Tiempon Minagof Student Registration

Tiempon Minagof

CHamoru Immersion After-school Program
AGES: 3 - 10

DAYS | TIME: Monday - Friday | 3:00pm - 5:00pm

LOCATION: P.C. Lujan Elementary School, Barrigada, GU
REGISTRATION FEE :

$75.00 per child

TUITION:

1 child - $250.00/mo

FAMILY RATES*

2 children - $485.00/mo

3 children - $720.00/mo

4 chlildren - $955.00/mo

*Please note that family rates will only apply to siblings.
OTHER FEES:

Late Payment: 10% of Tuition Balance Due to be charged after the 10th of every month

Bus Fee: Parents will be notified as needed.

Late Pick-up Fee: $25.00 will be charged after 5:15pm

PAYMENT MUST BE MADE AT TIME OF PICK-UP

As a security measure, all students will be required to wear Chief Hurao Academy t-shirts daily.

Available for purchase at our office.

T-Shirt: $20.00 each
STEPS TO REGISTER:
1. Complete Tiempon Minagof Registration Form (below)
2. Visit our office located at P.C. Lujan Elementary School, Monday to Friday from 9:00am - 2:00pm to make payment. Payment may be made via CASH or CHECK* ((payable to Chief Hurao, Inc.) *Return Check Fee: $50.00
3. Purchase t-shirts, if needed.
PLEASE NOTE:
- Due to limited slots in the program, all registrants will be enrolled on a first come first serve basis.
- Completion and submission of this form does not guarantee that your child(ren) will be enrolled in Tiempon Minagof 2022. You will recieve notification of enrollment upon payment of registration and tuition fees.
ALL REGISTRATION AND TUITION FEES ARE NON-REFUNDABLE
We want to reassure you that we are determined to create the safest environment for our students and eliminate as many risks as possible, while still nurturing their CHamoru immersion education and promoting the instillation of their self-identities.
- IT IS IMPERATIVE THAT ANY STUDENT WHO IS FEELING UNWELL OR EXHIBITING ANY COVID-19 SYMPTOMS, NO MATTER HOW MILD, BE KEPT HOME.
- MASKS WILL BE OPTIONAL
- ROUTINE AND FREQUENT HAND-WASHING, AND REGULAR SANITIZATION OF ALL SPACES WILL BE IMPLEMENTED.
I will be registering*

1 Child2 Children3 Children4 Children5 Children6 Children
Enfotmasion Estudiånte

Student Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Gender*

MaleFemale
Religion
(Optional)
Cultural Ethnicity*
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe. If none, please type none.*
Is your child prescribed any medication that needs to be administered? If yes, please explain any instructions. If none, please type none.*
Child 2's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Religion
(Optional)
Cultural Ethnicity*
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is your child prescribed any medication that needs to be administered? If yes, please explain any instructions.*
Child 3's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Religion
(Optional)
Cultural Ethnicity*
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is your child prescribed any medication that needs to be administered? If yes, please explain any instructions.*
Child 4's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Religion
(Optional)
Cultural Ethnicity*
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is your child prescribed any medication that needs to be administered? If yes, please explain any instructions.*
Child 5's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Religion
(Optional)
Cultural Ethnicity*
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is your child prescribed any medication that needs to be administered? If yes, please explain any instructions.*
Child 6's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Religion
(Optional)
Cultural Ethnicity*
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is your child prescribed any medication that needs to be administered? If yes, please explain any instructions.*
Enfotmasion Mañaina

Parent/Guardian Information
PARENT 1:
Name*

First NameLast Name
MotherFatherLegal Guardian
Sole CustodyJoint CustodyDoes not apply
E-mail*
example@example.com
Home Number*
Cell Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT 2:
Name

First NameLast Name
MotherFatherLegal Guardian
Sole CustodyJoint CustodyDoes not apply
E-mail
example@example.com
Home Number
Cell Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emfotmasion Diripente

Emergency Information
Emergency Contact (Other than parent)*

First NameLast Name
Relationship to Child*
Phone Number*
Alt. Phone Number*
Otro Mås na Enfotmasion

Other Information
What influenced you to enroll your child in Tiempon Minagof?*

AdvertisementFamily/FriendsActivities offeredLocationDesire to teach my child(ren) CHamoruOther
What is your child(ren)'s first language?*
What other CHamoru classes has/have your child(ren) attended?*
Additional comments:
Authorized Pick-up

