Student Registration Form
Please fill out the form accurately to register your child for the homeschool class.
Child's Full Name
*
First Name
Last Name
Child's Age
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Contact Number
*
Please enter a valid phone number.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Authorized Pick-up Person(s)
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Medical Information
List any allergies (if any)
List any pertinent medical information (Health conditions (asthma, epilepsy, etc.))
Medication needed (if any)
Permission to administer basic first aid
Yes
No
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Liability and Photo Release
While Fig & Olive Learning takes precautions to minimize potential accidents or injuries, I understand that nature-based learning carries inherent risks such as insect bites, uneven terrain, and weather exposure. I release Fig and Olive Learning from any liability for injuries that may occur during class time. (Please note: For the safety and legal protection of all parties, children whose parents do not agree to this waiver may not be accepted into the program.)
*
Yes
No
I give permission for photos of my child to be taken during class and used for class documentation, promotional materials, or social media.
*
Yes, full release (I give permission for my child's photo to be used for all purposes, including class documentation, promotional materials, social media, and website.)
Yes, partial release (I give permission for my child’s photo to be taken and sent to myself and the group.)
No photos please
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My Products
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( X )
6 - week drop in class
God in Nature - 9/9 - 11/14
$
175.00
Quantity
1
2
3
4
5
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Date
-
Month
-
Day
Year
Date
Signature
Payment Methods
Choose from one of the PayPal options to
make your payment.
Should be Empty: