Lab Learning Student Enrollment Form

Student Registration Form for Lab Classes (One per child)
Person completing form

First NameLast Name
Mobile Number

Area CodePhone Number
E-mail
Registering for:

Fall 2024Spring 2025Entire Year 2024-25
Program/s registering for:

WOW! 2-day ProgramA la Carte classes only
If registering for WOW! 2-day program, selection section (select only 1)(If registering for A-la-Carte skip to next question)

Wow! OWLS (Tk-2nd)Wow! Coyotes (3rd-4th)Wow! Dragons (5th-8th)
Which prospective days will your child attend?

MondayTuesdayWednesdayThursday
If registering for A-La-Carte classes, select from list below: (If registering for WOW! 2-day program skip this question)

A la Carte-Readers & Writers Owls (Tk-1st) (M-Tu)A la Carte -Readers & Writers Coyotes (2nd-4th) (W-Th)A la Carte -Readers & Writers Dragons (5th-8th) (M-Tu)A la Carte-Curiosity Studio Owls (Tk-1st) (M-Tu)A la Carte- Curiosity Studio Coyotes (2nd-4th) (M-Tu)A la Carte- Curiosity Studio Dragons(5th-8th) (M-Tu)A la Carte - Wednesday Park Day (TK-8th) (Wednesday)
Method of payment for classes

Instructional funds from my child's NCB CharterPrivate pay - Zelle or CheckCombination of instructional funds and private pay
I understand enrollment is by semester and that I must provide 30-days if I decide to disenroll my child before the end of the semester for which my child is registered.
Parent/Guardian Signature

Clear
I am aware that enrollment is by semester. Payment options include a lump payment at the start of the semester (Sep-Dec:$1600)(Jan-Jun:$2100), or I may choose to pay the fee in monthly installments of $400.

I am aware that I am responsible for paying the entire cost of my child's classes at The Lab and agree to pay any difference between the cost of Lab classes and the amount that is covered by instructional funds provided by my child's charter. See price list on website.

I am aware that payment is due on the 10th of each month and is considered late if not received by the Lab by 10th of each month. A $30 late fee will be applied for any payment received after that date each month.
Signature

Clear
I am aware that The Lab adheres to LA County and Long Beach Department of Public Health recommendations and requirements for COVID-19 including masking, hygiene, social distancing and vaccination or testing requirements.

I am also aware that the Lab may periodically need to move to ON-LINE/Virtual classes if required by LA County or Long Beach Departments of Public Health. I understand that this will not affect my child's registration for classes nor my financial obligations to pay for the classes they are enrolled in.
Signature

Clear
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Student's grade level for the Fall
Student's Gender
Student's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student's Race

American Indian or Alaska NativeBlackWhiteMiddle EasternHispanic/ LatinoAsianPacific IslanderOther
What language did your child first learn to speak in the home?

EnglishSpanishOther
Student's current/previous school or Home School Charter
Student's current teacher / EF / HST
Teacher/EF phone number

Area CodePhone Number
Teacher/EF email
example@example.com
What special services does your child use?

NoneIEP504SPEDOther
Why are you choosing The Lab for your child?
What should we know about your child in order to help them have the best experience possible at The Lab?
What are your goals for your child at The Lab?
Parent/Guardian 1

First NameLast Name
Parent 1 address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 email
example@example.com
Parent/Guardian 1 work phone

Area CodePhone Number
Parent/Guardian 1 cell phone

Area CodePhone Number
Parent/Guaridan 1 employer
Preferred language parent 1

EnglishSpanishOther
Parent/Guardian 2 name

First NameLast Name
Parent/Guardian 2 address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 email
example@example.com
Parent/Guardian 2 work phone

Area CodePhone Number
Parent/Guardian 2 cell phone

Area CodePhone Number
Parent/Guardian 2 employer
Preferred language parent/guardian 2

EnglishSpanishOther
What is your level of experience with homeschooling?

None1 year2 or more years
How did you hear about The Lab?

My child's EF/teacherA friendFacebookInstagramA flyer/posterOther
Emergency Contact Information
Emergency Contact Person 1

First NameLast Name
Relationship to student
Cell Phone

Area CodePhone Number
Emergency Contact Person 2

First NameLast Name
Relationship to student
Cell Phone

Area CodePhone Number
Individuals allowed to pick up student
Name

First NameLast Name
Relationship to student
Phone Number

Area CodePhone Number
Name

First NameLast Name
Relationship to student
Phone Number

Area CodePhone Number
Name

First NameLast Name
Relationship to student
Phone Number

Area CodePhone Number
Are there legal/custody issues concerning child we should know about

YesNo
Please describe
Medical Information
Primary Care Physician's Name

First NameLast Name
Phone Number

Area CodePhone Number
Health insurance provider
Insurance policy number
Does your child have allergies we need to know about

YesNo
Are any of the allergies potentially life threatening?

