2020-2021 Chicago Hope Academy: Student Enrollment Packet

Welcome

Thank you for filling out the Student Enrollment Paperwork for the 2020-2021 school year at Chicago Hope Academy. If you're new to Hope this year, we're excited for you to join the Hope Family! If you're returning, we are looking forward to another awesome year!

Please note the checklist below. Each one of these items, except for paying enrollment fee and signing the Lake Geneva Foundation Release, will be found in this digital packet.

Please have pictures or scans of the required documents (Birth Certificate, ID, Copy of Taxes, Utility Bill, etc.) ready to upload at the end of this packet.

Please allot 10-15 minutes to complete this packet. While there is a "save and return later" feature, we recommend that this packet be done in one sitting.

Admission Acceptance

PLEASE INDICATE YOUR ACCEPTANCE OF ADMISSION TO CHICAGO HOPE ACADEMY BY CHECKING THE APPROPRIATE BOX BELOW.

This spot is not guaranteed until this form is signed and submitted, and the non-refundable $400 enrollment fee is paid.

Please read the following before signing below:

We assume your permission to publish your child’s picture or video of your student in marketing material. We assume your permission to transport your son/daughter to sports activities and other school events.

We ask you to read the student handbook that is distributed when school begins in August. We ask that both the student and the parent understand and work with CHA to see that the
goals and guidelines described in the student handbook are upheld.

WE AGREE TO ALL OF THE ABOVE

YES, I accept admission to Chicago Hope Academy for my student. Please secure his/her spot in classes for the 2020-2021 school year.

Student Name

Parent/Guardian Name

Parent/Guardian Initials (in lieu of signature)

Date

Page 3

Contact Information 2020-2021

Student's First Name

Middle Name

Last Name

Gender

MaleFemale

Student's Race/Ethnicity

Grade

Student's Date of Birth

Student's Address

Address Line 2

State

City

Postal Code

Chicago Neighborhood

Student's Cell Phone

Father or Primary Legal Guardian

Father's Name

Does student live with you?

YesNo

Address (if different from student)

Address Line 2

Country

State

Provinces

City

Postal Code

Cell Phone

Secondary Phone

E-Mail Address

Primary Contact

YesNo

Mother or Secondary Legal Guardian

Name

Does student live with you?

YesNo

Address (if different from student)

Address Line 2

Country

State

Provinces

State/Province

City

Postal Code

Cell Phone

Secondary Phone

E-Mail Address

Primary Contact?

YesNo

Party Responsible for Billing

Emergency Contact(s)

In case of emergency or illness, list individuals who should be contacted if we are unable to contact you at home or at work.

Emergency Contact 1

Name

Phone

Relationship to Student

Emergency Contact 2

Name

Phone

Relationship to Student

Emergency Contact 3

Name

Phone

Relationship to Student

Liability Release Form 2020-2021

1. Authorization is hereby granted, by the undersigned, to Chicago Hope Academy and its representatives or agents (hereafter collectively referred to as “Chicago Hope Academy”) under any circumstances considered to be an emergency by Chicago Hope Academy to transport the above-named student to any hospital, clinic, or physician’s office and to agree to and sign for any emergency medical treatment deemed necessary. The undersigned further agrees to pay for all medical expenses associated with such emergency medical treatment and further releases from liability and agrees to hold harmless Chicago Hope Academy from any and all suits, claims, causes or action or demands of any kind or character whatsoever arising out of any damage, injury or death occasioned at Chicago Hope Academy, or activities under its supervision, and during travel to and from any such activities or emergency medical treatment as authorized under this release or at the hospital, clinic or physician’s office during treatment.

2. This authorization includes the administration of such anesthetics, transfusions, intravenous medications, oral medications, and the performance of such diagnostic studies including x-ray examinations and operative (surgical) procedures as advised by a duly licensed surgeon or physician chosen by Chicago Hope Academy if it is impossible to contact physicians listed in this document or if they are unavailable for consultation.

3. I hereby give consent for the above-named student to participate in Chicago Hope Academy approved sports or activities (including without limitation, collision sports), and travel with the coach or other representative of Chicago Hope Academy on any trips.

