Parent/Guardian Name *

First Name

Last Name

Alternate Caregiver Name

If another parent/caregiver will bring your child(ren) to SPARK sometimes please provide their name.

First Name

Last Name

Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child #1 *

First Name

Last Name

Child #1 Birthdate *

MM

DD

YYYY

Child #2

First Name

Last Name

Child #2 Birthdate

MM

DD

YYYY

Child #3

First Name

Last Name

Child #3 Birthdate

MM

DD

YYYY

Child #4

First Name

Last Name

Child #4 Birthdate

MM

DD

YYYY

Child #5

First Name

Last Name

Child #5 Birthdate

MM

DD

YYYY

Please Select Your Enrollment Choice *

Check "Mondays-Full Summer" if you plan to attend all 8 dates OR check the 5 dates you plan to attend

Mondays – Full Summer

Monday 6/3/24

Monday 6/10/24

Monday 6/17/24

Monday 6/24/24

Monday 7/1/24

Monday 7/15/24

Monday 7/22/24

Monday 7/29/24

Emergency Contact *

In case of emergency, list another adult we may contact if you are unavailable.

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Authorization for Medical Treatment *

I hereby authorize SPARK and its officers, agents, volunteers, Instructors, or supervising parents, to seek emergency medical care and/or emergency dental care for my child(ren.) I further authorize SPARK and its officers, agents, volunteers, Instructors, or supervising parent, to receive physical custody of my child upon completion of treatment. I understand that this Authorization for Medical Treatment is ONLY to be used in the case of an extreme emergency when I, the parent/legal guardian of my child(ren), am unavailable or cannot be reached by phone. By checking "I agree" below, I consider the Authorization signed.

I agree and consider this document signed.

I do not agree.

SPARK Co-op Summer Membership Agreement *

By signing this document I am stating I have read, understand, and agree to the SPARK Homeschool Co-op Summer Member Agreement for myself, my family, any children in my charge, and any other caregivers for my child(ren). Once I check "I agree" below, I consider the Agreement signed.

I agree and consider this document signed.

Waiver of Liability, Assumption of Risks and Indemnity Agreement *

I have read the SPARK Homeschool Co-op Waiver of Liability, Assumption of Risks, and Indemnity Agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I confirm that I agree to its terms knowingly and voluntarily. I also confirm that I am the parent or legal guardian of the child(ren) listed on this form. Once I check "I agree" below, I consider the Agreement signed and intend this to be a complete and unconditional release of all liability to the greatest extent allowed by law.

I agree and consider this document signed.

COVID Waiver

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren), myself, or members of my household including, but not limited to, personal injury, disability, and death, illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) or members of my household may experience or incur in connection with my child(ren)’s attendance at the Spark program. On my behalf, and on behalf of my child(ren) and members of my household, I hereby release, covenant not to sue, discharge, and hold harmless Spark, its employees, agents, and representatives, of and from any and all claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto as a result of my child(ren)’s attendance at the Spark program. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Spark, whether a COVID-19 infection occurs before, during, or after participation in any Spark program.

I agree and consider this document signed.

Photo & Video Release *

This question is about SPARK Homeschool Co-op using photos & videos of your family in our public social media, website, or marketing materials. You and your family will not be named in the photos or videos nor any personal information given or printed publicly. These photos and videos can be used even if you are no longer members at SPARK. SPARK uses a closed members only Facebook group for communication and we encourage our members to share photos & videos in this group about our time together so we can see things we've missed and look back on memories. If you do not want photos & videos of your family shared in our closed SPARK Member Families group, please bring it up at a community meeting as well as make a post in the SPARK Member Families group so that everyone is aware and can respect your preferences.

Yes, I give SPARK photo & video release for use on public facing marketing, including but not limited to website & social media.

Yes, I give SPARK photo & video release for use on public facing marketing, including but not limited to website & social media AS LONG AS our faces are covered or not visible.

No, I do not give SPARK photo & video release for use on public facing marketing, including but not limited to website & social media.

What is your preferred form of contact? *

Email

Text Message