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Site Locations:
If you have multiple children to enroll, each child requires a separate registration
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Please select the CTA site for your child. Operational Days: Monday-Friday. Once approved, further information will be provided from the CTA site.
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CTA Sites *
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Days of the Week to attend *
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Student Information:
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PowerSchool is North Carolina's student information system. Your child's PowerSchool number is available through your school districts Parent Portal or by contacting your school.
NC Power School Number (type)
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Current School Information
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Parent or Legal Guardian Information:
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Persons responsible for picking up child
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Emergency Contacts:
CTA requires 1 Emergency Contact for all participants.
CTA will automatically contact the parent or guardian first for children under 18. Contacts below will be called only if a parent or guardian cannot be reached.
Emergency contacts remain on file until changed by you or a parent or guardian, and are not specific to any CTA program. Emergency Contacts can be updated from your online account at any time before a program begins.
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Emergency Contact 1:
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Student Health Data:
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Primary Physician Info:
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Additional Health Information:
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Is the participant currently taking prescription/over the counter medications? *
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Is the participant currently under a doctor's care? *
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Any conditions requiring special care (e.g. diabetes, gastrointestinal, motor disorder, seizure disorder, ADHD, autism, cognitive disorder, asthma, etc) *
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Has the participant had surgeries, illness, and/ or severe injuries? *
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Does participant have allergies? (e.g. food, medications, seasonal, etc.) *
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Does participant have dietary restrictions?
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WAIVERS AND PERMISSIONS
Please review the information below and click on the check the box stating you have read these terms and then sign on the signature pad below.
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Special Accommodations Every child has unique needs; we can serve your family better when we know those needs. CTA is an inclusive, welcoming space dedicated to serving children and families in a way to meet your needs. Your child's success at CTA is our top priority; therefore, if you have a request or a medical need, please contact us so we can work together to create the best experience for your child.
Please read each of the following policies and sign at the bottom of the page to indicate your understanding of these policies. Policies are subject to all applicable laws.
WAIVERS AND PERMISSIONS
Field Trips - I permit my child to leave CTA on authorized trips under the supervision of the CTA staff.
Photography and Audio - I give Community Technical Assistance, Inc. ("CTA") and its employees and agents permission to use for any lawful purpose my and/or the likeness of my child in image, voice and/or appearance as such may be embodied in any pictures, drawings, renderings, photographs, video recordings, audiotapes, digital images or the like, with the understanding that CTA will not publish an associated name.
I agree that CTA has complete ownership of such pictures, etc., including but not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements and any promotional or educational materials in any medium now known or later developed, including but not limited to the internet, television, radio, newspapers, magazines, social media sites (e.g., Facebook, Twitter, Instagram, Flickr, blogs, etc.), and/or CTA audio, print or internet publications. I also agree that CTA has permission to release such pictures, etc. to the news media. I acknowledge that I will not receive any compensation or remuneration for the use of such pictures, etc. I understand that once such pictures, etc. are published to the media or on the internet, or are otherwise published, they may be used in publications and/or on websites outside of CTA control.
Transportation - I understand and agree that for CTA programs providing transportation for me/ my child 1) to a CTA program from home, 2) home from a CTA program or, 3) from his/her school to a CTA program, the liability of CTA of the Triangle Area for me/ my child begins when a participant boards a CTA vehicle and ends when the participant exits the vehicle. Under some circumstances, the liability of CTA will continue if the participant is exiting CTA vehicle to participate in a CTA program. Pickup and drop off points will be determined prior to me/ my child attending the program for which the participant is registered. If CTA staff encounters circumstances that they perceive as dangerous at the location where I am/ my child is scheduled to exit a CTA vehicle, I/ my child will not be permitted to exit. CTA staff do not buckle participants of any age into car seats or fasten seatbelts. I understand NC Boating Laws require completion of a NASBLA-approved course before operating a vessel propelled by a 10+ hp motor.
