Dream Big Co-Op

Dream Big

Homeschool Co-op
Information of Child
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Information of Parent
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact
Please list someone other than the guardian completing this form.

In the event of an emergency, please contact:
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information
Please list all allergies, health concerns, or anything specific you would like me to know about your child
Photo/Video Consent
I grant permission and give my consent to Dream Big LV Kids Homeschool Co-Op for the use of the any and all photograph(s), video, or electronic media images as identified below for presentation under any legal use including but not limited to; copyright purposes, advertising, publicity, and web content.
Release of liability
The undersigned hereby assumes all risk of injury or harm as a result of the activities specified above and agrees to release, indemnify, defend, and forever discharge the releasee from all liability, claims, demands, damages, costs, expenses, and causes of action due to death, injury, loss, or damage to the undersigned. The Dream Big LV Kids homeschool co-op will take place at 6824 Toros St. N. Las Vegas, NV 89096. The undersigned understands the risks, activities and responsibility of voluntarily taking part of Dream Big LV Kids homeschool co-op at this address and releases property and property owner of any liability.
Signature
Parental Supervision
The undersigned agrees that they will be present for the duration of the co-op class and at no time does Dream Big LV Kids assume legal responsibility of attendee
Signature
T-Shirt Size

If size is not listed please message Dream Big LV Kids
Please select size
Upon submission of this form a $25 registration fee is due via Venmo, Cashapp or Apple Pay. Message Dream Big LV Kids once payment has been submitted. This fee is non-refundable and covers the cost of supplies and t-shirt. Any leftover funds will be put into a reserve for unforeseen costs/classroom materials.
Should be Empty:

Dream Big

Information of Child

Information of Parent

Medical Information

Photo/Video Consent

Release of liability

Parental Supervision

T-Shirt Size