Hope Horizon East Palo Alto Registration Form 2024 - 2025

September 3, 2024 - May 23rd, 2025 | Program Start & End Date:
September 3, 2024 - May 23rd, 2025
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Elementary School Academics
Monday through Thursday
2:30 - 6:30 pm
Every other Friday at 2:30 - 6:30 pm
Elementary School Academics
Please look at the calendar for specific dates and times
Payment:
Q1-$130
Q2-$130
Q3-$130
Total for the year - $390
Scholarships are available
Program Manager - Ana Tuakalau
Ana@hopehorizonepa.org
(650) 327-9940
_______________________________
Middle School Academics
Monday through Thursday
2:30 - 6:30 pm
Every other Friday at 2:30 - 6:30 pm
Please look at the calendar for specific dates and times
Payment:
Q1-$130
Q2-$130
Q3-$130
Total for the year - $390
Scholarships are available
Program Manager - Ariana Palacios
Ariana@hopehorizonepa.org
(650) 543-2128
_______________________________
Teen Mentorship & Support
Monday through Friday
Time will vary
Please look at the calendar for specific dates and times
Payment:
Q1-$130
Q2-$130
Q3-$130
Total for the year - $390
Scholarships are available
Ariana Palacios & Leslie Tuakalau
Ariana@hopehorizonepa.org / (650) 543-2128
Leslie@hopehorizonepa.org / (650) 543-2129
_______________________________
Elementary/Middle School Robotics Program
Time Will Vary
Please look at the calendar for specific dates and times
Payment:
Q1-$45
Q2-$45
Q3-$45
Total for the year - $135
Scholarships are available
Director of Programs - Waniya Bryant
Waniya@hopehorizonepa.org
(650) 503-1440
________________________________
High School Robotics - FRC
September through December:
Friday: 6:30p - 10p
January through April:
Tuesday: 6:30p - 9p
Friday: 6:30p - 10p
Saturday: 10a - 2p
Please refer to the program for more updates
Greg Corsetto
Greg@hopehorizonepa.org
_______________________________
Please fill out this registration form and click submit and a Hope Horizon East Palo Alto Staff will be in contact. /
Complete este formulario de registro y haga clic en enviar y un personal de Hope Horizon East Palo Alto se pondrá en contacto.
Student Information / Información del estudiante
 
Please select all that apply.
 
 
 
 
 
 
 
 
 
Parent Information / información de los padres
 
 
 
 
 
 
 
Emergency Contact / Contacto de emergencia
Someone you want us to contact in the event of an emergency if we cannot get a hold of the primary contact. // Alguien con quien desea que nos comuniquemos en caso de una emergencia si no podemos comunicarnos con el contacto principal.
 
 
 
Authorized Pick-Up Person/s : Persona(s) Autorizada(s) de Recogida
Authorized pick-up person/s will need to present a valid photo ID with first & last name. La persona/s autorizada para recogerlo deberá presentar una identificación con fotografía válida con nombre y apellido.
 
 
Permission to walk home / Permiso para caminar a casa
Please select one option.
Program
Please select all that apply.
I understand that all releases listed below apply to all participants, parent/s & or guardians: 

For your child(ren) and or parent/s/guardian to be a participant/s in our programs, we must have permission for the following: 


Permission to participate in Hope Horizon East Palo Alto Programs 

I give permission for my child(ren) to participate in all program activities including biblical teaching, outings, sessions, workshops, sports, performance/s, and any other functions.

Performance/Publication/Media Rights Release 

• Recognizing that all items listed below are strictly for the purpose of promoting Hope Horizon East Palo Alto Programs:

• I give Hope Horizon East Palo Alto the right to publish and copyright any and all creative works generated by my child(ren) in the following media: social media, book, newspaper, magazine, radio, television, videocassette, etc.

• I further permit Hope Horizon East Palo Alto to use any photographs, video images and sound, and/or audio sounds of my child(ren) for the purpose of promoting Hope Horizon East Palo Altoprograms.

• I forfeit the right to be compensated for any of the above for my child(ren), myself, or my heirs.

Release of Liability

• In consideration of being allowed to participate in Hope Horizon East Palo Alto athletic programs, related events, and activities it is agreed that:

• The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

• I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of others, and assume full responsibility for participation; and

• I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard, I will bring such to the attention of the nearest official immediately; and,

• I, for myself and on behalf of my heirs, assigns, personal, personal representatives, and next of kin, hereby release, discharge, and hold harmless Hope Horizon East Palo Alto their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, with respect to any and all injury, disability, death, or loss or damage to person or property, to the fullest extent permitted by law, whether arising from negligence or otherwise.

