Foundations/Essentials Registration
Please copy the entire form and paste it to the body of an email and submit it to Jessica Herbert at jessicacctampa@gmail.com. Please complete this form in its entirety. She will send you a confirmation email upon receipt of your registration form.
Classical Conversations® Program Participation in Foundations/Essentials/Tots Email Registration Application for 2014-15
Parent(s)/Guardian(s) Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email Address:
Foundations Program (Grades K4-6th)
Student 1
Name:
Age:
DOB:
Grade:
Number of years in previous Foundations Program?
Student 2
Name:
Age:
DOB:
Grade:
Number of years in previous Foundations Program?
Student 3
Name:
Age:
DOB:
Grade:
Number of years in previous Foundations Program?
Student 4
Name:
Age:
DOB:
Grade:
Number of years in previous Foundations Program?
Student 5
Name:
Age:
DOB:
Grade:
Number of years in previous Foundations Program?
Essentials Program (Grades 3rd-6th)
Student 1
Name:
Age:
DOB:
Grade:
Number of years in previous Essentials program?
Student 2
Name:
Age:
DOB:
Grade:
Number of years in previous Essentials program?
Student 3
Name:
Age:
DOB:
Grade:
Number of years in previous Essentials program?
CC Tampa "Tot's" Program (Ages 1-3)
Tot 1
Name:
Age:
DOB:
Allergies or Special Needs?
Tot 2
Name:
Age:
DOB:
Allergies or Special Needs?
Tot 3
Name:
Age:
DOB:
Allergies or Special Needs?
RISK RELEASE WAIVER We, the parents of the children listed above, assume full responsibility for any Accident/Medical Insurance needed to cover our child in case of accidental injury, or the like, while our child is attending Classical Conversations®. We will not hold Classical Conversations® responsible in any manner for injury.
Please confirm the foregoing by typing your digital signature s/Full Name (for example, "s/Jane Doe").This will act as your legal signature.
s/
Date:
We the parents of the children listed above fully satisfy the laws of the state in which we currently reside with all the rights and privileges as outlined in our state’s home school laws. We understand that we are primarily responsible for our child’s education and that Classical Conversations® is a complementary service to our home school program.
Please confirm the foregoing by typing your digital signature s/Full Name (for example, "s/Jane Doe").This will act as your legal signature.
s/
Date:
We agree to pay the first year's tuition for our Foundation and/or Essentials programs and/or the full semester's tuition is due for our Challenge programs whether our child finishes the program or not.(This is standard practice among private school options and should be carefully considered before enrolling your child.)
Please confirm the foregoing by typing your digital signature s/Full Name (for example, "s/Jane Doe").This will act as your legal signature.
s/
Date:
Classical Conversations, Inc. is a registered business name. Please do not use it to name your school with your state department of education. We suggest Smith’s Classical Academy or something similar. Please feel free to use Classical Conversations® as your curriculum source. DO NOT enroll your home school in partnership with Classical Conversations® on your state’s home school registrationform. We are a tutoring service, not a school. Classical Conversations® admits students of any race, color, national and ethnic origin to all the rights and privileges, programs, and activities made available to enrolled students. It does not discriminate on the basis of race, color, national, or ethnic origin in administration of its educational policies, admission policies, or tuition assistance, nor in hiring facilitators, tutors, or administrators. We are a Christian organization and hold to the orthodox doctrines of the Christian faith.
Please confirm you understand the foregoing by typing your digital signature s/Full Name (for example, "s/Jane Doe").This will act as your legal signature.
s/
Date:
RELEASE & AUTHORIZATION TO USE NAME, IMAGE & LIKENESS
Program / Seminar / Activity: __________________________________________________________
I, the undersigned, hereby grant Classical Conversations, Inc., its subsidiaries and affiliates, its officers, directors, employees, and its agents (“Classical Conversations”), permission to use, exploit, adapt, modify, reproduce, distribute, publicly perform and display, in any form now known or later developed, my name, image, likeness, and/or voice (my “Likeness”) throughout the world and to incorporate or publish my Likeness in publications, catalogues, brochures, books, magazines, exhibits, motion picture films, videotapes, internet and/or other media (the “Works”), and any commercial, informational, educational, advertising, or promotional materials related thereto.
