2024-2025 Harbor Family Registration & Waiver

Primary Family Email*

example@example.com

VERY IMPORTANT: Please list all of your student(s) who will be enrolled in Harbor:*

	Student First Name	Student Last Name	Food Allergies?	Medical Allergies?	EpiPen?
1
2
3
4
5
6
7

Parent/Guardian:*

	Parent Name: First/Last	Mobile phone:	Other phone:	Email:
1
2

Primary Address:*

Street Address

(optional) Street Address Line 2

City

Postal / Zip Code

If parents cannot be reached:*

	Parent Name: First/Last	Mobile phone:	Relation to student
1

TUITION PAYMENT: If your classes will be funded by Oxford, or you indicated "unsure" on your Class Registration form, we will follow up with you about that and be in communication with OVA. If you are self-paying, we will send you an invoice for your tuition.*

Agree

Medical Waiver and Release:*

Medical Care Authorization: In case of an emergency, I authorize the Harbor Homeschool team to take such measures and arrange for such medical and hospital treatment as they may deem advisable for my child’s health and wellbeing. I release Harbor Homeschool, the staff, volunteers, and the Dearborn Free Methodist Church from claim or liability due to sickness or injury. I accept all financial responsibilities concerning any medical emergency that arises.Liability: In consideration for my child’s participation in activities sponsored by Harbor Homeschool, I hereby release, discharge, indemnify, and agree to hold harmless Harbor Homeschool, its directors, officers, and employees, agents, all volunteer personnel, and the Dearborn Free Methodist Church from any and all liability for personal injuries, damage(s) and/or illness that may be suffered. I further agree to indemnify and hold harmless Harbor Homeschool, its directors, officers, employees, agents, and all volunteer personnel concerning any awarded claim and/or damages as a result of any injury or damage. This includes reasonable attorney fees, litigation expenses, and court costs.Publication Release: As part of classroom/school projects, or the Harbor Homeschool Yearbook, the school occasionally uses photos or video of students. As a parent and/or guardian for the named child(ren), I give my permission for the use of photos or videos that contain my child and will hold Harbor Homeschool and its board and employees harmless from any liabilities in connection to printed or online publications.

If your student has a severe medical condition, please fill out one of the Medication and Medical Action Plan Forms (MAP) and submit it with your OVA paperwork and send Harbor a copy as well.

Parent/Guardian Signature*

Date*

Date