Registration Form
This form is best viewed and completed on a desktop.
First and Last Name, and Birthdate of Registered Children
Medical Consent and Information
We understand that the Free Learners Community does not undertake a duty to provide on-site medical treatment to students. If, in the opinion of the staff member, a volunteer, mentor or other responsible person at the campus, a medical emergency arises, this Campus representative will 1) attempt to contact the parents or legal guardians of the student and 2) if, in the Campus representative's reasonable judgment the student's condition warrants it, arrange transportation of the student to an appropriate medical facility for treatment. To that end, we authorize a representative of the Campus to consent on our behalf to the medical treatment for our child(ren) by a licensed physician, nurse, paramedic or hospital staff member.
I understand and agree to abide by these terms.
Does your child or children have any medical needs we should be aware of?
I understand that if my child needs a one on one aide to participate, I am responsible for providing that. Facilitators can not operate as aides.
Yes, I understand
Does your child have any allergies that we should be aware of?
Please list the Alberta Health Care Numbers for each child you are registering
Please provide the name and phone number for an emergency contact we can reach during group hours in the event that the parent(s) are unavailable.
Are there any family dynamics that Chinook Free Learners needs to be aware of? (i.e. Custody Disputes.)
Disclaimers
Educational Outcome Disclaimer:
We fully understand the educational philosophy of Chinook Free Learners and waive the right to litigate against Chinook Free Learners and/or its board members, volunteers, mentors or other Campus representatives should our child(ren) not achieve or progress educationally in a manner that is satisfactory to us.
I understand and agree to abide by these terms.
Supervision Disclaimer:
We understand that students, while at the Campus, are not under close adult supervision. We waive the right to litigate against Chinook Free Learners and/or its board members, volunteers, mentors or other Campus representatives in the event that our child(ren) should suffer harm or injury due to this non-supervision policy. We waive the right to litigate against the organizations, board members, staff members, volunteers, mentors or other representatives of the buildings and spaces we use or programs in which they participate in while attending the Campus in the event that our child should suffer harm or injury due to this non-supervison policy.
I understand and agree to abide by these terms.
Chinook Free Learners reserves the right to terminate a family's participation in our program at any time for any reason.
I understand and agree to abide by these terms.
We understand that in officially enrolling, we are committing to Chinook Free Learners for one full school year and are responsible for and agree to pay the full tuition. We understand that we are liable for full tuition and that we will not be refunded tuition if our child(ren) fail to attend. We and our child(ren) agree to abide by the rules of the campus community.
I understand and agree to abide by these terms.
Respect and Inclusion Policy
We are a fully inclusive organization. We operate as a secular, tolerant, inclusive and non-discriminatory group. We do not allow discrimination or disrespectful behaviour. We use evidence-based materials when required. We do not exclude religion, religious studies or families with religious beliefs, however we approach such subjects from a neutral viewpoint and with the aim of understanding and accepting personal differences. We will not tolerate homophobia, transphobia, racism, sexism, discrimination or any other intolerant beliefs that may cause discomfort or difficulty to any of our families or our children. Above all we want to create a welcoming and accepting environment where every child can feel accepted, seen and respected for who they are. Differences are to be celebrated, respected and accepted.
I understand and agree to abide by these terms.
Waivers
Off-campus excursion release:
In order to allow for spontaneity in the planning, organization and implementation of off-campus excursions, parents/guardians are requested to read and agree to this one-time, once yearly form which serves as an off-campus excursion consent form for the full duration of the current school year. This form also serves as a release for all modes of transportation used, destinations chosen and activities held at these destinations.
In consideration of Chinook Free Learners providing an opportunity for my child(ren) to participate in off-campus excursions during the school year, the student(s) and the parents/guardians of the student(s) on behalf of themselves, their heirs, their estates, executors , administrators and assigns do hereby RELEASE, REMISE AND FOREVER DISCHARGE, INDEMNIFY AND AGREE TO HOLD HARMLESS Chinook Free Learners, its officers, board members, agents, servants, employees, volunteers, mentors, directors and/or any one or more thereof against any claim demand or cause of action whether now in existence or hereafter arising from any loss of health, loss of property, inconvenience, delay, injury to the person of, or for death, wrongful or otherwise, of the student arising out of, resulting from, caused by, occurring during or in any way connected with the aforesaid excursions, whether or not such injury, death or damage is caused by or contributed to in whole or in part by any action or failure to act, negligence, breach of contract, or other misconduct on the part of Chinook Free Learners, its officers, staff members, agents, servants, employees, volunteers, mentors, directors and/or and one or more thereof. In case any provision in this contract and release shall be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby. The student and the parents/guardians intend this contract and release to take effect as a sealed instrument and to be governed by the laws of the Province of Alberta.
I, being the legal guardian of the child(ren) registering, understand and agree to this.
Photo Release:
I give Chinook Free Learners consent to use, publish and advertise the likeness of my child(ren), (photographic, recording or otherwise) in any and all manner and medium, provided such use is solely for the purpose of promoting Chinook Free Learners with the understanding that the likeness may be included in one or more catalogues, publications, audio-visual presentations, displays, exhibits, advertisements or websites.
I release and discharge Chinook Free Learners and its representatives, licensees, successors and assigns from all manner of actions, causes of action, debt, accounts, contracts, claims and demands, which I or my heirs, executors, administrators or assigns can, shall or may have at any time as a result of any act, matter or thing arising out of or in connection with the consent or authorization given by me in this release. Without limiting the generality of the foregoing I expressly release Chinook Free Learners and its agents, board members, licensees, successors and assigns from and against any and all claims which I have or may have for invasion of privacy, defamation or any other cause of action arising out of the production, distribution or exhibition of the photos or recordings or merging or otherwise incorporating such photographs or recordings into other works.
I, as the parent/guardian of the child(ren) I am registering to whom this release applies, certify that I have the legal authority to execute the release. I approve the foregoing and agree that myself and my child(ren) shall be bound by this release.
I, being the legal guardian of the child(ren) registering, understand and agree to this.
About your Family
Tell us a bit about yourselves. We strive to build community and consistency for our kids. We want to get to know you!
Do you, your partner/spouse or any adult family members have skills, spaces or tools/materials you would be willing to share with our kids? Our kids love being taught by their community!
Would you be interested in being trained as a facilitator?
Would you be willing to help out by volunteering? We rely on volunteers to make our school run! Everything from organizing classes to helping behind the scenes is done by volunteers. List any areas you think you can help out in!
Family Phone Interview:
The final step in your registration process is to book a phone interview. One of our board members will contact you and conduct a brief interview. Please indicate which days and time you prefer.
Thank you for joining us! We look forward to getting to know your family and joining along on your child's educational journey!
~Chinook Free Learners~
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