2022-2023 Returning Family Form eXtend Homeschool

Please Note: The facility fee must be paid and completed family forms turned in (including student photo) no later than August 26th. Parent duty days must also be scheduled before August 26th. Students with these items outstanding will not be issued an extendhomeschool.com email address and will not be allowed to begin classes in the fall.
2022-2023 eXtend Homeschool Tutorial Returning Family Application

Fill out the form carefully for registration. If needed, a family interview may be conducted in conjunction with this application.
Part 1 - Family Information
Parent 1 Name *

First Name Last Name
Parent 1 Email: *
example@example.com
Parent 1 Cell/Text Number *
Parent 2 Name

First Name Last Name
Parent 2 Email:
example@example.com
Parent 2 Cell/Text Number
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Enrolled Students *
Part 2 - Homeschooling Questions

Please read and answer the following questions
The state of Maryland says that the parent is the “first and best” teacher, which means that you, the parent, need to be the instructor at home. Extend requires one parent (mom, dad, or legal guardian) to be the full-time educator. With whom will your child be working with on a daily basis to ensure classwork is completed?blanks
Homeschooling does allow some flexibility, however being part of a homeschool tutorial necessitates a commitment to attending classes on Tuesdays and Thursdays. Is your family able to commit to regular, timely attendance at eXtend Homeschool Tutorial? *

Yes No
Our tutors work hard to cover as much material as possible in each class session. Students who are absent due to family travel, medical appointments or homeschool reviews that could have been scheduled on Mondays, Wednesdays, or Fridays will not be able to fully participate in the complete eXtend Homeschool Tutorial experience. Grades may suffer due to missed instruction, presentation days or other classroom activities, as determined by each tutor, and students who miss several classes in a quarter can expect to be graded accordingly in those classes for which class participation is a large component. Please plan your appointments and family vacations around the eXtend Homeschool Tutorial academic calendar which can be found on the eXtend Homeschool website. Tutors are not expected to grade work or projects that are beyond their published late policy on their syllabus. Moreover, tutors will not grade work or projects submitted after the close of a quarter. Are you willing to commit to the entire eXtend Homeschool Tutorial academic calendar, except in cases of family emergencies? *

Yes No
Are you willing to obtain/borrow the course materials and class supplies each tutor requires, and are you willing and able to have these resources available for your student when needed and in the required format? *

Yes No
If true hardship arises (economic, academic or otherwise), are you prepared to notify your child(ren)’s tutors immediately so that the tutors can assist you as you work to fulfill your responsibility to educate your child(ren)? *

Yes No
Signature: I hereby agree that all the above information is complete, true, and correct to the best of my knowledge and belief. *

Clear
Part 3 - 2022-2023 Educational Responsibility and Commitment Agreement

(One entry per family. Please read and initial )
Signature*   I affirm that eXtend Homeschool Tutorial is a Christian homeschool tutorial designed to assist me in my homeschooling endeavors. eXtend Homeschool Tutorial is NOT an umbrella and does not provide oversight for my homeschooling. eXtend Homeschool Tutorial is not to be used as a Tuesday/Thursday drop-off babysitting service.

Signature*    I understand that to maintain compliance with COMAR 13A.10.01 (Maryland’s Homeschool Code), class days at eXtend Homeschool Tutorial are not the only educational/schooling time my child receives. I am responsible to ensure that the work assigned by the tutor to be done on non-class days is completed to the best of my child’s ability in a timely fashion. As such, I, or another adult, will work with my child on non-tutorial days. I recognize that I have the freedom to have my child complete work in a way I feel is best for my child’s academic needs, but for the sake of continuity between tutorial and home, any changes I decide to make will be clearly communicated to my child’s tutor.

Signature*   I understand that as my child’s primary educator and in order for my family to reap the full benefits of participating in eXtend Homeschool Tutorial, it is my responsibility, and in my child’s best interest, to ensure he or she comes to class each day with all required resources, school supplies and supplemental materials. To this end, I commit to obtaining all required curriculum, resources and supplies necessary for my child to actively participate in class prior to the start of classes.

