Home School Physical Education Program

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RETURNING STUDENTS ONLY - Spring 2024

(If there has been any change to any personal information then please let us know on the first day of class)

Parent Name(s) *

Email(s): *

Phone Number(s): *

Student Name #1 *

Age *

Grade *

Student Name #2

Age

Grade

Student Name #3

Age

Grade

Student Name #4

Age

Grade

Student Name #5

Age

Grade

Media Permission Form *

In order to make the experience educational for the Teacher Candidates, video recording will/may be made of lessons with a primary focus on the teachers. In addition, photographs may be taken for promotional purposes. Children’s names will not be used in either of these media forms. NOTE: Videos and Photographs will still be taken, however the children specified will be left out of the recording frames.

I accept my child's image may be used for promotional purposes

I do not want my child's image used for promotional purposes

PLEASE NOTE: Please note to complete the registration process you will need to (1) complete the program waiver form. (2) Make payment for $20 per child at the first day of class. Checks should be made payable to the University of Jamestown. *

Checking the box below indicates you understand these requirements and all information on this form is correct and to the best of your knowledge.

I understand all requirements and all information is correct to the best of my knowledge.

Required

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