4. I have set out below any special concerns that I have regarding athletic participation or any activities in which I would like to limit the above-named student

5. The undersigned further acknowledges familiarity with the dangers involved to the above-named student in competing in athletic, intramural, or other events requiring physical activity. It is understood that even though protective equipment may be worn by the athlete, the possibility of accidents and injuries still remains. The undersigned hereby releases and holds Chicago Hope Academy harmless and assumes full and complete responsibility for any injury which may occur to the student as a participant or spectator in any such event or activity.

6. I have set out below certain medical conditions of the above-named student that are known to me which may be of importance should the above named students require medical attention. (Set out below any known medical conditions such as heart murmurs, allergic reactions to any medications, epilepsy, adverse reactions to certain anesthetics, heart disease, high blood pressure, diabetes, asthma, bleeding or clotting disorders, orthopedic, spinal, or head injuries, heart-related problems, etc.)

7. We assume permission to publish your child’s picture in our publications such as newsletters, website, and school events.

8. If such an emergency arises where treatment at a hospital, clinic, or physician’s office is necessary, please contact those listed on the following page:

Liability Release Form (cont.)

Physician

Name

Phone

Address

Address Line 2

State

City

Postal Code

Preferred Hospital or Clinic

Name

Phone

Address

Address Line 2

State

City

Postal Code

Primary Insurance Coverage

Company Name

Phone

Name of Insured

Policy Number

Parent/Guardian Initials (in lieu of signature)

Concussion Information Sheet

Parent Initials (in lieu of signature)

IHSA Performance-Enhancing Substance Policy

In 2008, the IHSA Board of Directors established the association's Performance-Enhancing Substance (PES) Policy. A full copy of the policy and other related resources can be accessed on the IHSA Sports Medicine website. Additionally, links to the PES Policy and the association's Banned Drug classes are listed below. School administrators are able to access the necessary resources used for policy implementation in the IHSA Schools Center.

As a prerequisite to participation in IHSA athletic activities, we have reviewed the policy agree that I/our student will not use performance-enhancing substances as defined by the policy. We understand that failure to follow the policy could result in penalties being assigned to me/our student either by the my/our student's school or the IHSA.

IHSA PES Policy

http://www.ihsa.org/documents/sportsMedicine/2017-18/2017-18 PES policy.pd! IHSA Banned Drug Classes

http://www.ihsa.org/documents/sportsMedicine/current/lHSA Banned Drugs.pd!

Student/Parent Consent and Acknowledgements

By signing this form, we acknowledge we have been provided information regarding concussions and the IHSA Performance-Enhancing Substance Policy.

Student

Student Name

Grade Level

Student Initials (in lieu of signature)

Date

Parent or Legal Guardian

Parent Name

Parent Initials (in lieu of signature)

Date

Relationship to Student

Consent to Self Administer Asthma Medication

Illinois Public Act 098-0795 provides new directions for schools concerning the self-carry and self-administration of asthma medication by students. In order for students to carry and self-administer asthma medication, parents or guardians must provide schools with the following:

Written authorization from a student's parents or guardians to allow the student to self-carry and self administer the medication.
The prescription label, which must contain the name of the asthma medication, the prescribed dosage, and the time at which or circumstances under which the asthma medication is to be administered.
A full copy of the law can be found at http://www.ilga.gov/leqislation/publicacts/98/PDF/098-0795.pdf.

Photo Release Form 2020-2021

This parental consent form is to both inform you and to request permission for your child's photo/image and personal identifiable information to be published on the district and/or school's website.

As you are aware, there are potential dangers associated with the posting of personally identifiable information on a website. These dangers have always existed; however, we as schools do want to celebrate your child and their work. The law requires that we ask for your permission to obtain any information about your child.

Pursuant to law, we will not release any personal identifiable information without prior written consent from you as parent or guardian. Personal identifiable information includes student names, photo or image, residential addresses, e-mail address, phone numbers and locations and times of class trips.

If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to the principal of your child's school and such rescission will take effect upon receipt by the school.

I/We GRANT permission for this student's photo/image and all other personal identifiers listed above to be published on the school and/or district's public internet site.

Parent/Guardian Name

Parent/Guardian Initials (in lieu of signature)

Dress Code 2020-2021

For more information, please refer to the 2020-2021 Student & Family Handbook

Student uniforms can be purchased through Lands’ End School Outfitters.

To purchase uniforms:
Go to www.chicagohopeacademy.org and click on the parent tab at the top. On the right 􏰋􏰐􏰮􏰄 of that page will be a button saying “Parents”, click the button. Click the “Purchase Uniform” button which will lead you to the Lands’ End website, follow that to fill out a profile for your student. On the Lands’ End website you will be able to purchase all the necessary pieces of the student uniform, though only the button down shirt and sweater must be embroidered.

