Youth Enrichment Registration Request Form

Parent or guardian information *

	Name	Home phone	Work phone	Cell phone	Email
Parent or guardian 1
Parent or guardian 2

Youth Course Selection

After completing this page, continue by clicking "Next" below.
Please select the course(s) for which you would like to register.

Exploring Spanish

Remote, Online, Offsite Attestation:

I am the student, or the legal guardian of the student identified above in this form.

I understand that SUNY requires offsite and online students to attest that they understand the vaccine requirement for participation in on-campus courses and activities. I am registered for an offsite, online or remote course and, as such, am exempt from the on-campus vaccine requirement and I attest that I will not have an on-campus presence in classes or events in the Spring 2022 semester.

I also understand that if I register for an on-campus course, I must submit proof of COVID-19 vaccination (and booster, if eligible) and receive confirmation of the validation of my vaccine information via email, prior to my arrival for an on-campus course. SUNY Adirondack requires the use of face coverings indoors for all individuals, regardless of vaccination status.
I have read and understand the attestation above. *

Yes, I have read and understand the above information. By clicking Yes here, I am confirming my attestation.

Medical Release Form

After completing this page, continue by clicking "Next" below.

If parents are not available in an emergency, notify: *

	Name	Relationship to student	Home phone	Other phone
Emergency contact 1
Emergency contact 2

Please specify any and all of the following (if applicable):
Operations or serious injuries (include dates):
Medical condition(s):
Allergies (including food, medication, insect stings, etc.):
Special diet:
Activity restrictions:
Medication (name) and how it is given:
MEDICAL RELEASE AUTHORIZATION: The above named child has permission to engage in all prescribed SUNY Adirondack Youth Enrichment activities, except those noted above. By typing my name below, I certify that I am the legal parent and/or have the legal ability to sign this authorization form on behalf of the above named child. In the event of illness or accident, I hereby authorize and consent to the administration of all medical and/or surgical treatment(s) to my child by a licensed physician or hospital in the event I am not able to consult with the attending physician(s), attempts to contact me have been unsuccessful, and the attending physician(s) deem it advisable to proceed with such treatment(s). *

Media Release Form

After completing this page, continue by clicking "Next" below.
A: MEDIA RELEASE: Student has permission for SUNY Adirondack to photograph or videotape student for publications, media use, and instructional purposes during this class. *

Yes No
B. COMPUTER/INTERNET USAGE: Some programs require computer and Internet use. If applicable, my child has permission to do so in a supervised environment and will abide by the guidelines below. *

Yes No
GUIDELINES:
1. All students must have permission from their parent/guardian that authorizes them access to the Internet.
2. Respect for school equipment and its network is a condition for use of the computers.
3. Students are to notify the teacher immediately of any disturbing material they may encounter on the internet.
4. Students are not to give out personal information like telephone numbers, full name, address, etc. to anyone on the Internet.
5. Students are to never give anyone their password to any of their accounts or allow another student to use their account to access the Internet or school network.
6. Students must gain clearance from the teacher before downloading any programs from the Internet.
7. The teacher must first scan all media devices brought to the lab to be used in the computers for viruses.
8. Violation of any of these rules may result in forfeiture of permission to use the Internet and school network and/or appropriate disciplinary action.

Submit Your Registration Request

PAGE 5 OF 5: Click the "Submit" button to complete your registration request.
IMPORTANT - Please read the following, then click the "Submit" button below to submit your registration request. Contact the Office of Continuing Education at 518-743-2238 or conted@sunyacc.edu with any questions.
- The information submitted in this form will be used by Continuing Education staff to register the individual listed on this form for the course(s) specified.
- Once you have been officially signed up for the class in the College’s registration system, Continuing Education staff will send you a confirmation by email or phone, as well as send a hard copy of the confirmation and bill to your mailing address.
- If a course is full and unable to take additional registrations , or if we need to clarify additional details to finalize your registration, we will contact you by phone and/or email as soon as possible.
- Please note that you will be automatically billed via mail for the course(s) once your registration has occurred. Details on our refund/bill adjustment policy and how to pay course fees are available at: https://www.sunyacc.edu/continuing-ed/registration
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Youth Course Selection