Emerson Waldorf School Pre-K-12

Girls Singing

Registration

Registration is completed by filling out the Registration Form and submitting payment for the course(s).  Confirmation of your registration will be provided.  A certificate of completion is mailed after the successful conclusion of the class.

Mail your payment to:

Emerson Waldorf School
6211 New Jericho Road
Chapel Hill, NC 27516

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Parent/Guardian #1 Name:
Home Phone Number -
Email Address:
Address -

Employer/Department -
Parent/Guardian #2 Name -
Home Number -
Email Address -
Address -

Names of 2 friends/relatives in the event you cannot be reached: Name, Relationship, Home Phone

Physician Name -
Physician Phone Number -
Dentist Name -
Dentist Phone Number -
Hospital of Choice -
Hospital Phone Number -
Chronic Conditions -

Allergies (medications, insect stings, food, other) -

Current Medications - *Medical Authorization form signed by physician required for any prescribed medications.

If your child needs Ibuprofen, Tylenol or other homeopathic remedies during the day, you authorize EWS personnel to administer according to package guidelines: (Please check the following)

Acetaminophen (Tylenol)

Homeopathic remedies

Ibuprofen (Advil/Motrin)

Benedryl

Soap & Water ONLY
Medical Insurance Carrier Name and Policy Number.

Course Registration - Please indicate below with a check mark which course(s) you are registering.
First Semester Classes Mythology

Geology

Modern World History 1

History Through Art
Second Semester Classes Organic Chemistry

Probability (Math)

Modern World History II

Comedy and Tragedy (Literature)