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  • www.vpac2020.org

    www.vpac2020.org

    ​720.620.2316
  • Registration Materials

    IF YOU ARE REGISTERING FOR VPAC PROGRAMMING, YOU ONLY NEED TO COMPLETE THIS FORM. IF YOU ARE REGISTERING TO ATTEND SCHOOL WITH VPAC YOU MUST PROVIDE: 1. Proof of Residency: Phone, utility or water bill, or lease agreement. 2.Proof of Age: Religious, hospital, or physician’s certificates; adoption record; parent affidavit; birth certificate; previously verified school records. 3. Prior transcripts/records
  • VPAC is an independent school system of educational institutions across the country that are dedicated to creating the system needed for education that liberates. This registration is applicable to all VPAC schools and will be housed and protected with the school leader you are enrolling with as well in the master VPAC enrollment file. If your student is attending a non-VPAC school (any school that is not named VPAC), the role of VPAC to your school is that we are responsible for the executive administrative support system that provides everything EXCEPT financial and budgeting responsibilities. However, we are advocates and provide helpful supportive resources for financices and budgeting. All of the language referring to VPAC in this registration for enrollment form, is inclusive of your school. 

  • www.vpac2020.org

    www.vpac2020.org

    ​720.620.2316
  • STUDENT REGISTRATION FORM

  • General Student Information

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  • Race and Ethnicity

  • What is the student’s ethnicity?

  • What is the student’s race? (check all that apply)

  • EDUCATION

  • Parent/Guardian Information

  • FAMILY INFORMATION


  • Is this person an emergency contact? ☐ Yes

    Active member of the Armed Forces or on full-time National Guard duty? {yes}{no}

  • Parent/Legal Guardian #2


  • Has this student ever received formal English Language instruction through a class specifically for English Language Learners (such as ELD, ESL, etc)?                {yes} {no}

     

  • SPECIAL NEEDS QUESTIONNAIRE

  • If your child is enrolled in this unschool program and has special needs, we will follow your desire in how to execute. We believe that families know what is best and will then meet with you to review the IEP and execute how you lead. VPAC is an independent unschool model that strongly believes in the right for parents to determine how their students learn. You agree that you are solely responsible for your child's educational experience and VPAC is not responsible for your child, rather a supporter of how you want your child to learn. The information that I have given above is correct to the best of my knowledge. 

  • ATHLETIC CONSENT FORM

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  • The undersigned has read and understands the material contained in this form and hereby authorizes the student named above to participate in physical education and extra-curricular sporting activities including, but not limited to recreational sports (basketball, football, etc.), gymnastics, tumbling, dancing, etc. while enrolled in VPAC.

    By the very nature, athletic activities can put students in situations in which serious, catastrophic and perhaps fatal injuries may occur. These injuries could include, but are not limited to the following:

    ❒Sprains/strains

    ❒Head injuries

    ❒Unconsciousness

    ❒Disfigurement

    ❒Cuts/abrasions

    ❒Paralysis

    ❒Fractures

    ❒Loss of eyesight

    ❒Death

    Students and parents must assess the risks involved in such participation and make their choice to participate inspite of those risks. No amount of instruction, precaution or supervision will eliminate all risk of injury. Although the school may suggest or recommend the use of certain equipment, the school does not guarantee that such equipment will be free from defects or protect the student from injury. By granting permission for your student to participate in athletic activities, you, the parent/legal guardian, acknowledge that such risk exists and assume these risks. Participation by your child is voluntary and is not required by the school. The undersigned has read and hereby agrees to hold​VICTORY PROJECT-BASED ACADEMICS & CAREER, its employees, agents, volunteers and/or sponsors and anyother person, firm or corporation charged or chargeable with responsibility or liability,free and harmless from any and all claims, demands, damages, costs, expenses, loss of services, action and causes of action resulting from the use of facilities, equipment and participation by my student in the above named athletic activity, to the fullest extent of the law.

