Registration 2024-25 School Year take 2

Registration 2024-2025 School Year

Santa Cruz Learning Center
Participant Name (Student):

First NameLast Name
DOB of Student:

MonthDayYear
Date
Age of Student as of August 2024
Grade level Fall 2024
School (enter homeschool, if the student is not registered to a school)
Email of Student (if applicable. We ask that middle school and high school students have an email for us to keep track of grades and assignments).
example@example.com
Cell Phone for student, if applicable

Area CodePhone Number
Info for Parent or Guardian 1
Parent or Guardian 1 Full Name:

First NameLast Name
Does the student live full time with parent or guardian 1? If no, please describe when the child stays with parent or guardian 1.
Parent/Guardian 1 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship(s) of parent or guardian 1 to the student (mother, father, etc.)
Cell phone number of parent/guardian 1

Area CodePhone Number
Work phone of parent/guardian 1

Area CodePhone Number
Email for parent/guardian 1
example@example.com
Info for Parent or Guardian 2

Leave blank if only Parent or Guardian 1 is the only Parent or Guardian
Parent or Guardian 2 Full Name:

First NameLast Name
Does the child live full time with parent or guardian 2? If no, please describe when the child stays with parent or guardian 2.
Parent or Guardian 2 address Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship(s) of parent or guardian 2 to the student (mother, father, etc.)
Cell phone of parent/guardian 2

Area CodePhone Number
Work phone of parent/guardian 2

Area CodePhone Number
Email for parent/guardian 2
example@example.com

Participant Information

Tell us a little about the student
Has your child been diagnosed with any learning exceptionalities and do they have an IEP or a 504 plan?
If you answered yes to the question above, please provide us with more information. If applicable, could you share their IEP or 504 plan report with our education team? Do you have specific tools and/or learning/teaching strategies that have been successful? Are there accommodations that we should be aware of?
Has your child ever been asked to leave an educational or extracurricular class or program due to behavioral issues? If yes, please describe below. If no, please enter no.*
What is the name of your ES or Educational Consultant?
Education Specialist/Consultant Email
example@example.com

COURSE ENROLLMENT SECTION

FOR THOSE OF YOU REGISTERING MORE THAN ONE STUDENT, PLEASE COMPLETE A SEPARATE FORM FOR EACH STUDENT
This section is to enroll in a course for Fall semester 2024.

Students who are continuing courses from the fall WILL NOT NEED TO REGISTER AGAIN FOR SPRING

RELEASE SECTION
Photo/video release: Santa Cruz Learning Center may use the above-listed participant's photo for promotional purposes. Does Santa Cruz Learning Center have permission to use photos or videos of your child?

YesNoOther
The parent or guardian signing shall be responsible for payment of amounts owed to Santa Cruz Learning Center under this agreement. Sign below to indicate you have read and agree to these terms*

Clear
Santa Cruz Learning Center is responsible for your children only while they are in class. Elementary children will be supervised until an approved adult arrives to pick them up. For Middle and High School students, if your child is attending multiple classes with breaks in between, they will have a designated space at the center to wait quietly. Please discuss any rules and boundaries with your child (and your instructor(s)) if you have any concerns. Sign below to indicate you have read and agree to these terms.*

Clear
In the case of illness or accident, Santa Cruz Learning Center is authorized to secure emergency medical treatment at my expense. Please sign below to indicate that you agree to these terms. *

Clear
The Santa Cruz Learning Center reserves the right to dismiss any participant who does not show respect for the facility, including but not limited to property, equipment, policies, other members, volunteers, and staff. Participants who are dismissed will not receive a refund of fees paid. Please sign below to indicate that you agree to these terms. *

Clear
The Santa Cruz Learning Center and its employees, contractors, and volunteers assume no responsibility for personal property. By signing this enrollment form, I (we) hereby waive any and all claims against the Santa Cruz Learning Center and its employees, independent contractors, and volunteers. I understand and agree that by signing this agreement, I am relinquishing my (or the minor for whom I sign) right(s) to make any claim against the Santa Cruz Learning Center, its agents, employees, volunteers, and independent contractors, including the right to sue them, for bodily or personal injury, property damage, or any other loss that I might suffer while using Santa Cruz Learning Center services, except as limited by law. Certainly! Here's the revised version for the release section of your registration form:The Santa Cruz Learning Center and its employees, contractors, and volunteers assume no responsibility for personal property. By signing this enrollment form, I (we) hereby waive any and all claims against the Santa Cruz Learning Center and its employees, independent contractors, and volunteers. I understand and agree that by signing this agreement, I am relinquishing my (or the minor for whom I sign) right(s) to make any claim against the Santa Cruz Learning Center, its agents, employees, volunteers, and independent contractors, including the right to sue them, for bodily or personal injury, property damage, or any other loss that I might suffer while using Santa Cruz Learning Center services, except as limited by law. Certainly! Here's the revised version for the release section of your registration form:The Santa Cruz Learning Center and its employees, contractors, and volunteers assume no responsibility for personal property. By signing this enrollment form, I (we) hereby waive any and all claims against the Santa Cruz Learning Center and its employees, independent contractors, and volunteers. I understand and agree that by signing this agreement, I am relinquishing my (or the minor for whom I sign) right(s) to make any claim against the Santa Cruz Learning Center, its agents, employees, volunteers, and independent contractors, including the right to sue them, for bodily or personal injury, property damage, or any other loss that I might suffer while using Santa Cruz Learning Center services, except as limited by law. Please sign below to indicate that you agree to these terms.

Clear
Name of person signing this registration form

First NameLast Name
Should be Empty:

Registration 2024-2025 School Year

Info for Parent or Guardian 1

Info for Parent or Guardian 2

Participant Information

Emergency Contact Information

Medical Insurance Information

Health Information

COURSE ENROLLMENT SECTION

This section is to enroll in a course for Fall semester 2024.

ELEMENTARY COURSES

MIDDLE SCHOOL COURSES

View Middle the School Course Schedule Here

HIGH SCHOOL COURSES

View the High School Course Schedule Here

RELEASE SECTION