HCTP 2024 Spring Program Registration Language English (US) Español 1. Student Information Please select a class to register:* SAT Math Prep (For 11th graders only, Sundays 9:15-10:45AM, 10/1-11/19)Math Tutoring (For 1st-4th graders, Sundays 9:30-10:30AM, 10/1-11/19) (Note: This class is ONLY for students who need help to perform at their grade levels.) Name* First NameLast Name Sex* MaleFemale Has your child attended an HCTP program before?* YesNo Current School Name* Please Select 16th Ave Elementary School Gantner Avenue Elementary School Gilbert Avenue Elementary School St. Leo's EP Memorial Middle School Memorial High School Washington Irving School #4 (Garfield) Rising Star Academy Other If you selected "Other" above, please indicate the school name below. Current Grade in School* 1st grade2nd grade3rd grade4th grade11th grade If you have another child(ren) to register, please provide their names below and submit separate registration forms. Back Next 2. Parents/Guardian and Emergency Contact Information Parent/Guardian Name* First NameLast Name What is your relationship to the student(s)* Address* Street Address Street Address Line 2 CityState / Province Postal / Zip Code Primary Phone Number (Cell if available)* Please enter a valid phone number. Confirm Phone Number (Cell if available)* Please enter a valid phone number. Can we use the above phone number to send text?* YesNo Email* example@example.com Confirm Email * example@example.com Emergency Contact Name First NameLast Name Emergency Contact Info Phone NumberEmail Back Next 3. Additional Information a) Medical or Special Needs Allergies or special medical needs (if applicable) Allergies or special medical needs (if applicable) Does your child have an IEP?* YesNo b) Pickup Arrangements Will your child be picked up either by yourself, the emergency contact or an additional authorized person listed below at the end of each class?* YesNo Additional Authorized Pickup Person(s) Name Relation Phone # Person 1 Person 2 c) Laptop SAT Math Prep requires a Windows/Mac laptop in the classroom. Will your child be able to bring a laptop? (We do not use tablets or Chromebooks)* Yes - my child can bring a Windows/Mac laptopNo - my child cannot bring a Windows/Mac laptopNot sure - I’m not sure what kind of laptop I have.Not Applicable (my child is registering for the math tutoring class.) d) Class Deposit/Refund & Attendance HCTP requires a refundable deposit of $100 per child for its program. My child must attend at least 6 out of 8 days of classes to receive the deposit back. I understand HCTP will not return the deposit if there are more than two absences.* YesNo Financial Aid - Please check below if you need financial aid in the form of a reduced deposit. Financial aid requested e) Cancellation Policy Cancellations can be made by writing to contact@hctpedu.org. I understand that HCTP will not issue a refund once the checks are processed.* YesNo f) How did you learn about our fall program? (Please select all that apply) HCTP emailsFacebook (Group = Elmwood Park School Moms)School or its teachers (flyers or email)AcquaintancesEP Recreation ComplexLibraryOther Back Next 4. Authorization and Release I, as the legal guardian of the student(s) named above, give him(them) permission to attend HCTP Summer Camp and participate in any camp-related activities. I assume all risks and hazards incidental to the camp’s activity and transportation (if any), and do further hereby release, absolve and hold harmless HCTP and Hanaim Church and its trustees, officers, directors, teachers, volunteers, staff in case of any incidents or injuries that may occur in relation to the camp and the students above. In the event of an emergency and all the guardians are not available, I give permission for the director or medical coordinator to give authorization for medical treatment. I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or videos of the student(s) registered above for publicity purposes. I understand that HCTP reserves the right to cancel or change its courses, programs, services, or schedule due to lack of enrollment or other necessary reasons. By e-signing my name below, I, hereby, authorize and accept all of the information above to be true. Parent/Guardian Name: * First NameLast Name Date* -Month -DayYear Submit Application Should be Empty:
