Education Cyberteck Program

Education Cyberteck Program Enrollment Agreement

Student Information

Date of Birth:    Student ID:    Grade/Program:

Parent / Guardian (if student is a minor)

Primary Phone:    Email:

Program Enrollment Details

Intended Start Date:    Program Duration (weeks):    Scheduled Days/Times:

Payment Plan (select all that apply):
Full payment due prior to start date    Installment plan with schedule to be provided    Scholarship / financial assistance approved

Emergency & Medical Information

Emergency Phone:    Alternate Phone:

Program Policies, Permissions, and Acknowledgments

Attendance and Participation: The student is expected to attend scheduled sessions, complete assigned coursework, and follow instructor directions. Excessive absences or failure to participate may result in removal from the program without refund where specified by the refund policy below.

Code of Conduct: The student shall abide by the Cyberteck Program code of conduct, which prohibits academic dishonesty, unauthorized access to computing systems, harassment, and other behaviors that jeopardize safety or learning. Violation may result in disciplinary action up to immediate dismissal from the program.

Digital Safety and Acceptable Use: The student agrees to comply with all acceptable use policies for equipment and networks. Unauthorized copying, distribution of proprietary materials, or deliberate interference with network integrity is prohibited.

Media Release: I consent to the use of my or my child's image, voice, and work for program-related promotional, educational, and archival purposes. Declining this release will not affect participation but may limit use of student work for public promotion.

Data and Project Ownership: Student-created code, designs, and documentation produced during the program shall be owned by the student, provided such work does not incorporate proprietary instructor or third-party materials. The program retains a non-exclusive, perpetual license to use student work for educational and promotional purposes unless otherwise agreed in writing.

Privacy and Records: The program will maintain records necessary for educational administration. Sensitive medical information will be disclosed only to staff on a need-to-know basis for safety. By enrolling, parent/guardian authorizes such limited disclosures for safety and emergency purposes.

Cancellation, Withdrawal, and Refund Policy

Cancellation by Participant: Written notice of withdrawal must be delivered to program administration. Refunds, if any, will be determined by the timing of withdrawal in relation to the program start date and incurred costs. Administrative processing fees may be assessed.

Cancellation by Program: The program reserves the right to cancel or reschedule courses for insufficient enrollment or unforeseen circumstances. In such cases, participants will be offered a full refund or credit toward future offerings.

Liability, Indemnity, and Emergency Authorization

Liability Waiver: To the maximum extent permitted by law, the program and its employees, contractors, and agents are not liable for personal injury, loss, or damage to property arising from participation in the program, except for gross negligence or willful misconduct. Participant and parent/guardian release and hold harmless the program from claims arising from ordinary negligence.

Emergency Medical Authorization: In the event of an emergency where immediate treatment is required and parent/guardian cannot be reached, I authorize program staff to seek and consent to emergency medical treatment for the student. I accept responsibility for costs incurred for such treatment.

Acknowledgments and Required Authorizations

Participant acknowledges receipt of program rules and policies and agrees to comply. By signing below, the undersigned certifies that the information provided on this form is true and complete, agrees to the terms set forth in this enrollment agreement, and authorizes program billing as indicated above.

Consent to Electronic Communications: I authorize the program to communicate with me via email, phone, and SMS regarding scheduling, billing, and program notices.

Additional Information

Certification

I certify under penalty of perjury that the information provided in this enrollment agreement is true and correct to the best of my knowledge. I understand that providing false information may result in denial or termination of enrollment.

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