Graceful Opportunities Career Academy

Graceful Opportunities
Graceful Opportunities Career Academy Application
1. Enrollment Application
Participant Information:
Full Name:*
Preferred Name/Nickname:
Date of Birth:*

MonthDayYear
Date
Address:*
Phone Number:*
Format: (000) 000-0000.
Email:*
example@example.com
Emergency Contact:
Name:*
Relationship:*
Phone:*
Format: (000) 000-0000.
Guardian/Representative (if applicable):
Name:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
PhoneEmailText
MedicaidSSI/SSDIVocational RehabWaiver ServicesCase Management
2. Code of Conduct Acknowledgement
I understand that the Graceful Opportunities Career Academy is a safe, respectful, and inclusive environment. I agree to:
- Treat others with kindness and respect
- Use respectful language
- Follow directions from staff
- Respect the property of others and Graceful Opportunities Career Academy
I understand that repeated violations may result in a behavior support plan or program review.
Participant Signature:*
Date:*

MonthDayYear
Date
Guardian Signature (if applicable):
Date:

MonthDayYear
Date
3. Consent for Participation and Liability Waiver
I hereby give permission for myself/my child to participate in all educational, vocational, and recreational activities of Graceful Opportunities Career Academy. I understand that all reasonable precautions will be taken to ensure safety. I release Graceful Opportunities Career Academy/Grace Reliant Health Services, its staff, and affiliates from any liability resulting from accidental injury during participation.
Participant Name:*
Signature:*
Date:*

MonthDayYear
Date
Guardian Signature (if applicable):
Date:

MonthDayYear
Date

4. Photo/Video Release Form
DODO NOT
Participant Name:*
Signature:*
Date:*

MonthDayYear
Date
Guardian Signature (if applicable):
Date:

MonthDayYear
Date
5. Attendance, Virtual Service Policy, and Participation Agreement
Participant Name*
I acknowledge and agree to the following policies related to attendance and participation in services at Graceful Opportunities Career Academy, including both in-person and virtual formats:
Virtual Delivery in Place of In-Person Services
If in-person services are canceled or otherwise unavailable (due to weather, emergencies, or other circumstances), Graceful Opportunities Career Academy may deliver services virtually using approved online platforms such as Zoom, Microsoft Teams, or Google Meet. I give my permission to participate in virtual services when in-person programming cannot be held.
Confidentiality
Graceful Opportunities will take reasonable steps to protect the privacy and confidentiality of participants during virtual service delivery. However, I understand that confidentiality cannot be absolutely guaranteed when using internet-based communication platforms.
Attendance and Participation Expectations
Regular attendance and active participation are essential to student success. I agree to:
- Arrive on time to the best of my ability
- Communicate absences ahead of time whenever possible
- Participate in scheduled activities during in-person or virtual sessions
I understand that excessive absenteeism may lead to a team meeting to reassess my goals and participation in the program.
Participant Signature:*
Date:*

MonthDayYear
Date
Guardian Signature (if applicable):
Date:

MonthDayYear
Date
Staff/Witness Signature:
Date:

MonthDayYear
Date
6. Technology Use Agreement (if applicable)
I agree to use Graceful Opportunities Career Academy computers, tablets, and internet access responsibly. I will:
Use devices for learning, job training, or communication
Not access inappropriate or unsafe content
Ask for help if I don't understand how to use something
Inappropriate use may result in supervised access or technology restrictions.
Participant Signature:*
Date:*

MonthDayYear
Date
Guardian Signature (if applicable):
Date:

MonthDayYear
Date
Should be Empty:

Graceful Opportunities

Graceful Opportunities Career Academy Application

1. Enrollment Application

2. Code of Conduct Acknowledgement

3. Consent for Participation and Liability Waiver

4. Photo/Video Release Form

5. Attendance, Virtual Service Policy, and Participation Agreement

6. Technology Use Agreement (if applicable)