  • Clear
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  • Parent/Guardian Printed Name Parent/Guardian Signature

  • STUDENT MEDIA RELEASE

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  • Clear
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  • PASSENGER BEING DRIVEN PERMISSION SLIP

  • VPAC students may leave the premises of program located for a richer educational experience. Students may be driven by the transportation service, car services, or staff. All drivers will pass background checks and meet the requirements set by the State of Colorado. To facilitate these drives, we ask you to sign a permission form for the school year that gives your child permission to participate in the drives to other locations.

    Students will ​always​ be accompanied by at least one VPAC staff member.

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  • STUDENT HEALTH RECORD

  • Does your child have any of the following serious medical conditions?

  • Does the student need to take medication at program? ​☐ Yes** ​☐​ No If “yes”, please complete the medication administration request form, attached to this page.

    Does the student wear a removable prosthetic device? If “yes”, where:

    Are there any additional health problems the school should be aware of? If “yes”, please describe:{pleaseMark}

    The information that I have given above is correct to the best of my knowledge. In addition, I understand that it is my responsibility to provide the school with a current version of the medication administration request form for each school year.

     

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  • MEDICATION ADMINISTRATION FORM

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  • Parental Consent

    If your child ​does​ require medication at school, please check “yes” in each box to give your consent.
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    If your child needs regular or occasional medication to be administered at school, please complete the steps in the checklist below and return medication administration request form to the school.

    1.Talk to your child’s doctor about making a medication schedule so that your child does not have to take medication while at school.

    2.If your child is regularly taking medication for an ongoing health problem, even if he/she only takes the medication at home, give a written note to the school’s First Aid Administrator at the beginning of each school year. You must list the medication being taken, the current amount taken, and the name of the doctor who prescribed it .

    3.If your child must take medication while at school, use the form provided to give permission from you and directions from your child’s doctor or other health care provider, who is licensed to practice in this state. Provide new, updated notes at the beginning of each school year and whenever there is any change in the medication, instructions or doctor.

    4.As a parent/guardian, you must supply the school with all medication you child must take during the school day. You or another adult must deliver the medication to school, except medication your child is authorized to carry and take by him or herself.

    5.All controlled medication, like Ritalin, must be counted and recorded on a medication log when delivered to the school. You or another adult who delivered the medication should verify the count by signing the log

    6. Each medication you child must be given at school must be in a separate container labeled by a pharmacist licensed in the United States. The container must list your child’s name, doctor’s name, name of the medication and instructions for when to take the medication and how much to take.

    7.Pick up all discounted, outdated, and/or unused medication before the end of the school year.

  • Parent/Guardian Printed Name

  • Parent/Guardian Signature

  • Clear
  • Date

  • STUDENT EMERGENCY INFORMATION AND RELEASE FORM

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  • STUDENT RELEASE

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  • EMERGENCY MEDICAL TREATMENT

    The undersigned as parent, as parent/legal guardian of the student indicated on this card, a minor, hereby authorizes the principal or designee in whose care the student has been entrusted, to consent to any X-ray examination, anesthetic, medical or surgical diagnosis, treatment and/or hospital care to be rendered to the student upon the advice of any licensed physician and/or dentist. It is understood that this authorization is given in advance if any required diagnosis, treatment, or hospital care and provides authority and power to​ VPAC, to give specific consent to any and all such diagnosis, treatment, or hospital care which a licensed physician or dentist may deem necessary. This authorization shall remain effective until revoked in writing and delivered to ​VPAC​, I understand that ​VPAC​ its officers, and its employees assume no liability of any nature in relation to the transportation of the student. I further understand that all costs of paramedic transportation, hospitalization, and any X-ray, or treatment provided in relation to this authorization shall be my sole responsibility as the student’s parent/guardian.
  • Insurance Name: Group ID: Doctor Name/ Medical Office: Phone:

  • I certify that I have read and understood this form and do hereby give my authorization for emergency medical treatment, and all information is true and correct.

     

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