CTA Guides Transportation - I understand and acknowledge that CTA does not furnish any insurance for my protection should any claim or suit be made against me arising out of, in connection with, or related to the operation of a personally owned vehicle. I also understand that CTA has no insurance to repair damage that may occur to my personally owned vehicle arising out of, in connection with, or related to mentor activities. At all times, I will maintain automobile insurance coverage, as required by the laws of the State of North Carolina. I agree to indemnify CTA against all claims, losses, damages, and expenses, including attorney fees, which CTA may incur arising out of, in connection with, or related to, the use of my personal vehicle. I waive all claims that I have, or may have in the future, against CTA and/or its Board of Directors, officers, employees, insurers, volunteers, and agents. This release of all claims includes, but is not limited to, all liability for damages of any type, losses, or injuries that may arise out of, in connection with, or related to, the use of volunteer’s vehicle. I understand that I may consult an attorney at their own expense prior to signing this agreement. In the event that any portion of this agreement is deemed unenforceable, the remainder will continue in full force and effect. The law of the state of North Carolina, without regard to conflicts of laws, will apply to this agreement. The exclusive venue for any action arising out of, in connection with, or related to, this agreement, will be the Superior Court sitting in Wake County, North Carolina. By my signature below, I acknowledge and agree to the following: I confirm that I have carefully read this Consent and Release. I agree to all of the above terms knowingly and voluntarily.
Programs Communication Policy - I hereby give permission for my teenager to communicate via email, web-based communication (such as Facebook) and phone (including cell phone text messages and images) with CTA staff and volunteer advisors. I understand that my school-aged child age and the staff and volunteer advisors may be communicate about CTA program information and other information while they are not supervised by CTA personnel. I release and hold harmless CTA from any legal claims or liability related to such communications via email, web-based communication and phone.
PROGRAM POLICIES
Babysitting Policy - CTA strives to employ the very best staff possible in all of our programs. During staff time off or after they are no longer employed with CTA, these persons are private citizens and are no longer subject to our employment rules and procedures. CTA cannot and does not endorse or recommend its present or former staff members as babysitters to any parent or guardian of any child in any of our programs. Any babysitting arrangements with present or former staff of CTA is separate and independent from any CTA program and must be based on the independent investigation, responsibility and judgement of the parent or guardian. I agree that CTA shall not be responsible and will be held harmless from any claims or liability in connection with such babysitting activities.
Indemnity - I understand that CTA activities have inherent risks, and I hereby assume all risks and hazards incident to my participation/my child’s participation in all CTA activities, and recreation activities provided by third party vendors. I agree to waive any liability arising out of any actual, alleged, or threatened infectious, pathogenic, toxic, or other harmful properties of any “organic pathogen”, which includes but may not be limited to bacteria, viruses or other pathogens whether or not a microorganism, regardless of whether such “organic pathogen” is the result of a local outbreak, epidemic, pandemic or unknown cause. I further waive, release, absolve, indemnify and agree to hold harmless CTA and its employees, organizers, volunteers, vendors, supervisors, officers, directors, participants, coaches and referees, as well as all persons or parents transporting participants to and from activities, from any legal claims, liabilities, damages and costs for any physical injury or damage to my personal property sustained during my use of CTA property and/or my participation/my child’s participation in any CTA activities.
I understand that CTA is not responsible for any personal items lost or stolen at our programs.
Force Majeure - The performance of this Agreement by CTA is subject to act of God, government authority, curtailment of transportation, disaster, widespread illness, including epidemic and pandemic events, and other emergencies, any of which make it illegal, impossible, or commercially impracticable, for CTA to perform its obligations. It is provided that this Agreement may be terminated by CTA for any one or more of such reasons by written notice from CTA to the other party without liability to CTA.
Horseback Riding - I acknowledge that horseback riding, trail rides, or using horses entail known and un-anticipated risks which could result in physical, emotional injury, paralysis, death or damage to myself, to property or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: loss of control, collisions; horses, irrespective of their previous behavior and characteristics, may act or react unpredictably based upon instinct, fright, or lack of proper control by rider, such as biting, kicking, bucking, lying down or stumbling; latent or apparent defects or conditions in equipment, animals or property; acts of other participants in this activity, adverse weather conditions; contacts with plants, insects, or animals; my own physical condition or my own acts or omissions, the condition of the remote roads, trails, waterways, or terrain, and accidents connected with their use; first-aid, emergency treatment or other services rendered; consumption of food or drink. In the event that I file a lawsuit against CTA, I agree to do so solely in the state of North Carolina, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I have been informed of the State Equine Liability Act. The summary of these rules should be reviewed here: State Equine Liability Act.