Signature*   I understand that it is not eXtend Homeschool Tutorial’s responsibility to verify that the work is completed. I answer first to the Lord, and second to my county in the state of Maryland (or local jurisdiction), regarding the completion of regular and thorough instruction for my child pursuant to applicable state/jurisdiction laws. However, I also recognize that grades provided by tutors are a reflection of the work completed and submitted to the tutor in a timely manner. I further understand that tutors are under no obligation to accept or grade late work, and work submitted after the close of a quarter will not be graded by the tutor.

Signature*    I understand that while homeschooling allows for flexibility, being part of a homeschool tutorial necessitates a commitment to regularly attending classes on Tuesdays and Thursdays. I further understand that students who are absent due to vacationing, routine medical appointments or homeschool reviews that could have been scheduled on non-tutorial days may miss out on the complete eXtend Homeschool Tutorial experience and may see their grades suffer due to missing instruction, presentation days or other classroom activities as determined by each tutor. As such, I commit to considering the eXtend Homeschool Tutorial academic calendar, except in the case of family emergencies, and the need for my student’s full participation.

Signature*   If for any reason eXtend Homeschool Tutorial learns that I am using the services provided in ways other than intended, I agree that eXtend Homeschool Tutorial reserves the right to evaluate my continued participation in the tutorial. eXtend Homeschool Tutorial will use quarterly reports, homework, and test scores, as well as tutor and parent feedback as resources for this decision. I understand it is eXtend Homeschool Tutorial’s desire to support my homeschooling efforts, not replace them, as I ensure classroom and academic success for my child. Should there be any concern regarding my child’s progress, a meeting and/or test may be requested by the tutor, parent, and/or Leadership Team member to make sure my child is in the best educational environment for his/her needs. If my child receives a failing grade for two quarters, eXtend Homeschool Tutorial has the right to withdraw them from that class.

Signature*   Finally, eXtend Homeschool Tutorial is a cooperative tutorial, with all members working together to make the workload as light as possible for each of us individually. I understand that if I am not fulfilling my responsibilities as an active, participating family, this may impact my return the following year.
Signature: I have read and agree to the Educational Responsibility and Committment Form and submit this application by electronic means. By signing this application electronically, I certify under penalty of law that my answers are correct and complete to the best of my knowledge. I certify that I understand the questions and statements on this application and that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. *

Clear
Part 4 - 2022-2023 Liability Release Form

(One entry per family)
While participating in the tutoring services organized by eXtend Homeschool Tutorial and provided by independent tutors, whether online or at the main tutoring location of Mt. Oak Church and Judah Temple AME Zion Church or an off-site location for an official eXtend Homeschool Tutorial sponsored event, I agree for myself and for the members of my family to the following:

1. I agree to obey all posted rules and warnings and further agree to follow any oral instructions or directions given by eXtend Homeschool Tutorial or the Tutors associated therewith.

2. I recognize there may be certain inherent risks associated with the course activities, and I assume full responsibility for the personal injury to myself and any family members and further release and discharge eXtend Homeschool Tutorial, the independent Tutors, Mt. Oak Church, Mt. Oak Church Staff, Judah Temple AME Zion Church, and Judah Temple Staff for injury, loss or damage arising out of my or my family’s use of their services or presence upon the facilities, whether caused by fault of my own or that of my family, or other third parties.

3. I agree to indemnify, hold harmless and defend eXtend Homeschool Tutorial and the independent Tutors, Mt. Oak Church, Mt. Oak Church Staff, Judah Temple AME Zion Church, and Judah Temple Staff against all claims, causes of action, damages, judgments, costs or expenses, including attorneys’ fees and other ligation costs which may in any way arise from my or my family’s use of their services or presence upon the facility.