School Code: 900166166

Pro tip: Sign up for the Lands’ End email promotions and in a few days you will likely get up to 50% off your order! Who doesn’t love 50% off?

Official student uniform

􏰰 CHA dress shirt: collared, solid white shirt with school logo, buttoned all the way up.
􏰰 Business casual pants, solid navy or black (athletic pants, sweat pants, yoga pants, tight-fitting pants, denim, and leggings are unacceptable).
􏰰 Optional CHA sweater: solid navy, with school logo.
􏰰 Business casual, casual, or athletic shoes in solid black; flat, and closed-toe (high heels, sandals, flip-flops and boots are unacceptable).
􏰰 Ties for boys: solid navy, tied squarely and securely at the collar.

􏰰 Skirts for girls (alternative): solid navy, knee length.

General Guidelines

􏰰 All clothing must be professional, scholarly, clean, and modest:
- 􏰰 No stains, wrinkles, holes, patches, ragged/ frayed edges, designs, logos, or slogans.
- 􏰰 No visible undergarments: undershirts, if worn, must be solid white tees􏰰
􏰰 Shirts must be tucked into pants in the front and in the back.
􏰰 Belts must be solid black and fastened securely.
􏰰 Sweatshirts, hoodies, jackets, or coats are unacceptable.
􏰰 Hats, hoods, sunglasses, and winter garments indoors are unacceptable. 􏰰
􏰰 Tattoos, facial/body piercings (other than earrings for females, as outlined below) are unacceptable; existing tattoos must be covered throughout the school day and at all school-related activities and events, and existing facial/body piercings must be removed throughout the school day and at all school related activities and events.

Athletic attire, which includes athletic socks, athletic shorts, athletic pants, sweat pants, t-shirts, and sweatshirts are not acceptable outside of P.E. class, athletic events, practices, competitions, or Spirit Days.

Title I Letter

Title I Consent

Student Name

Parent/Guardian Initials (in lieu of signature)

Date

I have read the letter on the previous page and agree/do not agree that my child may participate in the Title I program outlined above

AgreeDo not agree

Lake Geneva Youth Camp Waiver

Student Name

Student Initials (in lieu of signature)

Student Address

Address Line 2

City

State

Postal Code

Parent Name

In consideration of my student being permitted to participate in this activity, I further agree to indemnify and hold harmless Releases from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with participation by minor.

I agree to the above

Parent Initials (in lieu of signature)

Date

Retreat Permission Slip 2020

ACTIVITY: Hope Retreat

DATE: August 14-16

CHECK IN: August 14, 10:00 A.M.

RETURN TIME: August 16, 4:00 PM.

MODE OF TRANSPORTATION: Van/ Bus

LOCATION: All Students: Lake Geneva Youth Camp. W2655 W. South Street, Lake Geneva, WI 53147

This retreat is mandatory for all students attending Chicago Hope Academy.

Parent Phone Number

Emergency Contact Name

Emergency Contact Phone Number

My child has permission to participate in Hope retreat on August 14-16, 2020. I give permission to Chicago Hope Academy to transport my child to and from the field trip activity. I further agree to release and hold harmless Chicago Hope Academy and its agents and employees for any liability for any injury my child may sustain by reason of such activities or in the travel to and from the field trip. During this activity, I can be reached at the above phone number. If I cannot be reached, the emergency contact listed above is authorized to act my behalf. In any emergency situation the accompanying teacher is authorized to take whatever action is deemed necessary.

Yes, I agree to the above statement.

Parent/Guardian Initial (in lieu of signature)

Enrollment Checklist | Document Uploads

The documents requested below are required for enrollment at Chicago Hope Academy. Please upload a pdf or a photo of each of the requested documents.

Student's Birth Certificate (New & Transfer Students only)

Parent's ID

Copy of Taxes

Utility Bill

IHSA Sports Physical (must be signed by doctor. New copy required each year for every student.)

IDHS Full Physical (with immunizations)-- Freshman and Transfers ONLY. This must turn in and be in compliance. If not in compliance, you must receive the necessary immunizations before the start of school to avoid exclusion.

Dental Exam -- Freshmen and Transfers ONLY.