FPK8 Coda 5th-8th Grade Fall 2026

FPK8 Coda 5th-8th Grade: Fall 2026
This registration form is for 5th-8th grade students for Coda programs at Fayetteville PK-8 for the Spring 2026 Semester. Once this form has been submitted, the student is enrolled and can stay after school for the days they have registered for on this form. Students in 5th-8th grade can participate in Unplugged (bowling, art, games, and homework help) at Pinheads Bowling Alley or Coda Grow (gardening and nature) on Monday. Inspire classes in Music, Robotics, and Art/STEAM will be offered on Wednesday. For greatest benefit to the student, regular attendance is very important and encouraged.

WHEN: Sept 14 - Dec 9, 2026

- Monday & Wednesday 3:30 PM - 5:15 PM

WHERE: @ Pinheads on Monday; @ FPK8 on Monday and Wednesday

COST: FREE!!!!

GRADES: 5TH-8TH

Free meals/snacks provided.

Programs are provided multiple days a week and students are encouraged to attend as many of these as possible.

Free bus rides are available for all public school students within the FPK8 school district on Monday from Coda Grow and on Wednesday.

*Transportation is NOT AVAILABLE for FPK8 students on Monday for Unplugged at Pinheads.

*Other public, private, and homeschool students are welcome to attend Coda at FPK8, but unfortunately we cannot provide busing for these students.*

Please email Coda Mountain Academy at info@codamountain.com or call (304) 900-0096 with any questions.
Student Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student Age
Student Grade
School
School District Student Lives In (Required for Grant Purposes)
Student Gender (Required for Grant Purposes)
Student Ethnicity (Required for Grant Purposes)

Parent/Guardian 1

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Text Consent 1: Do you consent to receive text messages at this phone number? We send texts in the event of cancellations, emergencies, and announcements. If you don't choose to receive text messages from us, you may miss important information.
As the parent/guardian, please identify your relationship to the student
Parent/Guardian 2 (Emergency Contact will be requested later)

First NameLast Name
Parent/Guardian 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Text Consent 2: Do you consent to receive text messages at this phone number? We send texts in the event of cancellations, emergencies, and announcements. If you don't choose to receive text messages from us, you may miss important information.
Home Address

Street Address

Mailing Address

CityState / Province

Postal / Zip Code
Is your yearly income $35,000 or below? (Required for Grant Purposes: The program is free no matter your income.)

Terms & Policies
Loaned Instrument Policy: Our musical instrument distribution system is designed to meet the needs of students within Coda Mountain Academy. At the beginning of each semester, a labeled instrument will be loaned to the student (should they need to borrow one) and a record will be made to identify which instrument goes to each child. While it is free to be loaned, it is required that the instrument be well cared for and returned at the end of each semester in the same condition it was loaned. Failure to properly take care of the Coda loaned instrument and return it at the end of the semester, unless explained and agreed upon by Coda administration otherwise, may result in a fine equivalent to the cost of the loaned instrument or the cost of repairs.
Photo Waiver: Understanding that Coda photos and videos are important to promote public awareness, access future scholarship funding and reach more youth, I hereby consent for my child (or myself if 18 or older) to be photographed and/or videoed for Coda Mountain Academy. The resulting photographs or videos may be subsequently used without compensation to me by Coda Mountain Academy, or third parties for publications (including web sites), advertising, Facebook and/or publicity purposes at the discretion of Coda Mountain Academy. Some photos and videos may be used in the year end grant report. I waive the right to inspect or approve the finished photograph, video and/or publication use.

Bus Announcement
Free Busing will be provided to take students home after programming ends on Monday from Coda Grow and Wednesday. Unfortunately, busing home is not available on Monday from Pinheads for FPK8, homeschool, or private students. Fayette County Schools is also currently unable to transport other public, private or homeschool students from FPK8 on any day.

Buses leave the school around 5:15 pm on Monday from Coda Grow and Wednesday. If a child is signed up to ride the bus, a signed note from the parent/guardian must be provided each time they will NOT be riding the bus home. BUS STUDENTS MAY NOT WALK OR CAR RIDE WITHOUT WRITTEN PERMISSION FROM PARENT/GUARDIAN.
Bus Info
Medical Release
Does Your Child have any Allergies?
Food Allergies
Drug Allergies
Any medical problems and/or medications that we should be aware of:
Emergency Contact Person - NOT a Parent/Guardian (this is who we will contact if we CANNOT reach Parent/Guardian 1 or Parent/Guardian 2)
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Relationship to student
Release Form

I, the undersigned, am the parent or legal guardian of this minor and have given my consent for him/her to participate in activities hosted by Coda Mountain Academy. In the event of injury, accident, illness or other emergency while participating in the afterschool program, I consent to any reasonable medical treatment as deemed necessary by a licensed physician, emergency medical technicians, nurses, and laboratory technicians. In the event any treatment is required, which a physician and/or hospital personnel refuses to administer without my consent, I hereby authorize a Coda associated adult to give such consent for me, if I cannot be reached by telephone at one of the numbers listed above, or because of an emergency in which there is no time or opportunity to make a telephone call. In the event it becomes necessary for that person to give consent for me, I agree to hold such person, other associated adults and Coda Mountain Academy free and harmless of claims, demands, or suits for damages which may arise from the giving of such consent. I also acknowledge that I accept to be ultimately responsible for the cost of any medical care whether or not the cost of that medical care will be reimbursed by my health insurance provider.
Signature

Click submit to register your student for Coda.

Once you have submitted this form, your child is enrolled in Coda for the days you selected. If you provided us with a valid email address in this registration form, you will receive an email confirmation from Jotform informing you that we have received your form. Please remind your student to stay after school for Coda on the days you have registered them for starting the week of September 14th.
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FPK8 Coda 5th-8th Grade: Fall 2026

Programs

Terms & Policies

Bus Announcement

Medical Release

Click submit to register your student for Coda.