GENIUS HOURS REGISTRATION
Name
Your answer
Age
Your answer
Birthday
MM
/
DD
/
YYYY
Parent / Guardian
Your answer
Phone Number
Your answer
Address
Your answer
Email
Your answer
Emergency Contact (Person and Phone Number)
Your answer
Please, explain medications, illnesses, allergies, or any other medical information that we need to be aware of.
Your answer
Do you authorize emergency medial care in the event that a parent/emergency contact can not be reached?
Do you authorize TCA to use pictures, videos, and/or artifacts of or by your student for promotional materials including the website, Facebook, newspaper, etc?
Do you and your student agree to the TCA Code of Conduct? Code of Conduct: Avoid disruptive behavior including but not limited to:using profanity,displaying jewelry, clothing, other accessories that relate to gangs, violence, or illegal substances,fighting, threatening, stealing, damaging property, or endangering the well-being of self or others in person or online.
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