Inclement Weather - I understand that programs may not be available when school is closed due to inclement weather. Please refer to CTA web site for the most up to date information.
Toilet Training - Children age 3 and older need to be toilet-trained.
Sex Offender Registry - North Carolina law prohibits sex offenders from accessing CTA programs and facilities. In compliance with this law and in order to ensure the safety of our children, we regularly compare our membership and participant database to the National Registry of Convicted Sex Offenders and terminate the membership, programs, and/or access rights of anyone registered.
MEDICAL TREATMENT POLICIES
Accident Insurance - Participants are responsible for their own accident insurance when using CTA and when participating in CTA programs off-site.
Medication - CTA does not normally administer any medication and will do so only when directed in writing by a parent or guardian. Medications must be in original containers with written instructions for dispensing. Generally, children are prohibited from having medication with them, unless the medication is dispensed on their person (such as an insulin pump) or a doctor has specifically indicated in writing that the participant may self-administer and safety precautions are met for the safe handling of the medication. If a doctor has given this written permission, a copy must be provided to CTA. A parent or guardian must give the medication to program staff. Medication will not be transported when children travel between their school site and CTA program.
Notice: With respect to giving injections to children participating in its programs, CTA will comply fully with the requirements of the Americans With Disabilities Act. For those children who require injections, or who have other special medical needs, CTA will consider all requests for reasonable modifications to its program, including meeting with the parent(s) or guardian(s) of such children to discuss such modifications, and strive to develop a mutually acceptable plan designed to address the medical circumstances of each individual child. CTA does not administer, and is not responsible for administering, medications that have to be inserted into body cavities. CTA will consider requests for reasonable modifications to the above Medication Policies that do not amount to a fundamental alteration of its program.
Pathogen Exposure - I understand that, while I/ my child is in the care of CTA, if a participant is exposed to a body fluid on broken skin or mucous membrane (e.g. splashing in mouth or eye) from another participant, CTA will contact both parties involved. They will explain what has occurred, and provide the name of the attending physician of the source participant to the exposed participant. If a staff member has a blood or body fluid exposure from a participant, CTA will provide the name and telephone number of the attending physician to the staff member.
I have read and agree with the statement and specifically authorize CTA to release the name and telephone number of physician(s) and a description of the event to the participant/ parent or guardian of any participant who is exposed to blood or body fluid or to any staff member who experiences such an exposure from a participant.
Routine Care - I hereby give permission for a registered nurse or physician selected by CTA to perform routine tests and treatment for my health/ the health of the participant.
Permission to disclose information - I agree to allow medical staff to speak with CTA personnel regarding any medications I/ my child is taking as well as specific medical or psychological conditions that may impact my/ the participant's ability to participate in CTA programs. I authorize CTA to release any health records related to me/ my child as may be necessary for treatment, referral, billing or insurance purposes.
Health History - I understand I am required to inform CTA if I have/ my child has been exposed to or has contracted any potentially serious communicable disease (such as chickenpox, hepatitis, meningitis, lice, etc.) or has experienced fever, vomiting or diarrhea prior to attending a program. When required, in ordinance with the American Camping Association, I agree to have the participant(s) examined by a licensed physician within one year of arrival to an overnight camping program in addition to submitting a properly completed Health Examination Form, documenting required immunizations and proof of personal insurance. Falsification or lack of full disclosure of this information may result in a dismissal from the program.
Medical Expenses - I agree to pay for all medical expenses that may be necessary for the health and well-being of me/ my child. CTA does not file medical insurance claims. In certain circumstances, CTA staff will pay for medical care needed. CTA will provide detailed receipts and medical information for you to file a claim with your health insurance company, and CTA will invoice you directly for these expenses. I understand that I am responsible to pay CTA for these medical expenses within 30 days of receiving an invoice.
Emergency - In the event of an emergency in which the parent/guardian or listed emergency contacts cannot be reached, CTA will contact emergency medical personnel and, pending their arrival, take those actions that are in CTA judgement to be in the best interests of the participant.
