Student(S) Names, Date of Birth, and Grade in School

Student(s) names, date of birth, and grade in school:

1)______DOB______Grade______

2)______DOB______Grade______

3)______DOB______Grade______

Parent(s) name(s)______

Address______city______zip______

Parent’s email address______

Home phone______work______cell______

EMERGENCY INFORMATION

Are there health issues about which we should be aware? Yes_____ No _____

If yes, please explain: ______

In case of emergency, we will call you first. If you are not available, who else should be contacted?

#1 ______phone # ______

#2 ______phone # ______

Do you have medical insurance that will cover accidental incidences occurring while your child is on the HomeLink campus or traveling for a field trip? ______

Name the insurer ______

Do we have permission to make emergency health decisions in the event we are unable to reach any of the people on the contact list? Yes_____ No _____

PARENTAL AGREEMENT

Please initial next to each policy below to indicate you have read the statement.

_____ I understand that class fees are to be paid by the 15thof each month from September through

June (10 months), if paying by the month.

_____ I understand that the HomeLink program includes class time, curriculum research and selection,

assignment writing, and grading. Therefore, class fees are due regardless of attendance.

_____ If the student attends more than one session, but then drops the class before the end of the

quarter, a drop fee of $25 will be due.

_____ A student is considered enrolled until a parent completes a withdrawal form.

_____ I give permission to use photos of my student(s) in HomeLink/NARHS promotional materials.

_____ I understand that as a family new to HomeLink, attendance at the HomeLink Orientation and the

“Getting Started” classes is mandatory for parents and their students.

Parent signature ______Date______

Please submit registration with payment of $15 for 1 student, $25 for more than 1.

On the lines below, list the specific classes for each student you are registering:

______

Student’s Name Student’s Name Student’s Name

#1______#1______#1______

#2______#2______#2______

#3______#3______#3______

#4______#4______#4______

#5______#5______#5______

Parent Qualifications to Home School

The HomeLink Program serves families who comply with school attendance laws. Parents must “qualify” to home school legally. Please indicate under which provision your child fulfills the compulsory school attendance laws in Washington.

_____ I have 45 college credits.

_____ I have completed the 10-hour home school parent qualifying course.

_____ I will meet with a state-certified teacher once a week who will supervise

our home schooling program.

_____ I will file my “Intent to Home School” form with the school district.

Qualifying parent’s signature ______

Mail this form with the registration fee to:

HomeLink, 14 South 6th Ave., Yakima, WA 98902