Step 1 of 520%Student InformationFirst Name*Last Name*Birthday * Day / Month / Year* Grade Level*School District*School District *Klein ISDConroe ISDPrivate SchoolSchool Name Klein ISD*School Name *Benignus ElementaryEhrhardt ElementaryFrench ElementaryHassler ElementaryHaude ElementaryNorthampton ElementaryTheiss ElementarySchool Name Private School*School Name *Northland ChristianProgram Northland Christian*Select Program *Level I - Grades K-5 - Every Wednesday - Week of Feb. 12 - May 4, 2018Program Benignus*Select Program *Level I - Grades K-5 - Every Thursday - Week of Feb. 12 - May 4, 2018Program Ehrhardt*Select Program *Level I - Grades K-5 - Every Friday - Week of Feb. 12 - May 4, 2018Program French*Select Program *Level I - Grades K-5 - Every Tuesday - Week of Feb. 12 - May 4, 2018Program Hassler*Select Program *Level I - Grades K-5 - Every Tuesday - Week of Feb. 12 - May 4, 2018Program Haude*Select Program *Level I - Grades K-5 - Every Thursday - Week of Feb. 12 - May 4, 2018Program Northampton*Select Program *Level I - Grades K-5 - Every Wednesday - Week of Feb. 12 - May 4, 2018Program Theiss*Select Program *Level I - Grades K-5 - Every Monday - Week of Feb. 12 - May 4, 2018 Parent’s InformationFirst Name*Last Name*Email* Phone Number*UntitledMotherFatherLegal GuardianAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Emergency ContactFirst Name*Last Name*Relationship to Student*Phone Number* Medical Conditions & ConcernsDoes the student have any dietary requirements, food and/or drug allergies? (If none, please state NONE)*Does the student have any Medical Conditions? (If none, please state NONE)*Is the student on any prescription or over the counter medications? (If none, please state NONE)*I, the undersigned parent or legal guardian of the above named student, do hereby authorize Texas Phoenix International School and its agents or representatives to consent, on my behalf, to any medical/hospital care or treatment to be rendered to him or her upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization Terms & ConditionsParticipationI give permission for my child to participate in all after-school program activities similar to those described in the program description. I understand that Texas Phoenix International School reserves the right to change program activities or instructors and cancel programs, should Texas Phoenix International School decide in its sole judgment that it is necessary and appropriate to do so.Photographic ReleaseI hereby grant and convey onto Texas Phoenix International School sole and exclusive ownership of any intellectual property rights, in any and all photographic images and video or audio recordings made by Texas Phoenix International School of my child and myself during their activities with Texas Phoenix International School, including, but not limited to, any royalties, proceeds, or other benefits derived from such images or recordings. I further grant an irrevocable, freely transferable, royalty free license to Texas Phoenix International School for any images or recordings that was taken during activities with Texas Phoenix International School.Expectations/DismissalI have informed the teacher and other appropriate Texas Phoenix International School staff of any limitations to my child’s participation and agree to abide by Texas Phoenix International School’s sole judgment as to whether my child can be accommodated in the after-school program. I understand that failing to disclose any physical, emotional, or behavioral needs or conditions may result in the child’s dismissal from the program without refund. I understand that my child must follow the stated behavior expectations and safety rules and that Texas Phoenix International School reserves the right in its sole judgment to dismiss without refund any child whose behavior interferes with the rights and safety of others or consistently disrupts group activities or lessons.Refund PolicyYou may cancel your child's after-school program registration up to one week before the first day of lessons for a full refund minus a $25 handling fee. If you cancel after this time, the amount of refund you receive will be up to the discretion of Texas Phoenix International School. To cancel, please call or email Texas Phoenix International School. If your child is unable to attend due to medical reasons, you may receive a refund (minus a $25 handling fee) at any time prior to the start of lessons by providing a doctor's note. We are unable to refund for any missed days of lessons. After school registration fees are non-transferable. Texas Phoenix International School reserves the right to cancel an after school program due to low enrollment. After school programs cancelled because of low enrollment will be fully refunded.Texas Phoenix International School Acknowledgement of Risk and Assumption of Personal ResponsibilityTexas Phoenix International School staff members make every effort to conduct safe programs, to orient and support children, and to inform families of inherent risks. Risk management is an essential element of all the activities offered. While we anticipate that these efforts will ensure the well-being of each child, we are also aware that it is neither possible to foresee every contingency nor to eliminate all risk. I understand that program activities may include, but are not limited to: playing active games, activities such as craft activities using common household material, which may include, but are not limited to: handling common household materials which if ingested or used improperly could be harmful, batteries, use of scissors, building materials which contain small pieces that are choking hazards for children under age 3. Other risks may be inherent in program activities. I acknowledge that such risks exist, and I hereby agree on behalf of my child to assume such risks. Further, on behalf of my child, I hereby release and forever discharge, and agree not to sue, and agree to indemnify and hold harmless; Texas Phoenix International School, officers, directors, employees, and volunteers and each of them, from and against any and all liabilities and obligations of every kind and description, which I shall or may have against them or any one or more of them arising out of, or in connection with, my child’s participation in after-school program activities, including, but not limited to, for any personal injury that my child may suffer while participating in the after-school program and activities, excepting in the case of gross negligence. I understand and agree on behalf of my child that my child shares the responsibility for safety during programs and activities, and I personally assume on behalf of my child that responsibility. I understand and certify that my child’s participation in the Texas Phoenix International School after-school program and its activities is completely voluntary, and that I have become familiar with the program activities in which my child may participate, as described in the after-school program description.Untitled* I have read, understand and agree to the Terms & Conditions.Total $0.00 PaymentChoose Method of Payment*Send a CheckUse Credit CardCheckPlease make check payable to "Texas Phoenix International School" with the mailing address of "20008 Champion Forest Dr. #204 Spring, TX 77379"Check Credit CardCredit Card*DiscoverMasterCardVisa Card Number Expiration Month010203040506070809101112 Expiration Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Promo Code This iframe contains the logic required to handle AJAX powered Gravity Forms.