 or Wed and Fri), hold CTRL key while you choose your option. This will allow for 2 choices.)

FOR HIGH SCHOOL ONLY - Third Hour Class

FOR HIGH SCHOOL ONLY - Fourth Hour Class

First Name

Birth Date

Month Day Year

Grade

First Name

Birth Date

Month Day Year

Grade

First Name

Birth Date

Month Day Year

Grade

Parent's Name *

Father Mother

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Mobile Number

Area Code Phone Number

Are you able to receive text messages?

Yes - This is a great way to contact me. No

Home Phone Number

Area Code Phone Number

What number would you like me to put on the schedule sheet? This will be used by other mothers/fathers who may need to contact you in regards to swapping schedules or class plans.

Mobile Number Home Phone Number

Who will be fulfilling the role of helping at co-op every other week?

If you would like to discuss the possibility of working every week or not working at co-op (drop off) please make note of that above.

Parent Email *

Please make note of any special needs we should be made aware of for your child(ren). This may include allergies, academic needs, or other concerns.

Please list any special gifts or talents you have that you would like to utilize at co-op.

Which age group/area would you like to be involved with on the weeks you are working at co-op?

Are you currently CPR and/or first aid certified? (this is not required)

CPR First Aid CPR & First Aid

Who (other than the parents) will be able to pick your child(ren) up? This list is not final and can be altered on any particular Friday when you sign your child in.

NEW FAMILIES: How did you hear about us?

RETURNING & NEW FAMILIES: Why do you want to be a part of CHC for the upcoming year?

Please acknowledge each statement below by marking each box.

I will be faithful to and punctual for my role at co-op whether it be a room parent, teacher, or assisting in some other way. I realize that the upper level courses at co-op are for credit courses. As such I will make sure that I communicate with the teacher when I have concerns or questions about the class and/or assignments. I will also consistently check the online system, so I know how my child is performing in his/her classes (6th grade and up). I understand that my children are expected to complete the assignments as set forth by their teachers, especially in the upper grades. Instances of cheating and/or plagiarism will be dealt with through a zero grade first and if it occurs again a possible removal from the class or co-op. I will fulfill the pre-determined financial commitments which support the endeavors of the co-op. I realize that if I do not fulfill this obligation, I may be asked to cease attendance. All activities planned by co-op will be conducted in a safe and orderly manner to the best of our abilities and knowledge (including on site or off site for field trips). However, CHC, nor anyone serving as a representative of CHC accept or implies liability for anyone taking part in the activities. CHC retains the right to decline or discontinue anyone’s participation in any activity at any time at its sole discretion. Normal precautions are always taken to ensure the safety of everyone that is participating. You and/or your child are attending at your own risk and assume all risks on behalf of yourself and your child(ren). You shall release, indemnify, defend, and hold harmless CHC and its representatives from all liability to the fullest extent permissible by law.

Enter the message as it's shown *

Upon submitting your registration form the director will follow up to either confirm your information or to set up a meeting if you are a new family.

Non-Refundable Registration Fee - $70 (pd by 8/11) / $80 (after 8/11) CLASSES CLOSED AS OF 8/9/21: K/1ST, 4TH/5TH, 6TH/7TH, & HIGH SCHOOL ENGLISH