Howard Community College

Student Name (please print legibly) ______________________________________ PARENTAL CONSENT /RESPONSIBILITIES Please check box to indicate that you have read these policies. ATTENDANCE/DISMISSAL I understand and consent to these attendance/dismissal policies* Attendance is taken daily. Parents will be notified using information submitted on consent form. For early dis- missals, parents must come to HVPA 160A and sign the student out before the student will be released from class. At dismissal, students will be supervised until picked up or late policy comes into effect. Identification is not routinely required. Other arrangements (bike, walk, bus, etc.): Please specify other arrangements: ____________________________________________________________________________________________________ Parents should not leave their child on campus earlier than 10 minutes prior to the start of the class. UNSUPER- VISED STUDENTS ARRIVING EARLY WILL BE SENT TO BEFORE CARE AND CHARGED A FEE. Students must be picked up promptly after their classes. For 8:30AM—12PM classes, students not picked up by 12:15PM will be placed in a supervised lunchroom in the Hickory Ridge Building and registered for lunch. For 1PM—4:30 PM classes, students not picked up by 4:45PM will be escorted to HVPA—140 , where they will be in AfterCare. THERE WILL BE A $5 LATE FEE CHARGED FOR EVERY 15 MINUTES OF LATENESS. MEDICATIONS I understand and consent to these medication policies* HCC will not administer any medications to students. If medication must be taken while the student is on cam- pus, the parent/guardian is responsible for coming to campus to administer the medication. Written permission from a physician is required for those students who are able to self-medicate. Call 443-518-4110 for a required form. In an emergency, trained staff will administer epipens or inhalers provided by students. PARENTAL CONSENT AGREEMENT I understand and consent to the parental consent agreement* I approve of my child's enrollment in the Music Institute's summer enrichment program and take responsibility for my child's compliance with appropriate student behavior. DISRUPTIVE AND INAPPROPRIATE BEHAV- IOR WILL NOTE BE TOLERATED AND WILL RESULT IN NON-REFUNDABLE DISMISSAL. I do hereby grant and give TMI and Howard Community College the right to use my or my child(ren)'s pho- tograph or other image in conjunction with other persons or objects and presentations, advertising, publicity (including social media such as Facebook) and promotions for Howard Community College authorized groups related thereto. RELEASE OF INFORMATION TO HCC Please check this box to indicate you have read and agree to the release of information statement below* I authorize the release of my child's grade level to Howard Community College. This information is needed to verify either past or current enrollment in honors, gifted and talented, advanced placement, accelerated courses, or above grade level classes. This information will be submitted to the Maryland Higher Education Commission along with other enrollment data. If further information is needed, please call 443-518-4110. WAIVER OF RESPONSIBILITY Please check this box to indicate you have read and agree to the waiver of responsibility statement below* I/We understand and voluntarily assume all risks inherent in the nature of this activity and I/we waive and release all claims, costs, liabilities, expenses and judgements against HCC and release HCC and its representa- tives arising out of my child's participation in the activity at TMI. HCC and TMI are not responsible for personal items brought or left on campus. Electronic devices and cell phones may not be used during class hours without instructor permission. HCC is not responsible for lost, broken, or missing items. THIS FORM MUST BE SIGNED AND DATED TO BE OFFICIAL IN ORDER FOR STUDENT TO BE REGISTERED. I certify the above information to be true and correct to the best of my knowledge. I understand that it is my responsibility to notify the Records Office of any change in the information contained in this application. I will take financial responsibility for my child's tuition payment to HCC. I certify that I am registering a student for The Music Institute (TMI) summer enrichment program, that the student has resided at the above address WITH A PARENT OR LEGAL GUARDIAN for at least three months, and that the information presented here is correct to the best of my knowledge. Parent or Legal Guardian Signature* ____________________________________ Date*_______________ Parent/Guardian Name (please print legibly)*_________________________________________________

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