LTHH Registration Form

Name School Grade -Select- Grade 6 Grade 7 Other Home Address Home Phone Number Name of Parent / Guardian Daytime phone number of Parent / Guardian Name of Parent / Guardian #2 Daytime phone number of Parent / Guardian #2 Emergency Contact Name Emergency Contact Phone Number Please list any notable health / medical issues Health Card Number (Optional) Select One My son/daughter has permission to walk home alone upon leaving the program. My son/daughter has permission to take the bus home alone upon leaving the program. My son/daughter will be picked up at the library site by a parent, guardian or older relative at 6pm. My son/daughter will be staying at the library after the program has ended for the day. If you selected option 3, please list: the name(s) of the Parent/Guardian/Relative who will pick up the child and the individuals' phone number. . This year, Literacy Through Hip Hop would like to take steps to better protect the safety of our students upon leaving the program at the end of the day.[1] We strongly encourage students, guardians or older relatives to pick the student up at the program’s closing.  For the purpose of maintaining our files, please select the following point that best-describes your child’s situation [2]: [1] Literacy Through Hip Hop is not liable for any injury—accidental or otherwise—upon walking to, and being transported from the LTHH program site. [2] If there is a change in this arrangement, please let the instructor know ahead of time (eg. with signed note during the previous day's class).  Signature pages will be given to the Parent / Guardian and the student during the first class. View Error Details   Powered by