Registration – Homeschool STEAM Homeschool Registration Form - March Programs Name of child* First Last Age* Grade* Please Register my 5-14 year old for the upcoming Homeschool STEAM Program Series* Tuesdays (Mar.) Thursdays (Mar.) Both Days (Mar.) How did you hear about Homeschool Programs at The Phoenix School?* Facebook/Social Media Direct Mail Homeschool Group Email From a Friend Other Other: Please indicate What Homeschool Groups and/or Preschools are you connected with?* Parent's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Preferred Phone Number*Alternate Phone Number2nd Parent's Name (if applicable) First Last Email* Your Child's Allergies and other Medical Conditions*Please list all allergies, including food, environmental and pharmaceutical. List any medical conditions or limitations. if none, please list "none". I give permission to The Phoenix School to take, use, publish, and reproduce photos, slides, or videos of my child for its records and/or publications.* Yes No Please indicate if we may use your child's photo. The following waiver must be signed to complete registration: Permission is granted for my child to participate in all planned Phoenix School activities; understanding that competent leadership and supervision will be provided. I understand that programs that do not meet the minimum enrollment may be cancelled or changed Digital Signature - Permission to participate* Authorization for Medical and/or Surgical Treatment and for Release of Information Every effort is made to contact and inform the parents or guardians in case of a medical emergency, serious injury, or illness when immediate medical or surgical intervention is deemed necessary. On isolated occasions the parents or guardian cannot be reached. Accordingly, they are requested to sign the following statement: In the event of illness or accident involving our/my son/daughter, we/I hereby give permission to The Phoenix School, its officials, and the treating physicians, surgeons, and dentists, to secure and furnish medical, dental, or surgical care and treatment for him/her and to give, administer, and render any treatment or aid, including anesthetics or surgery, as is necessary to protect, preserve, and safeguard the life and health of our/my son/daughter. We/I further authorize The Phoenix School to release information to facilitate the medical or surgical care of our/my son/daughter, as is necessary for the completion of a claim for health insurance. I give permission to the Homeschool Day instructor to share information relevant to my child’s health condition with appropriate school personnel when needed to meet my/our child’s health and safety need.Digital Signature - Permission to Treat and/or to Release Medical Information as per the above Authorization Form* Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Δ Search for: Recent Posts Embracing Open-Ended Learning: Why It Benefits Your Child The Phoenix School: Laying the Foundation for Lifelong Success – Investing in Elementary & Middle School Education Personalized learning is at the heart of our educational philosophy. Unlocking Potential: The Power of a Well-Rounded Education at The Phoenix School One of the biggest advantages of The Phoenix School… Archives September 2023 July 2023 May 2023 April 2023 March 2023 October 2022 August 2022 July 2022 June 2022 April 2022 March 2022 May 2020 January 2020 June 2019 May 2019 April 2019 March 2019 November 2018 September 2018 August 2018 February 2018 October 2017