MOSAIC summer 2014

Registration for session 1 will close

Month Day Year Hour Minutes AM/PM Option
MOSAIC summer classes 2014 -- Registration
Online registration for July classes will end on July 24, 2014.. There may be some classes available for walk-in registration on July 28th.
Student Name

First Name Last Name
Student Gender

Male Female
T-shirt size
Student Grade for fall 2014
Student School in fall 2014
Enter student grade and course options will appear in a drop down list (click the arrow).

Please review course descriptions to ensure that your child has met the pre-requisites before enrolling in an advanced class.
June 9-13 (4th grade) 9am
June 9-13 (4th grade) 10:30am
July 28 - Aug 1 (4th grade) 9am
July 28 - Aug 1 (4th grade) 10:30am
June 9-13 (5th grade) 9am
June 9-13 (5th grade) 10:30am
July 28-Aug 1 (5th grade) 9am
July 28-Aug 1 (5th grade) 10:30am
June 9-13 (6th grade) 9am
June 9-13 (6th grade) 10:30am
July 28 - Aug 1 (6th grade) 9am
July 28 - Aug 1 (6th grade) 10:30am
June 9-13 (7th grade) 9am
June 9-13 (7th grade) 10:30am
July 28 - Aug 1 (7th grade) 9am
July 28 - Aug 1 (7th grade) 10:30 am
June 9-13 (8th grade) 9am
June 9-13 (8th grade) 10:30am
July 28 - Aug 1 (8th grade) 9am
July 28 - Aug 1 (8th grade) 10:30am
June 9-13 (9th grade) 9am
July 28 - Aug 1 (9th grade) 9am
July 28 - Aug 1 (Late registration)
If you have any questions, please contact Carrie Clark, gregcarrie@tx.rr.com

Parent Name *

First Name Last Name
Parent Home or Work Phone (during 9am-noon) *

Area Code Phone Number
Parent cell phone *

Area Code Phone Number
Parent email *
Student allergy information
Emergency contact *
Emergency Contact Phone *

Area Code Phone Number
Doctor's Name *
Doctor Phone *

Area Code Phone Number
Current CGA member? *

Yes No
Last name that CGA membership is under

RELEASE OF LIABILITY

- By agreeing below, I hereby acknowledge that I am enrolling my child is this MOSAIC course offered by Coppell Gifted Association (CGA). This course will be held at the stated date and time in the Coppell Independent School District (CISD). In consideration for my child's being permitted to participate in the Course(s) offered by CGA, I hereby execute this Release of Liability with the intent to bind myself, my spouse (if applicable), my heirs, assigns and legal representatives. I further represent that I am eighteen (18) years of age or older and competent to sign this affirmation and release.

- I fully understand and agree that certain aspects of the course(s) could be physically demanding and that my child faces risks of accidental or other physical and/or emotional injury by participating in the course(s). These risks may include, but are not limited to, (1) loss or damage to personal property, and (2) injury or fatality due to (a) use of machinery and/or electrical equipment, such as computers, engines and turbines, and (b) walking, running, jumping, or other physical activity, or inclement weather and conditions, which may cause slips and falls.

I understand and assume the risks for my child's participation in the course(s). I further represent that my child is in good physical condition, and does not possess, nor am I aware of, any physical or mental disabilities that will limit his/her ability to participate in the course(s).

- I EXPRESSLY AGREE AND INTEND THAT MY CHILD'S PARTICIPATION IN THE COURSE(S) SHALL BE UNDERTAKEN BY MY CHILD AT HIS/HER OWN RISK AND THAT NEITHER CGA, ITS OFFICERS, EMPLOYEES, AGENTS OR ASSIGNS, CISD, ITS TRUSTEES, OFFICERS, EMPLOYEES, STUDENTS, AGENTS NOR ASSIGNS SHALL BE LIABLE FOR ANY INJURIES, DAMAGES, CLAIMS, DEMANDS, ACTIONS OR CAUSES OF ACTION WHATSOEVER THAT MAY ARISE OUT OF OR HAVE A CONNECTION WITH MY CHILD'S PARTICIPATION IN THE COURSE, WHETHER FROM ACTS OF ACTIVE OR PASSIVE NEGLIGENCE ON HIS/HER PART, OR THE PART OF CGA, ITS OFFICERS, EMPLOYEES, STUDENTS, AGENTS, OR ASSIGNS, OR CISD, ITS TRUSTEES, OFFICERS, EMPLOYEES, STUDENTS, AGENTS OR ASSIGNS AND I DO HEREBY AGREE TO FOREVER RELEASE, DISCHARGE, INDEMNIFY HOLD HARMLESS AND DEFEND CGA, ITS OFFICERS, EMPLOYEES, STUDENTS, AGENTS AND ASSIGNS, AND CISD, ITS TRUSTEES, OFFICERS, EMPLOYEES, STUDENTS, AGENTS AND ASSIGNS FOR ANY SUCH INJURIES, DAMAGES, CLAIMS, DEMANDS, ACTIONS OR CAUSES OF ACTIONS.

- The laws of the State of Texas govern and construe the terms of this Release of Liability.
To accept this agreement, type "I AGREE" *
Name of person completing liability waiver *

MEDICAL AUTHORIZATION

In the event that I (we) cannot be reached to make arrangements for emergency medical attention, I (we) authorize Coppell Gifted Association to take my (our) child to the nearest medical facility for necessary treatments. (To accept this authorization, please type "I AGREE" in the box below).
To accept MEDICAL AUTHORIZATION, type "I AGREE" *
PHOTOGRAPHY AUTHORIZATION

I (we) give permission for the registered child in MOSAIC course(s) to be photographed and/or video taped for editorial, promotional, and audiovisual presentations by Coppell Gifted Association. I consent to reproduction and use of these photographs and understand my child's name will not be used. (To accept this authorization, please type "I AGREE" in the box below.)
To accept PHOTOGRAPHY AUTHORIZATION, type "I AGREE"
PROJECT PUBLICITY RELEASE

I (we) understand that as a part of the MOSAIC course(s), my child may be involved in the creation of projects, including photographs, animations, movies, stories, video games, academic work, and other materials. I consent to the display, use, and reproduction of these materials by Coppell Gifted Association and its representatives and understand that it may contain my child's name. (To accept this authorization, please type "I AGREE" in the box below.)
To accept PROJECT PUBLICITY RELEASE, type "I AGREE"
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MOSAIC summer classes 2014 -- Registration