Student’s name:

Age:

Select Grade for 2021-2022:

Email address:

Cell phone for student

Student’s name:

Age:

Select Grade for 2021-2022:

Email address: (Please fill an additional form for additional students)

Cell phone for student

Parents’ names:

Home address:

Home phone:

Mom’s cell:

Dad’s cell:

Discipline Policy: Students are expected to conduct themselves in accordance with the guidelines outlined in the Dutch Fork Homeschool Resource Center Behavioral Expectations. (See home page of www.dutchforkhomeschoolresource.com for details) Minor offenses will be given two warnings. A third offense will be cause for dismissal from DFHRC and no fees and/or tuition will be returned. Major offenses are subject to immediate expulsion from DFHRC and no fees and/or tuition will be returned. Instructors will no tify parents of any behavioral concerns in order for these to be addressed at home as well. Please print your names below stating that you and your student(s) have read and discussed our Behavioral Expectations and that your student intends to abide by them.

YesNo

If yes, please explain the situation by contacting one of the Directors to discuss this matter privately.

We reserve the right to deny our tutoring services to those who may be a disruption to our campus.

Part 2 – Dutch Fork Homeschool Resource Center 2021-2022 Course Matrix Please complete one Course Matrix per student. Check desired course(s) for your student(s) and check either CP (College Prep) or Honors.