Acorn Academy Acorn Academy Please complete this form for each child that will be participating. Step 1 of 4 25% Child's Name (1)* First Last Age* Child's Name (2) First Last AgeChild's Name (3) First Last AgeChild's Name (4) First Last AgeChild's Name (5) First Last AgeParent's Name* First Last Phone*Email* Enter Email Confirm Email Emergency Contact Name* First Last Other than parent already listedEmergency Contact Phone*Dates that my child(ren) can't attendThis is a semester-long program, so please let us know if there are dates that you know your child(ren) won't be able to make it to Acorn Academy, so that we can plan appropriately. Please keep in mind that registration is the same, no matter how many weeks they can attend.How'd you hear about this event?* personal invitation magazine Facebook church bulletin Hosanna e-blast other Parental Consent* My son or daughter has my consent to attend Acorn Academy at Hosanna Industries, Inc. Medical Consent* Hosanna Industries, Inc. has my permission to administer or have administered any medical attention necessary in the event of accident or injury. Photo Consent* I, the undersigned, permit use of photos and/or video images portraying my child in publications promoting Hosanna Industries, Inc. Liability Release* I hereby release Hosanna Industries, Inc. (as well as its successor(s) and assigns) from any and all claims for damages, whether to person or property, arising from any accidents or injuries, direct or indirect, including travel to and from the day’s activities, which are caused or arise from my participating with Hosanna Industries' Acorn Academy. Insurance Carrier*Hosanna Industries' participants must have medical coverage. In the event of an injury, parents must present their own medical insurance information to the doctor or medical service that will be treating your child.Date of Last Tetanus Shot* MM DD YYYY Hosanna Industries requires participants to receive a tetanus shot within the last 10 years. Special Medical ConsiderationsComments 1st Child* Price: $150.00 Registration for the one child is $200 for the semester, and each additional sibling for Acorn Academy participation is $50. Please contact us to learn about scholarship options.Additional Child(ren)* Price: $25.00 Quantity: Total* $0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.