4. I agree to pay for all damages caused by me or my family’s negligent, reckless, or willful actions.

5. Any legal or equitable claim that may arise from participation with the eXtend Homeschool Tutorial shall be resolved in accordance with the laws of the State of Maryland.

I have read this document and understand it. I further understand that by signing this release, I voluntarily surrender certain legal rights.
Signature: I have read and agree to the Liability Release Form and submit this application by electronic means. By signing this application electronically, I certify under penalty of law that my answers are correct and complete to the best of my knowledge. I certify that I understand the questions and statements on this application and that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. *

Clear
Part 5 - 2022-2023 Parent Duty Agreement
Signature   I understand that Parent Duty is ESSENTIAL to the success of Extend Homeschool Tutorial, and I am committed to doing my part. To that end, I have/will, via SignUp.com, choose 10 parent duty days as service to Extend Homeschool Tutorial.

Signature     I understand that Parent Duty is a full-day commitment, beginning at 8:00 am and ending at 2:00 pm. I agree not to bring any outside work to be completed on this day understanding that my full attention and time will be focused on the activities of the days at Extend Homeschool Tutorial.

Signature   I understand that in the event of circumstances beyond my control that prevent me from serving my agreed-upon dates, I will find a suitable replacement OR will make a $75 payment to the parent that Extend recruited to step in to serve in my place. I understand that non-payment will go on my balance and my student's email address will be frozen and my child will not be allowed to attend classes.
Signature: I have read and agree to the Parent Duty Agreement and submit this application by electronic means. By signing this application electronically, I certify under penalty of law that my answers are correct and complete to the best of my knowledge. I certify that I understand the questions and statements on this application and that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. *

Clear
Part 6 - 2022-2023 Financial Agreement

(One entry per family)
We hereby agree to pay, on time, the tutors identified directly for their services and any associated fees at the prescribed amount established by the tutor and in accordance with the agreed payment schedule and in the format accepted by the tutor.

We understand that non-payment of one tutor constitutes non-payment of all tutors resulting in suspension of all eXtend Homeschool Google Accounts in my family until all eXtend Tutors are paid according to the payment schedule. All students in my family will also not be allowed to attend classes until all Tutors are paid.

Furthermore, it is recognized that if our student(s) withdraws from the class(es) at any time or for any reason, between the payment periods of April through November, we the parents agree to fully compensate the tutor for their services according to the eXtend Homeschool Withdrawal Policy.

Withdrawal Policy

Pay In Full Option
- A family that pays in full and withdraws their student anytime between June 10th and the end of the program year, will not be refunded any Extend Homeschool payments, tutor deposit, tutor materials fee, or any tutor class payments.
Two-Installment Payment Option
- A family that chooses the two-installment payment, and withdraws their student anytime after June 10th and before the academic year begins, will not be refunded any Extend Homeschool program payments, tutor deposit, tutor materials fee, and the June 10th payment.
- A family that chooses the two-installment payment and withdraws their student anytime between the first day of classes and the December 10th payment, will not be refunded any Extend Homeschool program payments, tutor deposit, tutor materials fee, and no further money is owed to the tutor.
Three-Installment Payment Option
- A family that chooses the three-installment payment and withdraws their student anytime after June 10th and before the academic year begins, will not be refunded any Extend Homeschool program payments, tutor deposit, tutor materials fee, and the June 10th payment.
- A family that chooses the three-installment payment and withdraws their student anytime between the first day of classes and the December 10th payment, will not be refunded any Extend Homeschool program payments, tutor deposit, tutor materials fee AND will owe a withdrawal fee of $35 to be paid to the tutor.
- A family that chooses the three-installment payment and withdraws their student after the December 10th payment, will not be refunded any Extend Homeschool program payments, tutor deposit, tutor materials fee
Signature: I have read and agree to the Financial Agreement Form and submit this application by electronic means. By signing this application electronically, I certify under penalty of law that my answers are correct and complete to the best of my knowledge. I certify that I understand the questions and statements on this application and that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. *

