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Coda Engage Application
Coda Engage will be offering music, permaculture & gardening, Lego robotics & coding Tuesday and Thursday for 5-8th grade students and Wednesday for 3-4th grade students. The summer semester will begin August 5th, 2020 and end August 27th, 2020, 9am-3pm. Children MUST arrive at the designated drop-off time below. Lunch will be provided. Parents/Guardians should arrive at 2:55pm for dismissal. To best serve you and your child and follow COVID-19 social distancing restrictions, we are currently operating on a 25 student maximum enrollment for each day of class. Students and staff will have their temperature taken. Once registration reaches the maximum, classes will be unavailable. In the event that a student no longer wishes to participate and there is a vacancy, registration will re-open for that class.
Schedule
~ CHECK IN (8:45)-------------------------------------------------------------------------------------------------~ MORNING (9am-11am) - Language Arts & Math activities------------------------------------------- ~ LUNCH (11am) --------------------------------------------------------------------------------------------------- ~ AFTERNOON (noon-3pm) - Music, Coding & Lego Robotics,Arts & Crafts, Permaculture----~ PICK-UP (2:55pm)
Student Name
*
First Name
Last Name
School
*
FPK8
OHMS
Other
Grade
*
3rd
4th
5th
6th
7th
8th
My Child will be attending:
*
Tuesday and Thursday: 5-8th Grade Only
Wednesday: 3rd-4th Grade Only
(3rd/4th Grade) My Child Is Interested In: Please Select THREE
*
Recreation/Hammock Reading (9 seats left)
Drums (2 seats left)
Robotics (3 seats left)
(FULL) Arts & Crafts (0 seats left)
(FULL) Strings (0 seats left)
Gardening (6 seats left) ( counts as 2nd and 3rd Elective-2 hour class)
MY CHILD IS NOT IN 3rd/4th GRADE
(5th-8th Grade) My Child Is Interested In: Please Select THREE
*
Recreation/Hammock Reading (6 seats left)
Drums (2 seats left)
(FULL) Robotics (0 seats left)
Bluegrass Music (2 seats left)
Strings (2 seats left)
Gardening (1 seats left) ( counts as 2nd and 3rd Elective-2 hour class)
MY CHILD IS NOT IN 5th-8th GRADE
Strings Course Only
Instrument:
Violin
Viola
Cello
Bass
Does your child have experience playing this instrument?
Yes
No
Explain experience in a few sentences
Do you own this instrument?
Yes
No
Parent/Guardian 1 Name
*
First Name
Last Name
Parent/Guardian 1 Phone Number
*
-
Area Code
Phone Number
Does this number receive text message?
Yes
No
Parent/Guardian 2 Name
First Name
Last Name
Parent/Guardian 2 Phone Number
-
Area Code
Phone Number
Does this number receive text message?
Yes
No
I have multiple children attending this day
*
Yes
No
Student 2
First Name
Last Name
School
FPK8
OHMS
Other
Grade
3rd
4th
5th
6th
7th
8th
My Child will be attending:
Tuesday and Thursday: 5-8th Grade Only
Wednesday: 3rd-4th Grade Only
(3rd/4th Grade) My Child Is Interested In: Please Select THREE
*
Recreation/Hammock Reading (13 seats left)
Drums (6 seats left)
Robotics (16 seats left)
Arts & Crafts (5 seats left)
Strings (5 seats left)
Gardening (10 seats left) ( counts as 2nd and 3rd Elective-2 hour class)
MY CHILD IS NOT IN 3rd/4th GRADE
(5th-8th Grade) My Child Is Interested In: Please Select THREE
*
Recreation/Hammock Reading (13 seats left)
Drums (6 seats left)
Robotics (16 seats left)
Bluegrass Music (5 seats left)
Strings (5 seats left)
Gardening (10 seats left) ( counts as 2nd and 3rd Elective-2 hour class)
Strings Course Only
Instrument:
Violin
Viola
Cello
Bass
Does your child have experience playing this instrument?
Yes
No
Explain experience in a few sentences
Do you own this instrument?
