RETURNING STUDENT REGISTRATION FORM FOR CHILDREN
Fill out one Registration Form per family.
#1 Student’s full name (first, middle, last) *
Your answer
Date of Birth (mm/dd/yyyy) *
MM
/
DD
/
YYYY
#2 Student’s full name (first, middle, last)
Your answer
Date of Birth (mm/dd/yyyy)
MM
/
DD
/
YYYY
#3 Student’s full name (first, middle, last)
Your answer
Date of Birth (mm/dd/yyyy)
MM
/
DD
/
YYYY
Language the child/children want to study *
Which branch will your child/children attend? *
Required
Mother/ Parent 1/ Legal Guardian’s name
Your answer
Father/ Parent 2/ Legal Guardian’s name
Your answer
Has any of the previously provided information changed?
If you select NO we will use information provided last semester. If you select YES, please provide the updated information.
Yes
No
Address
Phone number
Email
Medical information
Allergies information
Emergency contact information
If you replied YES to any of the above questions, provide the new information here:
Your answer
Payment Options *
Bring your payment in the form of a check to the first class OR send your check to the school’s address: CZECH AND SLOVAK SCHOOL OF NORTH CAROLINA, 6 Barrington Pl., Durham, NC 27705. Visit the PROGRAMS page for the fees structure for Durham (http://www.czechslovakschoolnc.org/childrens-classes---durham.html) and Charlotte (http://www.czechslovakschoolnc.org/childrens-classes---charlotte.html). I agree to pay the full tuition for the child/children listed above using one of the payment options available. I understand that I am committed for the whole semester and that the tuition fees are non-refundable. If exceptional circumstances arise (prolonged illness, unexpected family situation, etc.) a refund for paid tuition may be issued. It is always at the discretion of the Czech and Slovak School of North Carolina to determine the level of the refund.
VolunteerAgreement *
As a non-profit organization, we rely on our volunteers. Every family attending classes at the Czech and Slovak School of North Carolina is asked to volunteer 4 (four) hours per semester. You may select from one of the following two options. We truly appreciate your help. Thank you! A list of volunteer opportunities to fulfill the volunteer requirement will be provided at the beginning of the semester.
Right to use images *
I understand that the Czech and Slovak School of North Carolina may produce or participate in video, motion picture, audio recording, web pages, still photographs, broadcast, social media, and/or other publications which may involve the use of students’ images, video or voice. Such productions will be used for non-commercial education, exhibition, or promotional purposes and will not be sold for any reason.They may be copied, copyrighted, edited, and/or distributed by the Czech and Slovak School of North Carolina in the manner described above. By checking YES and initialing below, I grant the Czech and Slovak School of North Carolina the right to use and re-use the images, video or audio of my child/children in the manner specified above. I waive the right of prior approval and hereby release the Czech and Slovak School of North Carolina, its agents or its designees from any and all claims for damages or remuneration of any kind based on the use of said materials.I have read the information above and fully and completely understand the contents thereof and accept or reject these terms and conditions as indicated below:
Sharing contact information *
To facilitate social interaction among students, the Czech and Slovak School of North Carolina may share contact information within the school community. Distribution is limited to the Czech and Slovak School of North Carolina families and staff for internal school use only. We will not share your information with any third party groups. If you not wish to have contact information shared in this way, please indicate by checking DO NOT below.
WAIVER OF LIABILITY *
The Czech and Slovak School of North Carolina is a non-profit public benefit organization. As condition of enrollment I hereby agree to the following: I understand and agree that, as a condition of my child/children being accepted at the Czech and Slovak School of North Carolina, I shall not hold liable the Czech and Slovak School of North Carolina, their employees, directors, officers, volunteers or agents for any accidents which may occur in connection with any activity of the Czech and Slovak School of North Carolina before, during, or after school hours, or involving any event, gathering, or occasion that I and/or my child/children attend as a result of connection with the Czech and Slovak School of North Carolina.I am aware that by signing below I have agreed to assume full legal liability for all rights involved in a participation in the Czech and Slovak School of North Carolina program and further that I have waived certain legal rights, including my right to sue.I am the parent or legal guardian of the child/children named above.I have read and understood this form in full and I agree to register my child/children at the Czech and Slovak School of North Carolina.I agree to abide by the rules and regulations of the Czech and Slovak North Carolina and my child/children will do the same. ............................................................................................................................................................................................................Parent/Guardian - Type your name
Your answer
ADDITIONAL POLICIES
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Data Protection Policy: All information provided in this form is for internal purposes only. It is treated as confidential and will not be shared with third parties.
Non-Discrimination Policy The Czech and Slovak School of North Carolina is committed to providing a learning environment that is free from discrimination and open to all students. The school does not discriminate on the basis of race class, religion, gender, age, ability, and national or ethnic origin.
If your child/ren will to be picked up/dropped off by anyone else than parents/guardians listed in this form, please print out this form, sign and bring it to the class or email it to us: https://docs.google.com/document/d/1U63uDwOi0e_Mg_l79jLx7QsuUaHIqXvuZNqqmUsQRUA/edit?usp=sharing
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