Clear
Part 7 - 2022-2023 PHOTO/VIDEO and CONTACT RELEASE AGREEMENT

(one form per family)
I hereby grant eXtend Homeschool Tutorial, Mt. Oak Fellowship Church (Mt. Oak), and Judah Temple AME Zion Church (Judah Temple) the right to photograph/video myself and or members of my family and use the photo/video and or other digital reproduction for publication processes, whether electronic, print, digital, or electronic publishing via the eXtend Homeschool Tutorial, Judah Temple and/or Mt. Oak websites and/or eXtend Homeschool Tutorial, Judah Temple, and/or Mt. Oak Facebook pages to further the purposes of eXtend Homeschool Tutorial, Judah Temple, and/or Mt. Oak, without payment or other considerations being provided to me or my family in return. Materials contained on the eXtend Homeschool Tutorial website are subject to U.S. copyright law: Title 17, USC.) No child will be identified or “tagged” in any images used on the eXtend Homeschool Tutorial website or social media page. Tutors may record virtual classes for educational purposes and those recordings may be uploaded to their class websites. Access to these websites are restricted to the specific tutor, administration, students and parents enrolled in that specific class. By signing this release, you are authorizing these recordings and subsequent publishing for educational purposes. Photos will also be used in the creation of Photo Identification Cards issued by eXtend Homeschool Tutorial for use at the tutorial. The student’s name will be on the card, but no other identifying information (i.e. address or phone number) will accompany the images on the ID cards. eXtend Homeschool Tutorial is granted permission to use my family’s contact information (address, phone number and email) to create a Family Contact Directory which will be available to other eXtend Homeschool Tutorial families. I understand and agree that this directory will not be used for any solicitation purposes whatsoever. * *

Yes No
Signature: I have read and agree to the Photo/Video Release Form and submit this application by electronic means. By signing this application electronically, I certify under penalty of law that my answers are correct and complete to the best of my knowledge. I certify that I understand the questions and statements on this application and that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. *

Clear
Part 8 - 2022-2023 MEDICAL RELEASE FORM

(one form per family)
This form must be signed by a parent and returned to the eXtend Homeschool Tutorial Leadership Team since you intend to leave your child at Mt. Oak Fellowship Church (Mt. Oak) or Judah Temple AME Zion Church (Judah Temple) during eXtend Homeschool Tutorial class times without their parents present at all times. Although we desire to keep this information confidential, a copy of this completed form will be accessible to the Leadership Team each time the students meet for eXtend Homeschool Tutorial classes and medical concerns will be shared with your student’s tutors as deemed necessary. In case of an emergency, the Leadership Team may need to use the help of Mt. Oak staff, Judah Temple staff, eXtend Homeschool Tutorial Tutors, Designated Parent, and Emergency Medical Personnel, and may see it fit to share this form at that time. It is imperative that we have all the information essential to caring for your child in the event that it becomes medically necessary.

PERMISSION

I give my permission for my child to participate in academic and extracurricular activities at eXtend Homeschool Tutorial. In case of an emergency, I authorize any medical treatment and the use of this form by medical personnel in my absence for the well-being of my child. In accordance with eXtend Homeschool Tutorial ’s Liability Release Form, I agree not to hold liable eXtend Homeschool Tutorial, Judah Temple, Mt. Oak Church and its representatives, eXtend Homeschool Tutorial tutors and all parent volunteers treating my son/daughter from any injury or sickness occurring during the activities associated with the eXtend Homeschool Tutorial program whether at the Mt. Oak facility, Judah Temple, or on a parent-approved outing.
Student(s) Medical Information (Please create one row for each child) *
Signature: I have read and agree to the Medical Release Form and submit this application by electronic means. By signing this application electronically, I certify under penalty of law that my answers are correct and complete to the best of my knowledge. I certify that I understand the questions and statements on this application and that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. *

Clear
Part 9 - ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. eXtend Homeschool Tutorial has put in place preventative measures to reduce the spread of COVID-19; however, eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple cannot guarantee that you and/or your child will not become infected with COVID-19. Further, participation in activities held by or associated with eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple could increase your or your child’s risk of contracting COVID-19. READ CAREFULLY BEFORE SIGNING – INITIAL EACH PARAGRAPH
Signature   INITIALS By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I and/or my child may be exposed to or infected by COVID- 19 by participation in events held by or associated with eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church; and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church employees, volunteers, and program participants and their families.

