Registration - Annandale Campus Program

Registration - Annandale Campus Program
2025-262026-272027-282028-292029-30
Parent information
Father's First Name
Father's Last Name
Father's Phone

Area CodePhone Number
Father's email
Mother's First Name
Mother's Last Name
Mother's Phone

Area CodePhone Number
Mother's email
Preferred addresses

These are the email and street addresses at which you would like to receive any correspondence.
Preferred email*
Street address 1*
Street address 2
City*
State*
If state, use 2-letter state abbreviation.
Postal / Zip code*
Country*

My Permission

The undersigned does hereby give permission for my child(ren) to attend and participate in homeschool enrichment programs organized by the Center for Redemptive Education.
First Name*
Last Name*
Student information
Student #1 First Name*
Student #1 Last Name*
Student #1 Date of Birth MM/DD/YYYY*
Student #1 Grade
This is the grade in which you expect your child to be enrolled in the academic year indicated in this registration.
#1 Notes:*
Please note any special concerns or information we should know about this student. If none, simply write "none."
Student #2 First Name
Student #2 Last Name
Student #2 Date of Birth MM/DD/YYYY
Student #2 Grade
This is the grade in which you expect your child to be enrolled in the academic year indicated in this registration.
#2 Notes:
Please note any special concerns or information we should know about this student. If none, simply write "none."
Student #3 First Name
Student #3 Last Name
Student #3 Date of Birth MM/DD/YYYY
Student #3 Grade
This is the grade in which you expect your child to be enrolled in the academic year indicated in this registration.
#3 Notes:
Please note any special concerns or information we should know about this student. If none, simply write "none."
Student #4 First Name
Student #4 Last Name
Student #4 Date of Birth MM/DD/YYYY
Student #4 Grade
This is the grade in which you expect your child to be enrolled in the academic year indicated in this registration.
#4 Notes:
Please note any special concerns or information we should know about this student. If none, simply write "none."
Student #5 First Name
Student #5 Last Name
Student #5 Date of Birth MM/DD/YYYY
Student #5 Grade
This is the grade in which you expect your child to be enrolled in the academic year indicated in this registration.
#5 Notes:
Please note any special concerns or information we should know about this student. If none, simply write "none."

Photo Permission

A YES answer indicates that the Center for Redemptive Education has my permission to use my child’s photograph in public communications. My child’s name will not be used in association with any photos, unless authorized by a parent. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Photo Permission*
Emergency Contacts

(For use in the event a parent/guardian cannot be reached)
Emergency Contact #1 First Name*
Emergency Contact #1 Last Name*
Emergency Contact #1 Phone Number*

Area CodePhone Number
Emergency Contact #2 First Name*
Emergency Contact #2 Last Name*
Emergency Contact #2 Phone Number

Area CodePhone Number

Carpool

Please name the individuals--including name(s) of parent(s)--who have your permission to pick up and/or drop off your child(ren).
Carpool #1 First Name*
Carpool #1 Last Name*
Carpool #1 phone*

Area CodePhone Number
Carpool #2 First Name
Carpool #2 Last Name
Carpool #2 phone

Area CodePhone Number
Carpool #3 First Name
Carpool #3 Last Name
Carpool #3 phone

Area CodePhone Number
Carpool #4 First Name
Carpool #4 Last Name
Carpool #4 phone

Area CodePhone Number

General policies

Agreement required for enrollment.
Weather: Educational programs take place outdoors, as weather permits. Students should be prepared for any weather scenario, including rain, snow, cold, or heat.

Food: Children and staff will bring their snack and meal food from home. Sharing food is not permitted. When drinks or foods will be part of a class experience, the ingredients will be sent to parents of all involved students, for permission to partake. We do not hold class parties for students during the class day, but with permission, treats may be sent in to share.

Health: Students with a fever, vomiting, diarrhea, or other significant symptoms of illness may return to class after none of these symptoms has occurred for 24 hours without mitigation by prescription or over-the-counter medicine. We encourage appropriately frequent hand-washing and other hygiene practices regularly.

