Registration Form

Student Name:
Date of Birth:
Grade Level:

Home Address:
Zip Code:

Parent / Guardian Name:
Contact telephone number:

Second adult contact name:
Relationship to student:
Emergency contact number:
Are there any allergies, medical conditions or other concerns that we should be aware of? :

This is my application to enroll the named student in the Great Teachers’ Academy program. I understand that this program has been sponsored and no payment is required.

I agree to ensure that the student arrives in a timely manner and any absences are notified in advance and agree to give at least 14 days notice of withdrawal.

I understand that the student must be collected at the time that class ends (3pm) or at the latest within 15 minutes thereafter.

I understand that class takes place in a professional environment and that students must deport themselves appropriately.

I understand that drinking water is available at all times but the student should either bring snacks / food or money to purchase same at the in-house snack bar.

I understand that the student will need to bring to class a laptop computer that can access the Internet via WiFi and to maximize the benefit of the program, home Internet access will be required.

Typing your full name in the signature box will constitute your agreement and digital signature.