School Registration Form

Your child will be able to start once:

1. This form is completed and signed.

2. They have been approved as eligable to participate in the program.

3. You have attended a virtual orientation (will be added to to text Remind Group to receive Zoom Link)

-TRAC will notify parents off application approval and student's start date.
-Parents must attend a virtual or onsite orientation prior to start.

- Students are expected to wear their face covering during program (we will have masks on hand).
- Students not adhering to staff instructions in regards to safety and/or behavior will be DISSMED from the program immediately.
Student

First NameLast Name
Student Information
Student Grade
Birth Date

MonthDayYear
Gender
School
Student Allergies
Photo Of Student
Parent Information
Parent Name

First NameLast Name
Email Address
Cell Phone Number (Will be added to Remind Text for TRAC Communications)
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I give permission for TRAC to pick my child up from school.

YesNo
I give permission for TRAC to pick my child/children up from home.**If you check NO, you will be required to bring your child to TRAC on Saturdays for trips and other Saturday activities.

YesNo
I will drop off and pickup my child:

YesNo
I will need transportation assistance to pick up and drop off my child (If yes, complete below?:

YesNo
Pickup/Drop Off Address

Please designate one address for drop off/pickup where an adult will be present .
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I give permission for TRAC to take my child home.

YesNo
Home Phone Number

Area CodePhone Number
I give permission for TRAC to obtain my child's progress reports and report cards from Washington County Schools for program reporting and tutoring purposes.

YesNo
Student Name

First NameLast Name
Parent Signature
I give permission for TRAC to facilitate medical treatment if needed.

YesNo
Authorization To AttendEvents/Media Release
I hereby grant permission to TRAC for my child to:1. Attend the following events, on or off campus, sponsored by TRAC: fieldtrips, athletic events, and special events (concerts, plays, park events, etc.).2. Appear in or on the following medium: brochures, videos, newsletters, radio talk shows, television ads, etc., all of which are used to promote the program. I understand that such promotions will be in keeping with the mission and educational philosophy of TRAC, and that TRAC reserves the right to utilize such material in current and future projects. 3. I/We further understand that there will not be any financial compensation for any type of media exposure of my/our child.

YesNo

Emergency Contact 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relation to Student
Emergency Contact 2
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relation to Student

Notes
Please inform TRAC of any other vital information you think they may need to know in the event of an emergency. Thank you.
Parent/Guardian Signature
Should be Empty:

Student Information

Parent Information

Pickup/Drop Off Address

Authorization To AttendEvents/Media Release

Emergency Contact 1

Emergency Contact 2

Notes