Schoolhouse Community Registration Forms

Fill out forms below and hit the SUBMIT button.

Schoolhouse Community Reg Form

Parent/Guardian Name

Church Schoolhouse Location

Home Phone

Cell Phone

Parent/Guardian email

Parent/Guardian address

Emergency Contact name

Cell Phone

PLEASE LIST ALL STUDENTS BELOW (You may print additional sheets if needed.)

Student name

Age

Grade level

Student email (optional)

Classes

Anything staff should know about

Student name

Age

Grade level

Student email (optional)

Classes

Anything staff should know about

Student name

Age

Grade level

Student email (optional)

Classes

Anything staff should know about

By signing this form, I am agreeing to the rules set forth by our Schoolhouse Community concerning registering my students for any classes.

Parent/Guardian signature

Date

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Schoolhouse Community Behavior Agreement Form

Schoolhouse Behavior Form

Parent/Guardian Name

Name of CHURCH Schoolhouse

Schoolhouse Community Behavior Agreement Form

As the parent/guardian of the aforementioned students, I am aware of the rules set forth within this Schoolhouse Community. I understand that it is my responsibility, as the parent/guardian, to remain in communication with any teachers or staff. I will ensure that staff have my updated contact information, and I will check for notifications regularly. I will have my student(s) in class on time. I will pick them up from their classrooms on time. I will stay onsite unless there is an unexpected emergency, in which case an alternate guardian will be designated onsite and the Director will be informed. I will make sure my children understand what is expected of them in regard to classroom behavior and any class work. I understand that instructors or staff may reach out to me in regard to my student(s), and I will work with them in regard to my students’ education. I understand my volunteer responsibilities within the program. I understand that failure on my part to adhere to this agreement will result in my family being asked to leave our Schoolhouse Community.

Guardian Signature

Date

Section

As a student, I am aware of the rules set forth within this Schoolhouse Community or have had a parent go over them with me. I understand the rules that I am expected to follow while at our Schoolhouse. I will arrive at class, with my materials, ready to learn. I will leave tech and toys at home unless bringing for Show & Tell and the tutor or Director has given advance permission. I will do all of my classwork and turn it in on time. I will reach out to my teacher if/when I need help. I will respect my teachers, the church, my classmates, and myself. I understand that failure on my part to adhere to this agreement may result in my removal from the Schoolhouse.

Student Signature

Date

Student Signature

Date

Student Signature

Date

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Schoolhouse Community Emergency Health Form

Schoolhouse Emergency

Name of CHURCH Schoolhouse

Student Name

Parent/Guardian Name

Parent/Guardian Address

City

State

Zip

Parent/Guardian Phone (Home)

Parent/Guardian Phone (Cell)

Parent/Guardian Email

Emergency Contact Name

Emergency Contact Address

City

State

Zip

Emergency Contact Phone (Home)

Emergency Contact Phone (Cell)

If your child has any allergies (medications, foods, insects, etc.), please list below and provide an Emergency Action Plan (Epi-Pen, inhaler, medication, etc.). If there are any other health concerns and/or special needs pertaining to your child(ren), please indicate them below

I, THE UNDERSIGNED, GIVE PERMISSION to the Schoolhouse Community to contact emergency medical personnel in the event of a life-threatening emergency. In the event of an emergency, I further agree to indemnify and hold harmless the Schoolhouse Community, the church, and its agents against all claims as a result of any injury, transport, or treatment

Guardian Signature

Date

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Schoolhouse Medicinal Administration Form

Schoolhouse Medicinal Administration

Parent/Guardian Name

Name of CHURCH Schoolhouse

Student Name

Student Date of Birth

Parent/Guardian Name

Parent/Guardian Phone (for emergency contact)

Parent Email

Medications to be allowed self-administration. Please list the medication name and the dosage guidelines of all medications that the student is allowed to self-administer.

As the undersigned parent, I, ________________________________ (parent name) acknowledge that the student listed on this paper is able to properly administer the medications listed on this paper. I understand that the student listed is completely responsible for keeping medications secured within their personal belongings while on campus. I release all Schoolhouse personnel from any responsibility of administering the listed medications for my student. This agreement shall be valid for the duration of the school year during which it was signed and must be renewed each school year.

Parent Signature

Date

Schoolhouse Director, Print Name

Date

Schoolhouse Director, Signature

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