FPK8 (3rd-4th) Inspire

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

Liability Waiver: 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.

Student Attendance *

I understand that any student missing more than two classes without a valid reason and a written parent or doctor excuse may be excused from the program.

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.

Food Allergies *

Drug Allergies *

Any medical problems and/or medications that we should be aware of: *

Emergency Contact Person- this is who we will contact if we cannot reach Parent/Guardian 1 or Parent/Guardian 2 *

Emergency Contact Phone Number *

Please enter a valid phone number.

Relationship to student *

Release Form *

I, the undersigned, am the parent or legal guardian of this minor and have given my consent for him/her to participate in activities hosted by Coda Mountain Academy. In the event of injury, accident, illness or other emergency while participating in the after-school program, I consent to any reasonable medical treatment as deemed necessary by a licensed physician, emergency medical technicians, nurses, and laboratory technicians. In the event any treatment is required, which a physician and/or hospital personnel refuses to administer without my consent, I hereby authorize Esther Morey, Robert Morey, Claire McGrew, Jessica Moneypenny, Eric Snuffer or an associated adult supervisor to give such consent for me, if I cannot be reached by telephone at one of the numbers listed above, or because of an emergency in which there is no time or opportunity to make a telephone call. In the event it becomes necessary for that person to give consent for me, I agree to hold such person, other associated adults and Coda Mountain Academy free and harmless of claims, demands, or suits for damages which may arise from the giving of such consent. I also acknowledge that I accept to be ultimately responsible for the cost of any medical care whether or not the cost of that medical care will be reimbursed by my health insurance provider. I further authorize disclosure of medical information by a treating physician to Esther Morey, Robert Morey, Claire McGrew, Jessica Moneypenny, Eric Snuffer or associated adult supervisor as permitted by The Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Signature

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EXCEL Registration

Bus Announcement

Terms & Policies

Medical Release