Illumination Registration 2024-25

Illumination Registration 2024-25

Monday Core Program
Name of Parent (primary educator)

First NameLast Name
If you are a returning family, you may skip to the student section (page 2). If you are a new family, please fill out the following information.

I am a returning family.I am a new family
Homeschool Name
Homeschool ID Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.

Student information

Please fill out the following for each student in your homeschool.
Student 1

First NameLast Name
Grade
Any allergies?
Student email (required for Canvas)
example@example.com
Student 2

First NameLast Name
Grade
Any allergies?
Student email (required for Canvas)
example@example.com
Student 3

First NameLast Name
Grade
Any allergies?
Student email (required for Canvas)
example@example.com
Student 4

First NameLast Name
Grade
Any allergies?
Student email (required for Canvas)
example@example.com
DUAL ENROLLMENT AT DDCC

We highly recommend this program for our older students. We encourage students to arrange their schedule to participate in Monday classes for the worldview exposure.
If you have a junior or senior participating in the dual enrollment program, please type their name.

All the fun stuff

(It says you won't sue us (or Greenwood) if your kid breaks an arm on the playground, etc.)
ILLUMINATION WAIVER OF LIABILITYAND HOLD HARMLESS AGREEMENT 1. IN CONSIDERATION for participation in Illumination’s homeschool enrichment program, and the facility of Greenwood Baptist Church in Thomasville, NC, and other valuable consideration, I hereby RELEASE, WAIVE, DISCHARGE AND CONVENANT NOT TO SUE Illumination, its Board of Directors, officers, servants, agents, and teachers(hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THERELEASEES, or otherwise, while participating in such activity, or while in, on or upon the premises where the activity is being conducted or in transportation to and from said premises. 2. To the best of my knowledge, I can fully participate in this activity. I am fully aware of risks and hazards connected with the activity, including but not limited to the risks as noted herein, and I hereby elect to voluntarily participate in said activity, and to enter the above named premises and engage in such activity knowing that the activity may be hazardous to me and my property. I give my permission for the use of my name and likeness to be used for informational and publicity purposes. I VOLUNTARILY ASSUME FULLRESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY,INCLUDING DEATH, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, WHETHER CAUSEDBY THE NEGLIGENCE OF RELEASEES or otherwise. 3. I further hereby AGREE TOINDEMNIFY AND HOLD HARMLESS THE RELEASEES from any loss, liability, damage or costs, including court costs and attorney's fees, that may incur due to my participation in said activity, WHETHER CAUSED BY NEGLIGENCE OF RELEASEES or otherwise. 4. It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and spouse (if any), if I am alive, and my heirs, assigns and personal representative, if I am not alive, shall be deemed as a RELEASE, WAIVER, DISCHARGE ANDCOVENANT NOT TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of North Carolina. 5.I UNDERSTAND THAT ILLUMINATION AND/OR GREENWOOD BAPTIST CHURCH WILL NOT BERESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH AN INJURY I MAY SUSTAIN.6.I further agree to become familiar with the rules and regulations of Illumination concerning student conduct, and not to violate said rules of any directive or instruction made by the person or persons in charge of said activity and that I will further assume the complete risk of any activity done in violation of any rule or directive or instruction.7. I also understand that I should and am urged by Illumination to obtain adequate health and accident insurance to cover any personal injury to myself which may be sustained during the activity or the transportation to and from said activity. IN SIGNING THIS RELEASE, IACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen(18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by same.
Signature

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Do we have permission to publish your child's picture on social media? You can scroll our FB for examples of how we use the pictures.

YesNo
Signature

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Illumination Registration 2024-25

Student information

DUAL ENROLLMENT AT DDCC

All the fun stuff