EHCRegistration volunteerform medicalrelease2012

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					                                                    REGISTRATION FORMS
                                           FOR ELLENSBURG HOMESCHOOL CO-OP
                    (Even if you’ve participated in Co-op before, we need every formed filled out for every Co-op session.)


LAST NAME:                                        FATHER:                             MOTHER:                                    .

ADDRESS:                                                                                                                         .

CITY, STATE, ZIP:                                                                                                             .

PHONE:                                     PARENT’S E-MAIL:                                                                   .

NAME, BIRTH DATE, GRADE AND AGE OF CHILDREN:

                                              /      /        GR           AGE           .

                                              /      /        GR           AGE           .

                                              /      /        GR           AGE           .

                                              /      /        GR           AGE           .

                                              /      /        GR           AGE           .

                                              /      /        GR           AGE           .

EMERGENCY CONTACT                                                                       PHONE                                .

DO ANY OF YOUR CHILDREN HAVE ANY ALLERGIES WE SHOULD BE AWARE OF?
                                                                                                                                  .

                                                                                                                                  .

HOW LONG HAVE YOU HOMESCHOOLED?                                                                                  .

NAME OF PARENT WHO WILL ATTEND CO-OP?                                                                                             .

EACH ATTENDING PARENT WILL BE ASSIGNED A VOLUNTEER POSITION. PLEASE INDICATE ANY
PREFERENCES YOU MAY HAVE THAT WILL ASSIST US IN ASSIGNING YOUR POSITIONS. WE WILL DO
OUR BEST TO PLACE YOU WHERE YOU WOULD MOST LIKE TO BE.

___Hall or Room Monitor (oversee hallways or assigned room during co-op
         hours to assure that all children are in their appropriate classrooms or otherwise under proper supervision, if not direct them to these areas.)
____Set up/take down (arrive early set up tables and chairs etc. as well as stay late to
          put them away)
____Classroom Facilitator (be the second adult in a classroom willing to assist teacher
         or retrieve a parent if needed)
____Cleaning (stay after to help with vacuuming, bathroom cleaning etc.)

DO YOU GIVE THE CO-OP PERMISSION TO USE PICTURES TAKEN OF YOUR CHILD(REN) DURING CO-OP
ON THE WEBSITE OR OTHER PROMOTIONAL MATERIAL?

YES            NO            (Please check one)
                                                   PARENT AGREEMENT
                 (Only one parent need initial the following items, but both must sign indicating their agreement.)




       I understand that EHC classes are supplemental to what is being taught in the home and are meant for
       enrichment purposes only. As the parent, I also realize that these classes will not complete any
       curriculum, only enhance them. The instructors do not teach the entire subject matter, but are only
       enriching and assisting my instruction at home.

       I understand that EHC does not keep permanent records or assign grades.

       I understand that EHC does not give credit toward high school graduation requirements; although
       parents may use class time toward fulfilling some requirements in a given subject, according to the
       parent’s own discretion.

       I understand that EHC does not give legal protection or legal assistance. Also EHC is not obligated to
       testify regarding your homeschool’s validity, authenticity, or effectiveness to legal authorities or in
       court.

       I agree that my children will strive to regularly attend all classes for which I have registered them. They
       will arrive on time, fully participate in the class by completing any homework assignments and engage
       with other students and the instructor during class time.

       I understand and agree that I must remain on the premises the entire time and be responsible for my
       children regardless of their age whenever they are participating in co-op.

       I understand and agree that EHC’s Leadership Team, Instructors or Calvary Ellensburg Church will at
       no time be responsible for mishaps, injuries, or accidents that may occur during the year.

       I understand and agree to fulfill my duties as assigned by the Leadership Team.

       I understand and will abide by the refund policy stated in the EHC Handbook.


Father’s Signature                                                                                 .

Mother’s Signature                                                                                 .

Date                                                   .
                                              STUDENT AGREEMENT



All students enrolled in EHC must adhere to the following guidelines:

 Be honest, courteous and patient with everyone; treating others with kindness.

   Respect and obey those in authority.

   Be on time for classes (this means arriving before class begins).

   Use respectful and polite language.

   Remain with your class unless you obtain permission from your teacher to leave and be in
    the appropriate areas at all times; not roaming the building or property.

   Do not bring electronic devices of any kind to classes (music, gameboys, etc). Do not
    bring weapons, including pocket-knives, on the property.

   Complete homework (if any) given by your instructor and fully participate in class by
    engaging with other students and the instructor during class time.

   Contact the instructor when you are absent.

   Reimburse for any damage done by the student to the facility or equipment.


Please have each child in your family read and sign this.
I have read (or my parent has read to me) and I agree to abide by the above guidelines. Each student only needs
to sign once.

Student signature                                                                       .

Student signature                                                                       .

Student signature                                                                       .