Safety: Students will be officially checked in at the designated area, typically curbside, each morning upon arrival. Students will be released only to an individual who is officially listed on the carpool list each day.

Any change to drop-off or pick-up schedule must be arranged by notifying the program office or lead instructor. Only children with the requisite Waiver/Release form(s) will be admitted to CRE programs.

No adult may be in the bathroom while children are in the bathroom, unless a parent is accompanying his or her own small child. If adults use the bathroom, the outer door must be closed to indicate that students must wait until the adult exits the bathroom. Bathroom and classroom doors will be open at all times, unless the classroom door has a viewing window.

Volunteering: We welcome both parents and relatives of the students as volunteers. While parental volunteering is not required, the program can only run well when a number of parents volunteer to do the following: serve as substitutes, perform office and lunch and recess duties.

Substitutes and office volunteers shall give permission and documentation to the CRE to obtain background checks.

General: We do not use toys, candy, or other rewards to shape student behavior. We employ Redemptive Discipline and Redemptive Leadership principles in shaping our program culture.

A YES answer indicates that I agree to all of these General Policies. Consent is required for enrollment.
Yes
Parent/Guardian Full Name*
Yes

Waiver / Release for communicable diseases
In consideration of being allowed to participate on behalf of Scent of Water and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and experience any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (Center for Redemptive Education) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

Consent is required for enrollment.
Yes
Parent/Guardian Full Name*
Yes

Waiver / release for outdoor risks
In consideration of being allowed to participate on behalf of Scent of Water and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1. Participation includes possible exposure to both wild and domesticated animals (dependent on campus location), insects, various plants, and other wildlife. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against risks in outdoor activities. If, however, I observe and experience any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (Center for Redemptive Education) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

A YES answer indicates that I consent to all of the provisions of the Waiver / Release for Outdoor Risks.

Consent is required for enrollment.
Yes
Parent/Guardian Full Name*
Yes

Parental consent and liability
As the primary homeschool parent, (the Releasor), an agent for myself and family members, the Releasor, being of lawful age, in consideration of being permitted to participate in homeschool support group meetings and homeschool activities, run and/or operated by the Center for Redemptive Education (referred to furthermore as the Releasee), WAIVE, RELEASE, and DISCHARGE the Releasee, its owners, officers, directors, employees, members, agents, assigns, legal representatives and successors, and all business associates and partners involved in the presentation of the above noted activities including but not limited to churches or commercial facilities in the District of Washington, the State of Virginia, and/or the State of Maryland; and their owners, officers and employees, from all liability for or by reason of any damage, loss or injury to person and property, even injury resulting in the death of the Releasor and/or family members, which has been or may be sustained in consequence of the Releasor’s participation in the activity(s) described above, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Releasee.

I hereby acknowledge and agree that I have carefully read this Waiver and Release agreement, that I fully understand same, and that I am freely and voluntarily executing same.

By signing this release I and my family members will be forever prevented from suing or otherwise claiming against the Releasee for any property loss or personal injury that I or my family members may sustain while participating in or preparing for the above noted activity(s).

This agreement is effective for the entire duration of my participation with this group.

I have been given the opportunity and have been encouraged to seek independent legal advice prior to signing this Waiver and Release agreement.

I understand that this Waiver and Release agreement is binding on me, my spouse, my heirs, my executors, administrators, personal representatives and assigns.

This release contains the entire agreement between the parties to this release and the terms of this release are contractual and not a mere recital. This Waiver and Release Agreement will be construed in accordance with and governed by the laws of the State of Virginia, and it is acknowledged by the Releasor to be as broad and inclusive as permitted by the laws of this jurisdiction.

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases.

Furthermore, my child/ward understands and accepts these risks and responsibilities.

I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Yes
Parent/Guardian Full Name*
Yes
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Registration - Annandale Campus Program

Parent information

Preferred addresses

My Permission

Student information

Photo Permission

Emergency Contacts

Carpool

General policies

Waiver / Release for communicable diseases

Waiver / release for outdoor risks

Parental consent and liability