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 email@example.com.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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Relation of Registrant to Attendee* Attendee Name* First Last Gender* Female Male Other Birth Date* MM slash DD slash YYYY Grade* School Name* Parent/Guardian InformationParent/Guardian 1 Name First Last Parent/Guardian 1 Relationship Parent/Guardian 1 PhoneParent/Guardian 2 Name First Last Parent/Guardian 2 Relationship Parent/Guardian 2 PhoneAccommodations and AllergiesPlease 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:WaiverHold Harmless WaiverMEarth 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 PaymentRegistration for One Student Price: Registration for One Student (CUSD Teacher) Price: CAPTCHACommentsThis field is for validation purposes and should be left unchanged.