I release and agree to indemnify, defend, and hold harmless Classical Conversations, its agents, and assigns (the “Released Entities”) from any and all claims I may have now or in the future for invasion of privacy, rights of publicity, copyright infringement, defamation, or any other cause of action arising out of the use, exploitation, reproduction, adaptation, distribution, broadcast, publication, performance, or display of my Likeness.
I waive and forego any right to inspect or approve any Works that may be created using my Likeness and waive any claim with respect to the eventual use to which my Likeness may be applied. My Likeness may be used at Classical Conversations’ sole discretion alone or in conjunction with any other material of any kind or nature.
I understand and agree that Classical Conversations is and shall be the sole and exclusive owner of all right, title, and interest, including but not limited to copyright and rights of publicity, in the Works and any commercial, informational, educational, advertising, or promotional materials related thereto.
I am of full legal age, and I have read this Release & Authorization and understand its contents. By the signature(s) below, a minor child’s parent(s) or legal guardian(s) indicate, on behalf of their minor child, their full and unqualified consent to the terms of this Release & Authorization.
Name:_________________________________________________ Age:__________________
Signature:______________________________________________ Date:_________________
Parent(s)/Guardian(s):____________________________________ Date:_________________
(For use of Minor’s Likeness)
Signature of Parent(s)/Guardian(s):________________________________________________
FAMILY COVENANT As parents we recognize the value in committing our time and talents to a dedicated community of Homeschoolers. We agree to the following:
1. We understand that it is strongly recommended to attend a CC Parent Practicum (if within 100 miles) prior to starting the Classical Conversations Foundations, Essentials, or Challenge Program to more fully understand the classical model of instruction.
2. We understand that we are fully responsible for our child’s education and that the Classical Conversations Foundation/Essentials/Challenge/ program will enhance that education.
3. We understand that purchasing the required materials from classical conversations at www.ClassicalConversationsBooks.com will help keep tuition costs as low as possible and supports Classical Conversations’ vision.
4. We understand that we are contractually obligated to pay the entire semester's tuition even if we leave the CC Central Tampa campus mid-year (Foundations/Essentials) or mid-semester (Challenge).
5. We understand that the $120 registration fee per student is non-refundable and non-transferable.
6. We understand, as parents, we are the primary teachers of our children. We will ensure that our children complete any work given by the Tutor to the best of their abilities.
Please confirm the foregoing by typing your digital signature s/Full Name (for example, "s/Jane Doe").This will act as your legal signature.
s/
Date:
COMMUNITY COVENANT As PARENTS we recognize the need to work in community to create a quality educational experience for us and for our children. We hope to develop a community of godly friendships with other families and students of every age. Our common goal is “To glorify God and Make Him Known.” In compliance to our Campus Policies and Procedures, I agree with the following... I understand and agree to abide by what is expected of what is expected of Challenge Parents, Students, and Tutors. I understand and agree to abide by the dress code, conduct, and discipline policies. I will follow the Mathew 18 model of conflict resolution and will refrain from gossip. I understand and agree to abide by the campus, food, drink, and cleaning policies. I will seek to serve well and to encourage the same in my children.
Please confirm that you have read and understood the Policies and Procedures on the CC Tampa campus website and agree to the foregoing by typing your digital signature s/Full Name (for example, "s/Jane Doe").This will act as your legal signature.
s/
Date:
STUDENT COVENANT As STUDENTS we recognize the privilege to participate and enjoy the weekly program meetings. We commit ourselves to the following:
1. Appropriately participating in class.
2. Respecting my Tutor/Director in words and actions
3. Working on weekly program work to the best of my ability.
4. Honoring my peers and other students in the program in words and actions.
5. Being on the ready to help wherever I can with a servant’s heart and to care for our facility.
6. Being calm and quiet in a classroom setting.
Please type Student's signature
s/
Date:
Your Registration is not considered complete until all fees are received
Foundations Program Registration Fees = $75 per child ($50 for each sibling thereafter)
Essentials Program Registration Fees = $75 per child ($50 for each sibling thereafter)
Please submit a check made out to Jessica Herbert to the following address. Thank you.
Jessica Herbert
29311 Yarrow Drive
Wesley Chapel, Fl 33543
"Train up a child in the way that he should go, and when he is old he will not depart from it.”