Mosaic Registration Form: 2023-2024

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***Please complete a separate form for each child.***

Tuition:
August - May: $60/month per family

Mosaic Performing Arts Company (Optional, Evening)
$15/month, $5/month for siblings

Student's Full Name *

Student's Birthday *

YYYY

Grade *

School
*We pick up at Lake Forest Elementary, Sevier Middle, and Wade Hampton HS. The League Academy school bus drops off at Mosaic. Students from other schools must be dropped off.
*

Lake Forest Elementary

Sevier Middle School

League Academy

Wade Hampton High School

Other:

Allergies and/or medical information *

Parent/Guardian: Full Name *

Address *

Parent/Guardian: Phone Number(s) *

Emergency Contact 1: Full Name *

Emergency Contact 1: Relation to Student *

Emergency Contact 1: Phone Number *

Liability Waiver/Photo Release *

I give Greenville County Schools permission to disclose grades, reports, assessments, exams and other information that is necessary for the education and growth of my child with the Mosaic Educational and Arts Program.

I grant Mosaic permission to take photographs and videos of my child, and acknowledge these may be used on social media (such as Facebook and Instagram) and other informational materials.

I release the staff, volunteers, and teachers of Mosaic Educational and Arts Program and Aldersgate UMC from any and all liability arising from claims of any kind of nature whatsover from my child's participation in this program. In case of an emergency, if the above numbers cannot be contacted, I give permission for Mosaic Educational and Arts Program staff to make the appropriate medical decisions necessary to treat my child.

Sevier MS & Wade Hampton HS Students - I grant permission for my child to be transported by Aldersgate UMC Mini-bus, and driven by Andre' Webb.

Required

I agree to/acknowledge the following: *

Students with a temperature of 100 F or higher may not stay at Mosaic. If a student spikes a fever of 100 F or higher during the day, a parent must pickup within 30 minutes.

If a student tests positive for COVID-19, they cannot attend Mosaic for 5 days or until cleared by a medical doctor

If any member of a student's household tests positive for COVID-19, the student cannot attend Mosaic for 5 days or until cleared by a medical doctor.

I acknowledge the health risks and dangers associated with the COVID-19 virus and other communicable diseases and recognize that exposure to either could occur while my child is in the care of Mosaic Educational and Arts Program.

Required

I have read and understand and agree on behalf of myself and my minor child to be bound by the terms of this agreement. I certify this to be true by typing my name below. *

I will explain this information to my child, and have them type their name below in agreement *

Date *

YYYY

If you are interested in enrolling your child in our Performing Arts Company, please complete this interest form:

Mosaic Performing Arts Company Registration Form

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