2016 – 2017 Registration Family Name(required) First Name(required) Relationship Parent Grandparent Guardian Other Cell Phone(required) Receive Text Message Notifications Yes No Email(required) Confirm Email(required) Home Address(required) City(required) ZIP(required) How did you hear about us? Friends Family School Ad Other Did anyone refer you to Kahoolal? Please type your friends name in the box below, so they can receive a $15 referral credit! Encourage your friends to take classes at Kahoolal and you too can receive $15.00 off of future tuition. Referred by: Emergency Contact Name(required) STUDENT No. 1 Student's First Name(required) Student's Last Name(required) Gender(required) Girl Boy Birth Date (MM/DD/YY)(required) School(required) Grade Level(required) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th Allergies or Special Needs Select Class(required) Coding L100 Coding L200 Coding L300 Robotics L100 Robotics L200 Robotics L300 Underwater Robotics Electronics & Arduino STUDENT No. 2 Student's First Name Student's Last Name Gender Girl Boy Birth Date (MM/DD/YY) School Grade Level 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th Allergies or Special Needs Select Class Coding L100 Coding L200 Coding L300 Robotics L100 Robotics L200 Robotics L300 Underwater Robotics Electronics & Arduino POLICIES AND PROCEDURES Tuition, Payments and Refunds *All registrations are first come, first serve. The online registration process is NOT a guaranteed spot in class until we’ve received payment. You’ll receive an email confirmation once the credit card has been charged. Monthly Tuition can be paid: A. Manually – by cash, check or credit card before the 14th of the preceding month. B. Automatically – on the 15th of the preceding month we will charge your credit card on file the monthly tuition. A major credit or debit card is REQUIRED to register for classes. But don’t worry, we are a year round enrichment program with no long-term commitments. To un-enroll from a class, please send an email or fill our form by the 14th of the month to avoid being charged for the following month of classes. You have the option to pay using: 1. Cash 2. Personal Check. Make checks payable to KORIMA LLC and please note your child’s name, class, day/time in the memo. 3. Credit Card A 10% Discount will be given off of 2nd & 3rd student’s tuition. Discount will be taken off of the class fee of lower amount. Classes have limited spaces. We plan and provide a place for each student in class, therefore missed classes can not be deducted from tuition. Tuition is budgeted on a 4-week month. This allows for a Winter and Spring Break, as well as a couple closures due to competitions and other events we participate at. For tuition purposes, we consider every month to have four weeks, and that also considers national holidays. School Year Dates: August 22nd, 2016 – June 11th, 2017. Transfers and cancellations may be requested up to the 14th day of each month. After this time and prior to the first class meeting, we will credit your household account for 50% of the class fee, valid for one year. After the first class has met, no refunds and/or credits will be issued. If unforeseen conditions, including, but not limited to, hurricanes, power outages, and epidemics, cause Kahoolal to shut down its classes for any length of time, no tuition will be refunded, credited, and transferred. Annual Registration Fee (per child): $35.00 Refund Administrative Fee: $25.00 ** See restrictions Returned Check Fee: $25.00 Declined Credit Card Charge: $10.00 Tuition(required) I've read and agree to abide by the above policy Admissions Kahoolal accepts students based on their talents and abilities and does not discriminate on the basis of sex, race, nationality, ethnic origin, or other irrelevant criteria. Attendance and Punctuality Students should make every attempt to attend all classes. Kahoolal does not offer individualized make-up classes. All Kahoolal classes start at the scheduled time. Students must be on time for each class. Tardiness is disruptive to both the instructor and the other students, and tardy students may have difficulty understanding the parts of the lesson missed. Conduct and Discipline Your child(ren) agree to use the facilities, tools, and materials in a safe way, and to alert fellow participants, mentors, and/or program leaders when facilities, tools, and materials are being used in a way that could cause harm to themselves or others. Students are expected to conduct themselves in an orderly manner and to treat those working around them with respect. Students whose behavior is disruptive to the class will be removed from the classroom, and their parents will be notified. The directors reserve the right, at their sole discretion, to withdraw any student whose influence or actions are deemed unsatisfactory or detrimental to the class or who will not abide by the studio rules and policies. If this occurs, no reduction or return of fee, or any part thereof, will be made. Drop-off and Pickup It is essential that a parent or other authorized adult pick up students when classes are over. Parents who fail to pick up their children within fifteen minutes of the end of their individual class are considered late and will be charged a $10.00 fee (per student per day) unless a previous arrangement has been made with the staff. In case of emergencies or other situations over which parents have little control, parents should try to telephone Kahoolal in order to alert the staff. For the safety of their children, parents must advise them to wait inside the Kahoolal building to be picked up. Parents must then come in to get their children. If an adult other than a parent is to pick up a student, Kahoolal staff must be notified prior to the pick-up. First Aid & Medications It is the responsibility of parents to provide Kahoolal with emergency phone numbers and instructions. Kahoolal staff is not allowed to administer first aid or to dispense over-the-counter medications to any student. A first aid kit is available for any student requiring an antiseptic or Band-Aid. All possible precautions are taken to ensure that the activities at Kahoolal are conducted in a safe and responsible manner. However, because of the nature of some of the activities, regardless of the high degree of supervision, there is a potential for accidental injury and/or death. Parents agree to assume these risks and to release Kahoolal and/or Korima LLC, its officers, directors, employees and agents from, hold them harmless from and waive any claim against Kahoolal and/or Korima LLC as to any injury that may occur to their child(ren) while attending Kahoolal. Media Release Kahoolal may take photographs and/or video of any child participating in the activities, and may use these images for marketing, public relations, and/or promotional purposes. No compensation will be made for the use of these images. You grant to Korima LLC DBA Kahoolal the right to use your child(ren)’s name and likeness in connection with the use of the recordings. You acknowledge that you have read this Agreement and understand that it includes an assumption of the risk and a release of liability. We are relying on this waiver to allow you to participate in Kahoolal’s Sessions. Terms(required) I've read and agree to abide by the above policy Enter Your Full Name(required) CREDIT CARD INFORMATION Card Type(required) MasterCard VISA Discover AMEX Other Cardholder Name (as shown on card)(required) Card Number(required) Expiration Month(required) Expiration Year(required) Cardholder ZIP Code (from Credit Card billing address)(required) CVV (from Credit Card)(required) Authorization(required) I authorize to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.