HVE Returning Student Form – CSU Campus

Higher Visions for Education – CSU Campus

Class Registration For Returning Students:

-Classes are Wednesday evenings from 6:30 to 8:30 PM.

-Tuition is $250.00 for each Quarter.

-Balance is due at or before the fourth class of the semester.

-Partial scholarships are available to those most in need.

Please complete the following form. After submitting you will be directed to your options for tuition payment.

*indicates required information

CSU STUDENT INFORMATION:

Name (First & Last)*

Street Address*
Address 2
City*

State*
Zip*

Daytime Phone
Evening Phone
Mobile Phone

Your Email*

Please update us with any medical changes or helpful information

TRANSPORTATION:
Self (Car, walk, bus, or bike)Car PoolAccess-A-Ride**Other **Who should we contact if there are problems with Access-A-Ride?

Please indicate which block you are registering for:*
First SemesterSecond SemesterSummer Class

COVID-19 Liability Release* (must read and accept)

Due to the outbreak of the novel Coronavirus (COVID-19), Rocky Mountain Down Syndrome Association (RMDSA) is taking extra precautions with the care of every individual to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance.

Please review the information below. All staff and students of RMDSA's Higher Visions for Education (HVE) class must adhere to these guidelines for safe class participation.

Symptoms of COVID-19 include (but are not limited to):
• Fever
• Chills
• Fatigue
• Dry cough
• Difficulty breathing or shortness of breath
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Muscle or body aches (myalgia)
• Nausea, vomiting or diarrhea

I agree to the following: I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days of each HVE class/event.

I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 14 days of each HVE class/event.

I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 14 days of each HVE class/event.

I affirm that I, as well as all household members, have not traveled outside of the country within the past 14-days of each HVE class/event.

I understand that RMDSA cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each participant. Our association is following enhanced procedures to prevent the spread of COVID-19. By clicking the box on the student registration form, I agree to the above statements and release Rocky Mountain Down Syndrome Association from any and all liability of unintentional exposure or harm due to COVID-19.

I agree NOT TO ATTEND CLASS if I have been exposed to someone with COVID-19 and/or experiencing any of the symptoms listed above.

By checking this box you accept these terms.