YesNo
How would you like us to support your child with their allergies while they are at The Lab?
My child has other serious health concerns

YesNo
If yes, please describe
If yes, please describe how would you like us to support your child with this health issue while at The Lab?
Permission to be photographed
Please check one box. This form must be on
file for each student and is valid as long as your child attends activities at the Lab. If you choose to
change your child’s release status, you must submit a new form. Forms may be obtained from the Lab
administration.

BY CHECKING “YES” AND SIGNING THIS CONSENT FORM, I GIVE PERMISSION FOR MY CHILD’S FIRST AND LAST NAME AND/OR PHOTOGRAPH TO BE USED IN PUBLICATIONS, PRESENTATIONS, VIDEOS, WEB PAGES, OR NEWS RELEASES
PRODUCED BY THE LAB OR BY AGENCIES WORKING WITH THE LAB.

NOTE: No payment will be made to a child photographed under the terms of this release or to his/her family if and when photographs are used in district publications, presentations, video productions, or web sites. Parents/guardians waive the right to preview or approve the finished photographs or videos.
Yes , I give permission for my child(ren) to be photographed or videotaped while in school orduring school-related activities outside the classroom.No, I do NOT want my child(ren) to be photographed or videotaped while in school or duringschool-related activities outside the classroom.
Parent signature

Clear
Technology use agreement
The Lab recognizes the evolving use of technology on education supports the appropriate use of the Lab network and internet as tools for instruction, research, communication and data collection.

The assure success for all students, we provide internet access at The Lab. Please read the following guidelines and sign.

1. Students will have access to email and internet based resources.

2. Responsibility. The Lab has taken reasonable precautions to restrict access to "harmful sites" and materials that do not support approved educational activities. However on a public network it is impossible to control all materials. The teacher/staff will choose materials based on the child's age, maturity and ability. Use of any information obtained through the internet is at the user's risk.

3. Acceptable use. The purpose of having access to the internet at The Lab is to support research and education only. Use of the internet must be consistent with these purposes and the educational objectives of The Lab.

4. Prohibited use. Transmission of any material in violation of state or federal law is prohibited. This includes the distribution of information that violates or infringes on the rights of others as well as "hacking."

5. Privileges. Use of The Lab internet is a privilege, not a right, and inappropriate use will result in cancellation of those privileges.

6. Security. Security on any computer is a high priority. If you feel you can identify a security problem, you must notify our director in writing, in person or via the internet.

7. Vandalism. Vandalism will result in cancellation of privileges.

8. Use of personal devices while at The Lab. Use of personal devices at The Lab by students is prohibited unless specifically requested by staff or a teacher. Cell phones are to remain put away until the end of the day. Students who do not adhere to this policy will be required to turn in their phones to the office until the end of the day. Students with repeated offenses will be required to leave their phone and other personal devices at home.

I understand and will abide by the above terms and conditions for access to the internet.

I understand the signatures on this document are binding and indicate the parties who signed have read the terms and conditions and understand their significance.
Student Name

First NameLast Name
Student signature

Clear
Parent Name

First NameLast Name
Parent signature

Clear
Date

MonthDayYear
Date
Permission to leave campus for lunch (age 13+)

Does not apply to on-line only students
Student's name

First NameLast Name
My child has permission to leave campus for lunch with out an adult chaperone.

YesNo
Parent Signature

Clear
Parent name

First NameLast Name
Date

MonthDayYear
Date
Permission to leave after class at end of day unaccompanied (Only students 5th - 8th grade)
Student's name

First NameLast Name
My child has permission to leave campus at end of the day without an adult chaperone.

YesNo
Parent Signature

Clear
Parent Name

First NameLast Name
Date

MonthDayYear
Date
Permission to go to the Park
Student's name

First NameLast Name
My child has permission to go to the local park during The Lab's weekly park visit.

YesNo
Parent Signature

Clear
Parent Name

First NameLast Name
Date

MonthDayYear
Date
Thank you!
Should be Empty:

Student Registration Form for Lab Classes (One per child)

Emergency Contact Information

Individuals allowed to pick up student

Medical Information

Permission to be photographed

Technology use agreement

Permission to leave campus for lunch (age 13+)

Permission to leave after class at end of day unaccompanied (Only students 5th - 8th grade)

Permission to go to the Park

Thank you!