2023 Afterschool is Cool at MEarth!

Thank you for registering for Afterschool is Cool at MEarth! This afterschool program will occur on March 24th from 1 PM - 4 PM at the Hilton Bialek Habitat. All students and all ages are welcome to join us. Students are encouraged to bring their lunches to eat between 12:30-1:00. Programming begins at 1 PM. The total registration cost for one student is $40. If you are a CUSD teacher and you are registering your child, please register using your CUSD email for a discounted price. You must fill in this form for each student you are registering, and a registration form must be completed before March 24th to ensure participation in the program. Carpooling is encouraged for student drop off as a parent/guardian does not need to be present; however **a parent/gaurdian must be present for pick up.** Drop off and pick up will occur in front of Carmel Middle School with a MEarth Staff member. If you have any additional questions, please feel free to reach out to info@mearthcarmel.org.

Registrant Name*

The name of the person filling out this registration form.

First Last

Are you a CUSD teacher?*

Yes
No

Email*

If you are a CUSD teacher, please register using your CUSD email for a discount.

Address*

Street Address Address Line 2 City State ZIP Code

Relation of Registrant to Attendee*

Attendee Name*

First Last

Gender*

Female
Male
Other

Birth Date*

Grade*

School Name*

Parent/Guardian Information

Parent/Guardian 1 Name

First Last

Parent/Guardian 1 Relationship

Parent/Guardian 1 Phone

Parent/Guardian 2 Name

First Last

Parent/Guardian 2 Relationship

Parent/Guardian 2 Phone

Accommodations and Allergies

Please explain any special accommodations that your child needs:

Does your child have any allergies?*

Yes
No

Please explain:

Does your child have any medical or behavioral issues which will require special attention from our staff?*

Yes
No

Please explain:

Does your child take any medications?*

Yes
No

Please explain:

Waiver

Hold Harmless Waiver

MEarth will collect a Hold Harmless Liability waiver for every student who is registered before their entry into the afterschool program. You can submit your Hold Harmless through DocuSign. You will recieve a link after you submit your registration form, or you can also use the following link to submit your Hold Harmless waiver. https://mearthcarmel.org/hold-harmless-submission/

Waiver Statement:*

I understand that checking the Terms & Conditions box below, and clicking the "Continue" button acknowledges that I have read, understand, and agree to the terms and conditions outlined herein as a condition of my child's participation in the MEarth program for which I am registering them. I further understand that checking the Terms & Conditions box below and clicking the registration “Continue” button has the same force of law as my original signature. I understand that I am not obligated in any way to make such agreement, except as a prerequisite to my child's participation in this program. By checking the box below and clicking the "Continue" button, I agree that all information submitted in this form is true and accurate to the best of my knowledge. I understand that checking the Terms & Conditions box below and clicking the "Continue" button acknowledges that, in accordance with national and county guidelines for safety measures and protocols related to Covid-19, my child will be required to adhere to such preventative measures as wearing a face mask, physical distancing, and frequent hand washing and/or sanitization during this program. I understand that my child's inability to adhere to these required measures may result in their removal from the program without a refund of registration fees.

I agree

Payment

Registration for One Student

Price:

Registration for One Student (CUSD Teacher)

Price:

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Comments

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