Medical Release/Permission for Treatment/Release to Administer Medicine 

I give authorization for Hope Horizon East Palo Alto staff members to administer the medications(s) listed below and any others in writing at a future date as authorized or directed by a doctor, parent, and/or guardian. I agree to release Hope Horizon East Palo Altofrom any liability related to medications, which are permitted to be administered as noted below. 


I do hereby authorize all volunteers and employees of Hope Horizon East Palo Alto as an agent(s) for the undersigned to consent to any x-ray, examination, anesthetic, medical and/or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provision of the Medicine Practice Act or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or surgeon or at said hospital. 


It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required and is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent for any and all such diagnosis, treatment, or hospital care which the aforementioned physician or surgeon, in the exercise of his/her best judgement, may deem advisable. I also agree to release Hope Horizon East Palo Alto, its staff and volunteers from any financial responsibility related to any and all such diagnoses, treatment or hospital care mentioned above. I, the parent/guardian of participants listed on Side 1, have read, understand and agree to all of the releases noted above. 

Note: All of the above releases will remain in effect for the entire time each participant is enrolled in Hope Horizon East Palo Alto's programs or until revoked in writing to the address listed below. 

By submitting this form, you verify that you are the legal parent or guardian of the registered student.



If you decide to opt out of any spiritual components of our Hope Horizon East Palo Alto programming, your student will be excluded from participation in discipleships, mentoring, spiritual activities, retreats, and any spiritual programming.
Si decide optar por no participar en ningún componente espiritual de nuestra programación Hope Horizon East Palo Alto, su estudiante será excluido de la participación en discipulados, tutorías, actividades espirituales, retiros y cualquier programación espiritual.
Please select all that apply.
Registration Fee // Cuota de inscripción (all programs)
You have the option to pay the registration fee in full upon submission of this application. If you opt to pay at a later time, please note that your student is not fully registered in his/her program until the registration fee has been received. // Tiene la opción de pagar la tarifa de inscripción en su totalidad al enviar esta solicitud. Si opta por pagar más tarde, tenga en cuenta que su estudiante no estará completamente registrado en su programa hasta que haya recibido la tarifa de inscripción.
 
 
 
 
 
 

Description

September 3, 2024 - May 23rd, 2025
Program Start & End Date:
September 3, 2024 - May 23rd, 2025
---
Elementary School Academics
Monday through Thursday
2:30 - 6:30 pm
Every other Friday at 2:30 - 6:30 pm
Elementary School Academics
Please look at the calendar for specific dates and times
Payment:
Q1-$130
Q2-$130
Q3-$130
Total for the year - $390
Scholarships are available
Program Manager - Ana Tuakalau
Ana@hopehorizonepa.org
(650) 327-9940
_______________________________
Middle School Academics
Monday through Thursday
2:30 - 6:30 pm
Every other Friday at 2:30 - 6:30 pm
Please look at the calendar for specific dates and times
Payment:
Q1-$130
Q2-$130
Q3-$130
Total for the year - $390
Scholarships are available
Program Manager - Ariana Palacios
Ariana@hopehorizonepa.org
(650) 543-2128
_______________________________
Teen Mentorship & Support
Monday through Friday
Time will vary
Please look at the calendar for specific dates and times
Payment:
Q1-$130
Q2-$130
Q3-$130
Total for the year - $390
Scholarships are available
Ariana Palacios & Leslie Tuakalau
Ariana@hopehorizonepa.org / (650) 543-2128
Leslie@hopehorizonepa.org / (650) 543-2129
_______________________________
Elementary/Middle School Robotics Program
Time Will Vary
Please look at the calendar for specific dates and times
Payment:
Q1-$45
Q2-$45
Q3-$45
Total for the year - $135
Scholarships are available
Director of Programs - Waniya Bryant
Waniya@hopehorizonepa.org
(650) 503-1440
________________________________
High School Robotics - FRC
September through December:
Friday: 6:30p - 10p
January through April:
Tuesday: 6:30p - 9p
Friday: 6:30p - 10p
Saturday: 10a - 2p
Please refer to the program for more updates
Greg Corsetto
Greg@hopehorizonepa.org
_______________________________
Please fill out this registration form and click submit and a Hope Horizon East Palo Alto Staff will be in contact. /
Complete este formulario de registro y haga clic en enviar y un personal de Hope Horizon East Palo Alto se pondrá en contacto.