  Signature   INITIALS I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself and/or to my child (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my participation in events held by or associated with eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church (“Claims”). On my behalf and/or that of my child, I hereby release, covenant not to sue, discharge, and hold harmless eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church, its employees, volunteers, contract workers, agents, and representatives (“Releasees”), of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church, its employees, volunteers, contract workers, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation held by or associated with eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church.

Signature   INITIALS I represent that I have adequate insurance to cover any injury or illness I and/or my child may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or illness myself. I further represent that I and/or my child have no medical or physical condition which could interfere with the safe participation in this activity, and I am willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition.

Signature   INITIALS Any legal proceeding that is brought to interpret or enforce the rights and obligations covered by this agreement will be brought in the State of Maryland, Prince George’s County, and governed by the laws of the State of Maryland. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

Signature   INITIALS I agree that my child will not attend in-person classes with eXtend Homeschool Tutorial at Mt. Oak United Methodist or Judah Temple AME Zion Church if I or a caregiver identify new developments of any of the following symptoms: temperature of 100.4 degrees Fahrenheit or higher, sore throat cough (for students with chronic cough due to allergies or asthma, a change in their cough from baseline), difficulty breathing ( for a student with asthma, a change from their baseline breathing), diarrhea or vomiting, new onset of severe headache, especially with a fever.

Signature    INITIALS If I have signed a separate general waiver of liability connected to my participation in events held by or associated with eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple, I agree that the terms of that waiver are wholly incorporated into this document and that the terms of this document are incorporated into the separate general waiver.

Signature   INITIALS I agree that I comply with all health and safety rules and guidelines imposed by eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church or by any state, local, or federal governmental entity, and will practice safe social distancing, when possible, and clean hygiene during my participation at events held by or associated with eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church or while on all eXtend Homeschool, Mt. Oak United Methodist Church, and Judah Temple AME Zion Church campus.
Signature: I read and agree to the Assumption of the Risk and Waiver of Liability Relating to Coronavirus/Covid-19 Release and submit this form by electronic means. By signing this application electronically, I certify under penalty of law that my answers are correct and complete to the best of my knowledge. I certify that I understand the questions and statements on this application and that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. *

Clear
Part 10 - 2022-2023 STUDENT PHOTO UPLOAD

Please upload a photo of your student to be used for a program student photo ID card and 2021-2022 eXtend Homeschool Yearbook. Please submit one picture per child.
File Upload - Student #1 *

Cancel of
Configurable list *
File Upload - Student #2

Cancel of
Configurable list
File Upload - Student #3

Cancel of
Configurable list
File Upload - Student #4

Cancel of
Configurable list
File Upload - Student #5

Cancel of
Configurable list
File Upload - Student #6

Cancel of
Configurable list
Should be Empty:

2022-2023 eXtend Homeschool Tutorial Returning Family Application

Part 1 - Family Information

Part 2 - Homeschooling Questions

Part 3 - 2022-2023 Educational Responsibility and Commitment Agreement

Part 4 - 2022-2023 Liability Release Form

Part 5 - 2022-2023 Parent Duty Agreement

Part 6 - 2022-2023 Financial Agreement

Part 7 - 2022-2023 PHOTO/VIDEO and CONTACT RELEASE AGREEMENT

Part 8 - 2022-2023 MEDICAL RELEASE FORM

Part 9 - ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19

Part 10 - 2022-2023 STUDENT PHOTO UPLOAD