Natomas Homeschool Alliance Enrollment Application 2025/2026

Enrollment Application 2025/2026
Parent/Guardian Information
Parent Name (Primary Contact)

First NameLast Name
Cell Number

Area CodePhone Number
E-mail
Parent Name (Secondary Contact)

First NameLast Name
Cell Number

Area CodePhone Number
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number

Area CodePhone Number
Number of Years Homeschooling:
Homeschool Affiliation
Emergency Information
Emergency Contact (not listed above)

First NameLast Name
Emergency Contact Phone

Area CodePhone Number
Family Doctor
Family Doctor Number

Area CodePhone Number
Health Insurance Company
Policy #
Desired Hospital in the event of an emergency
Please include information for all children who will be participating in NHA programs this year.
Child Registration Information (first child)
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Grade (as of September 1)
Allergies/Medical Information/Learning Differences/Other - if none use N/A
Add another child
Child Registration Information (second child)
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Grade (as of September 1)
Allergies/Medical Information/Learning Differences/Other
Add another child
Child Registration Information (third child)
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Grade (as of September 1)
Allergies/Medical Information/Learning Differences/Other
Add another child
Child Registration Information (fourth child)
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Grade (as of September 1)
Allergies/Medical Information/Learning Differences/Other
Add another child
Child Registration Information (fifth child)
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Grade (as of September 1)
Allergies/Medical Information/Learning Differences/Other
PLEASE NOTE: For severe allergies, chronic medical conditions, or behavioral challenges, please contact Tiffany Millen with additional information at tiffany.millen@hackschooling.net.
Drop off/Pick up Policy TK-2nd (3rd) River City Baptist Campus Only (Click to acknowledge)
Waiver and Release of Liability
IN CONSIDERATION of being a participant in the Natomas Homeschool Alliance (hereafter “NHA”) and being permitted to utilize the facilities of The Crossing Church (hereafter “The Crossing”), Iron Mile Gym (hereafter “Iron Mile”), River City Baptist Church (hereafter “RCBC”), The Cornerstone Bible Church (hereafter “TCBC”) or any other facility graciously provided for use by the NHA, I, the undersigned, intending to be legally bound for my family, do hereby:
(Click to agree)
(Click to agree)

Release and agree to indemnify both NHA, The Crossing, Iron Mile, RCBC, TCBC and any other facility utilized by NHA, which includes any NHA member, board member, instructor, vendor, Iron Mile owners and employees, and any of The Crossing’s officers, elders, staff members, and employees, from any and all claims by or against my family for property damage, personal injury, and/or claims arising from my family’s participation and/or utilization, including claims that are known or unknown, foreseen or unforeseen, future or contingent;
(Click to agree)
(Click to agree)
(Click to agree)
(Click to agree)
(Click to agree)
(Click to agree)

By signing this agreement, I acknowledge that I am aware of the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 at NHA, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I voluntarily choose to assume all of the foregoing risks and accept sole responsibility for any injury, illness, permanent disability, or death related to COVID-19 arising from or in connection with my presence at the NHA. I hereby release and hold harmless NHA, its facilities, employees, agents, directors, officers and representatives and other participants from and against all liabilities.
Signature
Should be Empty:

Enrollment Application 2025/2026

Please include information for all children who will be participating in NHA programs this year.

Waiver and Release of Liability