Charge Ahead Registration 2023

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Chantilly High School Freshman Orientation Class of 2027

Email *

Please select 1 session date *

Aug 10 (9am-1pm drop off door 1, report to cafeteria)

Required

9th Grader's Last Name *

Student's First Name *

Home Address (must be in Chantilly High School District to attend) *

Lunch and snacks will be provided. Lunch will be Chic Fil A original sandwich or grilled nuggets as an alternative if there is an allergy to peanut oil. Snacks will be fruit snacks, assorted chips, & bottled water. Select 1 *

Original Chicken Sandwich (my child isn't allergic to peanut oil)

Grilled Nuggets (alternative meal only because my child is allergic to peanut oil)

I prefer my child bring their own bagged lunch

T-shirt size? (Adult Sizes) Please note, we can no longer guarantee your size preference at this time. *

XXL

List any medical needs or special needs that staff should be aware of for this day? write N/A or Explain: Food Allergies, Seizures, etc *

If my child requires medication to be administered, I understand that I will need to have a medical authorization form filled out by my Physician and included in a ziplock bag with child's name on it and brought in by parent. Example: Epi Pens! Dhttps://www.fcps.edu/resources/student-safety-and-wellness/school-health-services *

I understand that a parent needs to bring medication in with medical authorization form at 8:30am.

N/A

Required

Parent First Name, Last Name? *

Parent Cell Phone? (only used for incase of emergency) *

Parent Email Address (reminder info will be sent 1 week before your session) *

Medical Insurance Company Name? *

Medical Insurance Policy Holder's First & Last Name *

Medical Policy #? *

Parents will be responsible for arranging transportation to and from school no earlier than 8:40am-1:00pm. Drop off and Pick up will be in the front of the building Door #1 *

I understand that there will not be buses

Required

The cost to attend is $50 per student due within 24 hours of this submission or it shall be canceled. A Registration with emergency care information, and medical info provided on this form requires that a parent agrees by checking the box below, agreeing that in case of an accident involving his/her child while attending Charge Ahead Program, he/she releases Charge Ahead Program from any and all liability. In case of emergency, I give permission to the Directors of Chantilly High School Charge Ahead Program to transport my son or daughter to the emergency room for care. I fully understand that Charge Ahead Program does not provide medical insurance. *

I agree

Required

Please use my school bucks to pay the registration fee of $50 to secure your registration after submitting this form. Registrations submitted without payment within 24hours will be canceled.

More info will be sent via Parent/Guardian email the week before your session. Questions? Please email Carmen Wise, Coordinator. Spots are limited to a first come first serve basis.

Please make a note: Carmen Wise's email is: clwise@fcps.edu

Required

A copy of your responses will be emailed to the address you provided.

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