H.O.I.S.T.  Application 2022-2023
H.O.I.S.T. stands for Helping Our Incredible Student Triumph.  It is a 21st Century funded after-school program that focuses on Academic Tutoring, Homework Help, Enrichment Activities, Mentoring, and Field Trips.   The program meets every Monday-Thursday from 3-5 pm.  
Name of Student:
Student NPS Email Address:
Grade Level
Clear selection
Student Home Address:
Shirt Size (Adult sizes)
Clear selection
Parent/Guardian Name:
Parent/Guardian Phone Number:
Parent/Guardian Email Address:
Emergency Contact Name:
Emergency Contact Number:
Is your student a bus rider who would require transportation after school?
Clear selection
Does your child have any allergies?
Clear selection
If yes, what are they?
Can your child take part in our meal program?
Clear selection
List all individuals who are authorized to pick up your child.
Please list any existing medical conditions:
I give permission to the H.O.I.S.T. program staff to take whatever emergency measures are judged necessary for the care and protection of my child while under their supervision.  In case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency team deems it necessary.  It is understood that in some medical situations the H.O.I.S.T. staff will need to contact local emergency resources before parents/guardians, the child's physician, and/or other adults acting on the parents/guardians behalf are notified.  I understand that any expenses incurred will be the child's parent/guardian responsibility.  
Clear selection
I give permission to the H.O.I.S.T. program to publish any and all pictures of my child taken during the duration and implementation of this program.
Clear selection
I give permission for my child to participate in field trips during the course of the H.O.I.S.T. program.
Clear selection
I understand that my child will be under the direct supervision and care of the H.O.I.S.T. program staff.  I will not hold the program staff, any volunteers. or Norview Middle School responsible for any injuries or loss of property which may be sustained by my child as a direct or indirect result of participating in the H.O.I.S.T. program.
I understand that my child will be transported at times in the H.O.I.S.T. program for fields trips and other special circumstances.  While en route, my child will be under the direct supervision of the driver and will be subject to all regulations set for the safety of the child.  I will not hold the driver, H.O.I.S.T. program staff, volunteers, or Norview Middle School responsible for any injuries or loss of property which may be sustained as a direct or indirect result of this service.  
Clear selection
Students are expected to follow all bus rules and regulations while riding the bus.  Failure to follow the expectations listed below will result in removal of bus privileges and the student's parent or guardian will be responsible for transportation for the remainder of the program.   Expectations are as follow and each should be checked.
Clear selection
By typing your name you understand everything written above and are signing your child up for the H.O.I.S.T. Program.
Date Signed
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Norfolk Public Schools.
Google Forms