Ukulele Lessons with Halle Kerr Fall 2023

Student Information
Student's Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Student's Age*
As of Sept. 1, 2023
How many years has this student been homeschooling?*
Has this student been asked to leave any school or homeschool program due to disciplinary/behavior issues?*

YesNo
If so, please explain:
If your child has a known issue (learning, behavior, etc.) that you believe could potentially impact their experience in class, it would be helpful to know that in advance in order for Mrs. Kerr to proactively plan for ways to help set your child up for the best chance of success. Please indicate anything you wish to share in the space below.
Is your child currently participating in Wellspring Homeschool's co-op program?*

YesNo
Do you have other students to register?*

YesNo

Student Two Information
Student's Name

First NameLast Name
Student's Date of Birth

MonthDayYear
Student's Age
As of Sept. 1, 2023
How many years has this student been homeschooling?
Has this student been asked to leave any school or homeschool program due to disciplinary/behavior issues?

YesNo
If so, please explain:
If your child has a known issue (learning, behavior, etc.) that you believe could potentially impact their experience in class, it would be helpful to know that in advance in order for Mrs. Kerr to proactively plan for ways to help set your child up for the best chance of success. Please indicate anything you wish to share in the space below.
Is your child currently participating in Wellspring Homeschool's co-op program?*

YesNo
Do you have other students to register?

YesNo

Student Three Information
Student's Name

First NameLast Name
Student's Date of Birth

MonthDayYear
Student's Age
As of Sept. 1, 2023
How many years has this student been homeschooling?
Has this student been asked to leave any school or homeschool program due to disciplinary/behavior issues?

YesNo
If so, please explain:
If your child has a known issue (learning, behavior, etc.) that you believe could potentially impact their experience in class, it would be helpful to know that in advance in order for Mrs. Kerr to proactively plan for ways to help set your child up for the best chance of success. Please indicate anything you wish to share in the space below.
Is your child currently participating in Wellspring Homeschool's co-op program?*

YesNo
Do you have other students to register?

YesNo

Student Four Information
Student's Name

First NameLast Name
Student's Date of Birth

MonthDayYear
Student's Age
As of Sept. 1, 2023
Has this student been asked to leave any school or homeschool program due to disciplinary/behavior issues?

YesNo
If so, please explain:
If your child has a known issue (learning, behavior, etc.) that you believe could potentially impact their experience in class, it would be helpful to know that in advance in order for Mrs. Kerr to proactively plan for ways to help set your child up for the best chance of success. Please indicate anything you wish to share in the space below.
Is your child currently participating in Wellspring Homeschool's co-op program?*

YesNo

Media Release: I grant/deny permission to Wellspring Homeschool Community to use the image(s) of my child(ren) as marked by my selection below. Such use includes the display, distribution, publication, transmission, or other use of photographs, images, and/or video taken of my child(ren) for use in materials that include, but may not be limited to printed materials such as yearbooks and newsletters, videos, and digital images such as those on the Wellspring Homeschool Community website and in slide show presentations. I understand that my child's name will not be used in conjunction with any video or digital image.*

Grant permission to use my child's imageDeny permission to use my child's image

First United Methodist Church of Richmond, Inc. and Wellspring Homeschool Community, Inc. User Agreement, Release, and Waiver of Liability
Please use the following steps to complete the user agreement/release/waiver of liability.

1. Click on the highlighted text below for "MMC Waiver" and complete the form, which will open up in a separate tab.

2. After you complete and submit the MMC Waiver, you will see a Thank You message indicating that your form successfully went through.

3. Come back to the Ukulele Class registration form and check the box stating that you have filled out the MMC Waiver.

4. Pick up where you left off and complete the remainder of the Ukulele Class registration.

Class Meeting Time Preference

Every effort will be made to accommodate your first choice, but we cannot guarantee your class time preference will be available.
Please indicate your preferred class time for your student(s) below.

6:30-7:157:15-8:00

The Ukulele Class will be using the Band app to keep parents/guardians informed of important information, updates, and other details which need to be communicated. You will receive an invitation to join the group by the registration deadline (Sept. 6th). Will you join the Band group and check it regularly for notifications regarding class information?*

Yes

Ukulele Class Payment

Current Wellspring Homeschool Co-op Members are $90 per student; Area Homeschoolers are $130 per student
*Please note that it is the student's responsibility to purchase their own soprano ukulele and tuner before the first class meeting.
Calculation
Total Class Fees Due*

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Ukulele Lessons with Halle Kerr