Homegrown Education Student Registration

Student Registration

Please complete one form for each student.
Student Name

Preferred First NameLast Name
Student's Birth Date

MonthDayYear
Date
Student email (if applicable):
example@example.com
Student Phone Number (if applicable):
Please enter a valid phone number.
Student Gender

FemaleMale
Where does the student attend school? For homeschooled students, type "homeschool."
Primary Parent or Guardian Name

First NameLast Name
Additional Parent or Guardian Name

First NameLast Name
Address for Primary Parent or Guardian

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Parent or Guardian Email
example@example.com
Primary Parent or Guardian Phone Number
Please enter a valid phone number.

LIABILITY WAIVER

1. Acknowledgment of Risk

I, the undersigned parent or legal guardian of the above-named child (“Participant”), acknowledge that participation in outdoor activities at Homegrown Education Nature Day Camp involves inherent risks. These may include, but are not limited to:
Exposure to natural elements (sun, insects, plants, animals)
Uneven terrain, water features, and weather changes
Physical exertion and minor injuries (scrapes, sprains, etc.)
I understand that while Homegrown Education staff will take reasonable precautions to ensure safety, they cannot eliminate all risks associated with outdoor activities.

2. Waiver and Release

In consideration of my child’s participation, I hereby release and hold harmless Homegrown Education, its staff, volunteers, affiliates, and property owners from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury—including death—that may be sustained by the Participant while attending or participating in camp activities.
Signature

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MEDICAL RELEASE

I authorize Homegrown Education staff to administer basic first aid and seek emergency medical treatment for my child if necessary. I understand that reasonable efforts will be made to contact me before such action is taken. I agree to be responsible for any medical expenses incurred.
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Emergency Contact (if different from primary parent or guardian)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
List any allergies or medical conditions that Homegrown staff may need to be aware of:
List any medications the student is currently taking:
I authorize the use of the following OTC medications administered according to label directions.

Hydrocortisone CreamAntibiotic OintmentCough DropsAdhesive Bandages
** Homegrown Education is located in a rural area which may result in limited access to emergency services and extended response times. Students with severe medical conditions or anaphylactic reactions should be aware of this prior to registration.

**Homegrown Education staff will not be responsible for administering or overseeing the administration of any prescription medications.

PHOTO RELEASE

I grant permission for Homegrown Education to take photographs or videos of my child during camp activities for promotional, educational, or documentation purposes. I understand these may be used in print or online media.
Photo/Video Consent

Yes, I consent to photo/video useNo, I do not consent to photo/video use
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CODE OF CONDUCT

Homegrown Education is a Christian environment. While we do not employ a Christian curriculum, all students and visitors are expected to conduct themselves in accordance with the principles of love, kindness, respect, and tolerance. Students who do not meet the expectations will be given a warning and reminded of the expectations for behavior. A second warning will result in parent/guardian notification and the understanding that the bahvior will be corrected before the student returns to class. A third warning/infraction will result in removal from the program and all future sessions. For major infractions such as physical violence, inappropriate sexual speech or bahavior, and other actions deemed to put another visitor to Homegrown Education in danger, no warnings will be given, a parent/guardian will be called for immediate pickup, and the student will not be allowed back on the premises. In the case of student removal from the program, no refunds will be issued.
I agree to the Code of Conduct.

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How would you like to be invoiced for registration?

I will be using Education Freedom Account funds.I will be paying out-of-pocket.
TERMS AND CONDITIONS

ENROLLMENT

If your student will be unable to attend a session, please contact us at registration@homegrown-education.com as soon as possible so that students on the wait list may attend.

PAYMENT POLICY

Once this registration form is submitted, an invoice will be sent within 24 hours and is due upon reciept. Enrollment in the camp session is not secured until payment is received when paying out-of-pocket. EFA payments are due within 30 days.

REFUND POLICY

No cash refunds will be given. Students may choose another session to attend or choose to complete the session virtually. Please contact registration@homegrown-education.com to make arrangements for a missed session.

PRIVACY POLICY

The privacy policy for Homegrown Education is available on the company website.

BY SUBMITTING THIS FORM, YOU AGREE TO THESE TERMS AND CONDITIONS.
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