Registration Form

Contact Information
May we add your phone number and email address to the Co-op directory?
Emergency Medical Information
Health Insurance Information
Emergency Medical Consent

In the event that reasonable attempts to contact me and the other emergency contact(s) is unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by the physician, dentist, and/or hospital, as applicable, listed above.

Please download and print our Medical Waiver form, and turn it in with your semester co-op fee.

Child Supervision Responsibility

I understand that I am personally responsible for my child(ren)'s safety and supervision during the time that he/she is attending Encourager's Co-op classes. In the event that I must leave the premises for any reason during classes, I will designate a supervising adult for disciplinary situations or emergencies. I will notify Sarah Molinari of the person responsible, in writing, while I am gone.

Please download and print our Absent Parent Authorization Waiver form, and turn it in with your semester co-op fee.

Rules and Guidelines Agreement

I have read and understood the Rules and Guidelines for Encourager's Co-op and agree to abide by them. Also, I have discussed them with my child(ren).