Other than Parent(s)/Guardian
Aside from the parent(s)/guardian(s) listed above, your child(ren) will only be released to the people designated below.
Name

First NameLast Name
Relationship to child
Phone Number
Name

First NameLast Name
Relationship to child
Phone Number
Name

First NameLast Name
Relationship to child
Phone Number
MEDIA WAIVER AND RELEASE

I consent to having my child(ren) photographed, interviewed, and/or videotaped by representatives of CHIEF HURAO, INC. and/or media outlets (newspaper, T.V. stations, etc.) in relation to CHIEF HURAO, INC. I understand that CHIEF HURAO, INC. uses photos / videos of children in publications to share information about its programs and the promotion of the CHamoru language and culture. Any images/videos obtained may be reproduced by CHIEF HURAO, INC. and/or public media for use in advertising, publicity, or educational activities. CHIEF HURAO, INC. publications include, but are not limited to: the website, advertisements, annual reports, posters, banners, bulletin boards, and other public relations mediums.

I hereby waive any claims I may have, and release CHIEF HURAO, INC., its employees, officials, volunteers, and associates from any liability or claims that may arise out of such activities. This release is valid indefinitely, unless otherwise stated, to the fullest extent allowable by Guam Law.
YES, my child(ren) may be photographed, interviewed, or videotaped for media use.NO, my child(ren) may not be photographed, interviewed, or videotaped for media use.
WHATSAPP CONSENT*

YES, please add BOTH PARENTS/GUARDIANS to the Tiempon Minagof 2022 WhatsApp Group to receive notices and updates throughout the duration of the program.YES, please add me (PARENT/GUARDIAN) to the Tiempon Minagof 2022 WhatsApp Group to receive notices and updates throughout the duration of the program.NO, I decline. I would not like to be added to the Tiempon Minagof 2022 WhatsApp Group.
I understand that ALL FEES AND TUITION ARE NON-REFUNDABLE.
PARENT/FAMILY COMMITMENT*

As a full CHamoru language FAMILY immersion program, Chief Hurao Academy's Tiempon Minagof requires parent/family participation. By completing and submitting this registration form, I/we commit ourselves to attend Chief Hurao Academy's Eskuelan Mañaina (Parent Classes) for the duration of my/our child/ren's enrollment in the Tiempon Minagof program and agree to also implement the use of CHamoru language at home with my/our child(ren).
WAIVER AND RELEASE OF LIABILITY AGREEMENT

I, the undersigned, hereby represent that I am the parent/guardian of {childsName}{child2s}{child3s}{child4s}{child5s}{child6s} and agree to the following:

I understand and agree to a full and complete waiver and release of any and all liability (“Liability Release”) on the part Chief Hurao Academy in connection with my Child(ren)’s attendance at the Chief Hurao Academy and participation in all Chief Hurao Academy activities, including, but not limited to, playground activities, classroom activities and field trips taken in connection with the Chief Hurao Academy.

I understand and agree that this Liability Release will apply to the entire duration of my Child(ren)’s attendance at the Chief Hurao Academy and participation in all Chief Hurao Academy activities.

I further authorize anyone working at the Chief Hurao Academy to obtain medical care for my Child(ren) or to transport my Child to a clinic or hospital if, in the opinion of anyone working at the Chief Hurao Academy, medical attention is needed for my Child(ren). Chief Hurao Academy staff will inform me if the need should arise.

I agree that if the Chief Hurao Academy releases my Child(ren) to me, my designee, an ambulance or other medical transport, a medical facility, a clinic or a hospital, that the Chief Hurao Academy staff shall not have any further responsibility for my Child(ren).

I agree to pay all costs associated with such medical care and related transportation for my Child(ren) and indemnify and hold the Chief Hurao Academy, its representatives and agents harmless from any costs incurred in connection with such medical attention or any related claims.
I acknowledge that we have carefully read this Liability Release and understand its contents.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Parent/Guardian Signature*

Clear
Should be Empty:

Tiempon Minagof

Enfotmasion Estudiånte

Enfotmasion Mañaina

Emfotmasion Diripente

Otro Mås na Enfotmasion

Authorized Pick-up