registration form - CSI Off-Campus Centers

REGISTRATION FORM
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Complete and sign this form. One form per participant. Make duplicates, if needed for multiple registrations.
Payment required at time of registration. Make check(s) payable to: College of Southern Idaho
For Twin Falls classes only, you can register online at communityed.csi.edu.
Registrations are processed on a first-come, first-served basis.
Parents must read College for Kids Rules and Guidelines prior to registering their children.
Student’s Legal Name ______________________________________________________ Today’s Date __________
Street Address ______________________________________ City______________________ Zip Code __________
Sex _______ Age _________ Birthdate ____________ Parent’s Email Address ______________________________
Where parents or guardians can be reached during the day:
Parent I (name) ________________________________________________ Phone __________________________
Parent I (name) ________________________________________________ Phone __________________________
If parents/guardians cannot be reached, notify the following person:
Additional Contact Name: ________________________________________ Phone __________________________
List Class(es) In Which Your Child is Enrolling:
NAME OF CLASS
REG FEE
OFFICE USE
TOTAL FEES
By signing, I agree to the rules and guidelines on the following page and my child can participate in the program.
Parent/Guardian Signature _______________________________________ Date ____________________________
PAYMENT INFORMATION
Total Amount Enclosed $ _________Circle Appropriate Credit/Debit Card: VISA MASTERCARD AM EX DISCOVER
Credit Card #
CVC Code
Exp. Date
Print Name (as it appears on your card)
Billing Address
Authorizing Signature
City
St
Zip
COLLEGE FOR KIDS RULES AND GUIDELINES:
Permissions: By signing this form, you give the above minor permission to participate in the CSI Community
Education Center’s (CEd) College for Kids program and accept full responsibility for delivering the student to the class
at the appointed hour and for picking up the student at the conclusion of each session. Arriving no earlier than 15
minutes before the class start and no later than 15 minutes after the conclusion.
Additionally if your child becomes ill or hurt, you authorize CSI CEd to seek provide first aid or seek medical treatment
as deemed necessary. As the undersigned, you agree to hold the College of Southern Idaho and any officer or
employees thereof harmless from any claim to the above named minor arising out of or in any way connected with
CSI CEd College for Kids program.
Photography: The undersigned agrees to permit photographs to be taken of this student enrolled in the CSI CEd
College for Kids program to be used for future promotional purposes.
Cancellation Policy: CSI CEd classes are held based on the number of students enrolled and students are required to
make a payment at the time of registration. The decision to cancel a class, prior to its beginning, is based on the
number of persons pre-registered and paid. Students will be notified 24 hours prior to the first session if a class is
cancelled.
Drop Policy: If you are unable to attend, please call the campus or local center at the number listed below to drop
your child from the class. Students will be charged for all classes they have registered for unless they drop the class
72 hours prior to the first class session. No refunds will be given on or after the start date of class. If there is a supply
fee and the student does not attend or drop the course, you will be billed for the fee.
Twin Falls Campus: (208) 732-6442  North Side Center (208) 934-8678  Mini-Cassia Center (208) 678-1400
Blaine County Center (208) 788-2033  Jerome Center (208) 324-5101
Behavior Guidelines: Proper standards of conduct are necessary to protect the health, safety, and enjoyment of all
College for Kids participants. Behavior that might interfere with the educational process is not acceptable. Students
will be respectful to other students and staff. Students will be careful with college equipment and property, and the
property of other students. Parents will be contacted if their child is involved in any unacceptable situations during
class. Appropriate college personnel reserves the right, at any time, to exclude a child from activities due to failure
or inability to follow as directed any rules and/or policies for participants and parents will be notified to pick up their
child. No refund of tuition or registration fees will be made if child is requested to be picked up.
CSI Community Education is committed to the idea that each child should have a positive and enjoyable experience
in our College for Kid’s classes and camps. Please notify us of individual needs your child might have, such as food
allergies, upon registration so all participants can thrive in this fun learning experience.
Computer Use: Certain classes may use the internet as part of their curriculum developed by the instructor. With
this educational opportunity comes responsibility, to be shared by the participant, parent/guardian, and the college
staff. Students will only use the software that pertains to their class. They may only use the internet when the
instructor gives them permission. Students shall not give out personal information while online and should tell the
instructor immediately if they encounter information that is inappropriate or makes them uncomfortable. Parents
will be contacted if their child is involved in any unacceptable situations while using the computer.