Enrollment FORM

PARTICIPANT INFORMATION
Student's Full Name *
Student's Full Name
Date of Birth *
Date of Birth
Please indicate the student's current or new grade as of Sept for the calendar year. (If the student is enrolled at school, indicate current grade. If the student will be in a new grade when participating at Ti2, indicate the latter grade.)
PARENT/GUARDIAN INFORMATION
Parent/Guardian (1) *
Parent/Guardian (1)
Please provide first and last name(s) of parent or legal guardian(s).
Primary Phone (1) *
Primary Phone (1)
The number to best reach you when your child is at Ti2.
Alternate Phone (1) *
Alternate Phone (1)
secondary phone number
Parent/Guardian (2) *
Parent/Guardian (2)
Please provide first and last name(s) of parent or legal guardian(s).
Primary Phone (2)
Primary Phone (2)
The number to best reach you when your child is at Ti2.
HEALTH INFORMATION
Emergency Contact Person (3)
Emergency Contact Person (3)
Unless indicated otherwise, Ti2 staff and volunteers will seek to contact parents/guardians (in order listed on the enrollment form) should contact be deemed necessary. Please designate two additional emergency contacts.
Emergency Contact Phone (3)
Emergency Contact Phone (3)
Emergency Contact Person (4)
Emergency Contact Person (4)
Emergency Contact Phone (4)
Emergency Contact Phone (4)
I certify that all information I have provided is complete and accurate. I agree to notify The Innovation Institute of any changes to the information provided immediately in writing. I understand that this information will only be used for medical emergencies and to provide guidance and relevant information to staff and personnel. *
I understand that every reasonable attempt will be made to contact the emergency contacts named on this form. I give permission to The Innovation Institute staff and personnel to arrange necessary related emergency medical transportation for my child named above on this form in the unlikely event of a medical emergency. *
In the event of an emergency, if a contact cannot be reached, I hereby give permission to The Innovation Institute to seek emergency medical treatment for my child named above on this form. I further authorize hospital physicians, medical personnel, and related personnel to release relevant information concerning the medical status, medical condition, injuries, prognosis, diagnosis and related personally identifiable health information of my child named above on this form to The Innovation Institute staff and personnel. *
I will download from the Ti2 website and read and review with my child the Student Preparation Sheet and Code of Conduct below. I understand that I am responsible for ensuring that my child abides by the rules and regulations in these documents while at The Innovation Institute. *
By entering my first and last name below, I acknowledge, understand, accept, and agree voluntarily to the terms of this online. By entering my first and last name, which represents my signature below, I acknowledge and agree that I am freely entering into a binding agreement with The Innovation Institute. *
Online Signature *
Online Signature
I am the parent or legal guardian with binding authority to enroll my child at The Innovation Institute.
Today's Date *
Today's Date
Please indicate intended payment method for tuition and fees. *
PLEASE SELECT CAREFULLY. Incorrect selection can result in NON-enrollment, despite payment. Thank you.
PLEASE SELECT CAREFULLY. Incorrect selection can result in NON-enrollment, despite payment. Thank you.
Number of Hours