Student signature                                                                       .

Student signature                                                                       .

Student signature                                                                       .

Date                                      .
                              RELEASE WAIVER FORMS
                        FOR ELLENSBURG HOMESCHOOL CO-OP

                                    MUST READ AND SIGN

I have read and concur with the Ellensburg Homeschool Co-op (EHC) guidelines, policies and
procedure and agree to abide by them.

I understand that the EHC serves solely as a support group and enrichment cooperative program
and is not responsible for the education of my children. I understand and agree that it is my
responsibility to be aware of, and in compliance with, the laws governing home educators in the
state of Washington.

I, the undersigned, acknowledge that participation in all activities involves risk of personal
injury. In consideration for being allowed participation in the EHC, I hereby release, discharge,
and hold harmless EHC and Calvary Ellensburg Church, its representatives, teachers, volunteers
and members from any claims arising out of, or relating to, physical or other injury that may
result while participating in EHC events.

 I understand and except that CCE or EHC does not carry or maintain health, medical,
disability, damage or liability or other insurance coverage for the benefit of any person
involved in EHC.

I understand that CCE and EHC does not assume any responsibility or obligation to provide
financial assistance, including, but not limited to medical, health or disability, in the event of
injury, illness, death or property damage.



Father’s Signature                                                            .

Mother’s Signature                                                           .

Date                                      .
                   Ellensburg Homeschool Co-op Volunteer Application
The following questions are designated to help us get to know you better. All those who work with or around
children are required to turn in this application before we can place them in a position.

The attached form is requesting information of a personal nature. The purpose for this information being
provided, is to ensure safety and accountability among our children and volunteers. It is not meant to offend or
cause any doubts about your ability to contribute to EHC.

We want to encourage you that all information is kept confidential and in a secure locked area. If you are
uncomfortable with, or have questions regarding the information requested, please feel free to speak with the
administration, so we can address any questions you may have, on an individual basis.

We are looking forward to working with you and your family.
PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION                                           Today’s Date

                                                                                     ____________________
Personal Data
Legal Name: Mr./Mrs./Ms. (Circle one)

_________________________________________________________________________________________
              Last                  First                 Middle               Nickname

Mailing Address: _______________________________________________________________________
                               Number                       Street                Apt #
                                ______________________________________________________________________________________
                                City                         State                               Zip
Previous Address:
_____________________________________________________________________________________________
                      Number                      Street                               Apt #
____________________________________________________________________________________________
                      City                        State                                Zip

Name Changed in last 5 years?__________________________________________________

Have you lived out of state in the last 10 years? Yes ‫ ٱ‬No
  If yes, what year and which state? ____________________________

Date of Birth ____________ Age_______ Marital Status ______________Spouse’s Name __________ _________

Driver’s License # ____________________________________ Social Security # _________________________



Do you use illegal drugs                                          Yes                                  No   
Have you ever molested or physically abused a minor?              Yes                                  No   
Have you ever been arrested?                                      Yes                                  No   
Have you ever been convicted/adjudicated?                         Yes                                  No   
Have you ever pleaded guilty to a felony?                         Yes                                  No   
Would you mind being finger printed?                              Yes                                  No   
Would you mind being photographed?                                Yes                                  No   
Do you have any communicable diseases?                            Yes                                  No   

     If you answered yes to any of these questions, please explain. ____________________________________________________________
      ____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________
Please provide two non-family personal/professional references who know you well:

Name ________________________ Address: _____________________________ Phone:____________________


Name ________________________ Address: ______________________________Phone:____________________


In the event of an emergency contact

_______________________________________________________________________________                     Name
              Relationship          (area code) Phone #

Please read   before signing:

I understand that:
        The information given in this application is correct to the best of my knowledge. I authorize any
           references listed in this application to give you any information that they may have regarding my
           character and fitness for contributing to EHC. In       consideration of the receipt and evaluation of
           this application by EHC. I hereby release any individual, church, charity, employer, reference, or
           any other person or organization, including record custodians, both collectively and Individually,
           from any and all liability for damages of whatever kind or nature that may at any time result to me,
           my heirs, or family, because of compliance or any attempts to comply, with this authorization. I
           waive my right that I may have to inspect any information provided about me by any person or
           organization identified by me in this application.

        In the course of volunteering for EHS, I may be dealing with confidential information and I agree to
            keep said information in the strictest confidence.

        The relationship between EHC and volunteers is an “at will” arrangement, and it may be terminated at
           any time without cause by either the volunteer or EHC .
I affirm that I have read the above and that the information I have given is true and complete.


Signature ___________________________________________________________ Date_______________
                       CLASS REGISTRATION

I would like to sign my child/ren up for the following class/es:

Child’s name                    Class               Teacher        Time

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

__________________ ______________ ____________ _______ ___________

				
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