Register for an AM/PM Program at Sage Please enable JavaScript in your browser to complete this form.Program InformationProgram *Nature NavigatorsLearning Lounge / Homework Club on Location Frequency Dates *Session I: October 19 - 30 (two weeks)Session II: November 2 - 20Session III: November 30 - December 18Preferred Location *Mill ValleyLarkspurDays (Choose all that may apply)MondaysTuesdaysWednesdaysThursdaysFrequency *5 days per week ($300)Hours *AM Cohort (9:00am - 11:00am)PM Cohort (12:45pm - 2:45pm)PM Cohort (3:00pm - 5:00pm)Hours are flexible. Please let us know if you have specific scheduling needs. Hours *AM Cohort (8:30am - 11:30am)PM Cohort (12:00pm - 3:00pm)Hours are flexible. Please let us know if you have specific scheduling needs. Student InformationStudent Name *FirstLastStudent SchoolStudent GradeStudent Date of BirthStudent EmailStudent Phone NumberIs there anything else of which we should be aware?Parent InformationParent Name *FirstLastParent Email *Parent Phone (Primary) *Parent Phone (Alternate)Address *AgreementsBilling and Cancellation Policies *Yes, I have read and agree to the billing and cancellation policies outlined below.Billing will be done every three weeks. Payment may be made by cash, check or credit card and must be received 10 days prior to the next session to ensure continued enrollment. If paying by card, we will bill automatically 10 days before, unless otherwise indicated. There will be no refunds unless in the case of prolonged illness (i.e. a student or member of a student’s immediate family contracts Covid-19 and this student must be removed from the pod for an extended period of time). In this case, the client will be refunded the prorated amount. Session dates are as follows: October 12 - 30, November 2 - 20, November 30 - December 18 Health and Safety Policies *Yes, I have read and agree to all health and safety policies outlined below._____ I understand I will not be allowed to enter Sage Educators facilities for the duration of the pandemic except in the case of emergency. _____ I will inform all authorized pickup and drop off persons of this guideline. _____ I understand that if I do need to enter the facility in the case of emergency I will wash my hands before entering and wear a mask. I will maintain social distancing of 6ft at all times. _____ I understand I am to keep my child home at any sign of illness. Similarly, if a teacher notices any signs or symptoms of illness with a student, they will notify me or the emergency contact and we are to pick up our child within 30 minutes. _____ I understand that Sage Educators’ staff will be employing measures to ensure the health and safety of students, all of which are outlined below and if my child fails to cooperate with suggested procedures, I will be notified and could forfeit my child’s place in a pod. _____ I understand that outside of Sage Educators, I will comply with any and all local, County, and State stay-at-home orders, as well as limit my exposure to other community members, performing only essential errands and duties as permitted (i.e. grocery shopping). In the interest of the health and safety of Sage staff and students, and in accordance with county guidelines, we will: -Take every child’s temperature at the beginning of each day, and take a specific child’s temperature any time there is a concern that child may have a fever. -Upon entering the classroom, require children and adults to wash hands. Repeat throughout the day as necessary. -Teach and reinforce washing hands and covering coughs and sneezes among children and staff. Students are required to bring a personal hand sanitizer, in addition to those provided by Sage. -Teach and reinforce mandatory use of cloth face coverings among all staff. Cloth face coverings will be encouraged for students while indoors. Staff will be frequently reminded not to touch the face covering and to wash their hands frequently. -Ensure safe and correct application of disinfectants and keep products away from children. -Ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible by opening windows and doors, using fans, or other methods. -Sanitize the sink and toilet handles before and after each child’s use. -Teach children to use a tissue when using the handle to flush the toilet. -Wash hands for 20 seconds and use paper towels (or single use cloth towels) to dry hands thoroughly. Please contact your Sage Director for any specific precautions you’d like enforced apart from what is listed here. COVID-19 Release *I release Sage Educators, Inc. from any and all liability resulting from exposure to the COVID-19 virus.PaymentPayment MethodCashCheckCredit CardRegardless of your preferred method of payment, we require that a backup credit card be kept on file. Name on Credit Card *Credit Card Number *Credit Card Expiration *Credit Card CVV *Help Sage Educators Foundation provide educational opportunities for deserving students in need. We share your concern that distance learning exacerbates educational inequity in our community. Please join us in our effort to level the playing field by donating to the Sage Educators Foundation (a 501 c3 organization). All proceeds will go directly to providing educational opportunities to deserving students in need. No donation is too small; every little bit helps. Thank you for your generosity. Donation FrequencyOne Time DonationMonthly DonationRegister