Yes
No
Student 3
First Name
Last Name
School
FPK8
OHMS
Other
Grade
3rd
4th
5th
6th
7th
8th
My Child will be attending:
Tuesday and Thursday: 5-8th Grade Only
Wednesday: 3rd-4th Grade Only
(3rd/4th Grade) My Child Is Interested In: Please Select THREE
*
Recreation/Hammock Reading (13 seats left)
Drums (6 seats left)
Robotics (16 seats left)
Arts & Crafts (5 seats left)
Strings (5 seats left)
Gardening (10 seats left) ( counts as 2nd and 3rd Elective-2 hour class)
MY CHILD IS NOT IN 3rd/4th GRADE
(5th-8th Grade) My Child Is Interested In: Please Select THREE
*
Recreation/Hammock Reading (13 seats left)
Drums (6 seats left)
Robotics (16 seats left)
Bluegrass Music (5 seats left)
Strings (5 seats left)
Gardening (10 seats left) ( counts as 2nd and 3rd Elective-2 hour class)
Strings Course Only
Instrument:
Violin
Viola
Cello
Bass
Does your child have experience playing this instrument?
Yes
No
Explain experience in a few sentences
Do you own this instrument?
Yes
No
Attendance Policy: Due to limited space and high demand for admission, we are paying special attention to attendance. We are asking that all parents/guardians notify us within the following 3 days of their child's absence if their child plans to continue the program.If the student is absent for one week of classes without notification by parent/guardian within the 3 day grace period, their reserved spot in the program will be withdrawn, allowing another student to register.
*
I understand the attendance policy and will contact a Coda Mountain Academy staff member (Perri Kiser or Azaleah Davis) by note, text, email or phone call in the event that my child/s is absent for a week of class within 3 days following their absence. I understand that failure to do so will result in my child's reserved admission to be withdrawn, allowing another student to register
Signature
*
Loaned Instrument Policy
Our instrument distribution system is designed to meet the needs of students within Coda Mountain Academy. At the beginning of each semester, a labeled instrument will be loaned to the student (should they need to borrow an instrument) and a record will be made to identify which instrument goes to each child. While it is free to be loaned an instrument during the semester, it is required that the instrument be well cared for and returned at the end of each semester in the same condition it was loaned. Failure to properly take care of the Coda loaned instrument and return it at the end of the semester, unless explained and agreed upon by Coda administration otherwise, will result in a fine equivalent to the cost of the loaned instrument or the cost of repairs.
*
I have read and agree to the above stated policy
Signature
*
Back
Next
Liability Waiver: I acknowledge that this program is an outdoor event and that my child is at risk of allergic reaction, injury, sun burn, heat exhaustion, dehydration and even the contraction of illnesses. The overall health and well being of my child/children is my responsibility. I am aware that my child will be exposed to others including but not limited to Coda staff, students, interns, teachers and volunteers. In the chance that my child is exposed to COVID-19 or any other contagious disease, there is a risk of illness, permanent disability, and even death. In the event that any issue listed above were to occur, I agree to not sue nor seek any legal action, neither would Coda Mountain Academy, supervisors, staff, volunteers, interns, nor teachers will be held accountable.
*
I understand and acknowledge the liability waiver written above and that Coda Mountain Academy nor any supervisor, staff, volunteer, intern nor teacher will be held accountable for the risk of exposure to COVID-19 or any other liabilities.
Signature
*
Back
Next
Photo Waiver: Understanding that Coda photos and videos are important to promote public awareness, access future scholarship funding and reach more youth, I hereby consent for my child (or myself if 18 or older) to be photographed and/or videoed for Coda Mountain Academy. The resulting photographs or videos may be subsequently used without compensation to me by Coda Mountain Academy, or third parties for publications (including web sites,) advertising, facebook and/or publicity purposes at the discretion of Coda Mountain Academy. Some photos and videos will be used in the year end grant report. I waive the right to inspect or approve the finished photograph, video and/or publication use.
*
I, parent or guardian, consent to the above stated photo/video waiver for Coda.
I, parent or guardian, DO NOT consent to the above stated photo/video waiver for Coda.
Allergies/Prescription Medications?
Yes
No
If yes, Please List them Here
Emergency Contact 1
*
First Name
Last Name
Relationship to the Student
*
Emergency Contact 1 Phone Number
*
-
Area Code
Phone Number
Questions, Comments, or Concerns
For additional questions or comments, please call us at our Coda Hotline 304-900-0096 or contact us online at www.codamountain.com or on our Facebook page
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