2019 Fall Intensive Enrollment

Child to Enroll*

Please include a preferred name or nickname for child when applicable.

Child Information*

Date of Birth is required.

Date of Birth	Age (at time of workshop)	Gender	School

Child's Home Address*

Street Address City State ZIP Code

Home Phone*

Parents / Guardians*

To add additional parents or guardians, click the plus sign on the right. At least 1 phone number is REQUIRED for each person.

Name	Relationship	Phone, Work	Phone, Cell

Parent/Guardian 1 Email*

Mtn SOL communicates with parents/guardians primarily through email. At least 1 email is required.

Parent/Guardian 2 Email

Please indicate on the following pages the Fall Intensive Workshops you child will attend. Additionally, please note the following and sign below.

Once my child is registered in Mountain SOL’s Fall Intensive workshops, I agree to pay for the classes I have indicated on the attached form, at the rate indicated. In order to reserve my child’s place, I have enclosed a non-refundable deposit of 50% of total workshop fees by November 25, 2019. The deposit will be refunded if, and only if, someone from the waitlist takes my child’s place. I understand that full payment is due on day of service or may be paid in full at any point in time prior to that. There will be a $5.00 per business day late fee penalty for any payments not received by 5:00pm the day following the scheduled class (or day following the first class day in a series of classes).

Please Note: After December 2, 2019, you are financially responsible for the classes you have indicated on your enrollment form. After this date, if you need to cancel, full payment will be waived if, and only if, another child can take your child’s place.

Mountain SOL will keep enrollment open for all workshops until filled.

Photo/Video Permissions*

Please check one of the following:

I hereby grant permission for my child to be included in evaluation and photographic pictures, including video/audio recordings, connected with the Mtn SOL program.
Check here if you permit your child to be in photos and videos, but not the use of his/her name.
Check here if you do NOT grant permission for your child to appear in any photographs, video or audio recordings.

Emergency Form and Immunization Record*

A complete and updated emergency form & immunization record must be on file with Mountain SOL prior to attending workshops (see Emergency Contact form for additional details.)

I agree to submit a completed EMC once a year or upon request

Parent/Guardian Signature*

By typing your name and clicking the submit button it constitutes a legally binding signature just like a handwritten one.

Today's Date*

2019 Fall Intensive Enrollment

Step 1 of 2

Fall Intensive Workshops