Behavior Expectations and Discipline Policies
At CTA of the Triangle, our behavior expectations and discipline procedures are based on our core values of caring, honesty, respect, responsibility and faith. We believe in creating a safe, secure and fun environment where all participants have the opportunity to learn the importance of demonstrating good character. We believe that in order to do this, all participants need to know and understand the rules and expectations for appropriate behavior. We also believe that when participants do not follow the rules or when they demonstrate inappropriate behavior, we have an opportunity to help them learn from their mistakes.
CTA promotes behavior guidance and discipline through creating a positive environment, developing structure and clear limits, promoting social and emotional learning, reinforcing our core values and addressing challenging behaviors.
CTA of the Triangle uses six simple rules to communicate behavior expectations to all participants in our programs. The purpose of these rules is to ensure the safety of our participants and staff and to create a positive environment for all. These rules are:
i. Listen and follow directions
ii. Do what's right.
iii. Keep your hands and feet to yourself.
iv. Try everything and do your best.
v. Be an upstander. If you see something, say something.
vi. Be safe and have fun!
All participants are expected to follow the rules established by CTA for the safety of all other participants in the program. Your cooperation and support help ensure that everyone has a safe and fun experience.
CTA uses positive discipline which means staff members promote desired behaviors through teaching and reinforcement. Staff will redirect or problem solve with participants when they are not displaying desired behaviors, rather than restrict behaviors by taking away opportunities or controlling participants with fear of punishment. We believe this approach focuses on the needs of the participants and contributes positively to their overall development. Staff shall use positive discipline, which shall include the following:
i. Communicate to participants using positive statements.
ii. Encourage participants/youth, with staff support, to communicate their thoughts and provide solutions in order to resolve interpersonal conflicts.
iii. Communicate with participants by speaking in a calm, quiet manner about the expected behavior.
There are times when restrictions may be necessary, and will most likely be directly linked to the health, safety or well-being of you/ your child or others. CTA staff does not use corporal punishment under any circumstance. In the event of a participant harming themselves, another participant, or an adult, staff may physically restrain the participant to ensure safety.
CTA does not allow the following behaviors including but not limited to:
i. Any action that could threaten the physical or emotional safety of the participant, other participants or staff.
ii. Prohibited conduct may include, but is not limited to: abusive jokes, insults, slurs, threats, name calling or intimidation.
iii. Destructive behavior.
iv. Behavior that is of a habitual nature and negatively impacts the program, and/or safety and enjoyment of others.
v. Behavior that is of a sexual nature.
Additionally, all participants agree to the behaviors and expectations outlined in the CTA Code of Conduct. Some behaviors could result in immediate suspension or dismissal.
CTA Discipline Procedures - If a participant is unable to meet established behavior expectations, CTA staff will follow these disciplinary procedures below. CTA staff desire to partner with individual participants and families of the youth in our care. If at any time you have concerns about your child's behavior or success in our program, please do not hesitate to reach out to your Program Director to set up a conference.
i. Conversation between staff and participants to discuss behavior and reset expectations
ii. Staff will first use positive reinforcement and redirection to redirect a participant's behavior. If this is ineffective, staff may use a temporary suspension/ timeout as an opportunity for the participant to take a break from the behavior before rejoining the activity.
iii. Staff will communicate with the participant directly or with a parent/guardian if/when youth is not following established CTA rules. This communication may be at Rides Out, over the phone or via a conference.
iv. If positive discipline and redirection are ineffective in changing participant behavior, the Program Director may suspend the participant. Length of suspension will be determined based on each individual situation. Factors such as type/severity of behavior, behavior history, age of participant, etc. will be considered when determining the length of suspension.
v. If the participant continues to have challenges after a suspension, the Program Director may set up a conference to develop a behavior plan for the participant.
vi. If suspensions nor a behavior plan are effective in changing the participant's behavior, the participant may be dismissed from the program. Dismissal from the program for disciplinary reasons could result in permanent removal from all CTA programs and facilities.
Special Accommodations - Everyone who attends CTA programs has unique needs. We are better when we take time to find out what those needs are, build empathy and understanding, and respond to individuals appropriately. CTA offers inclusive, welcoming programs dedicated to serving those needs in the best way possible. Because every person is unique, we address each request individually.
Your/ your child’s success and safety in our programs are our top priorities; therefore, we respectfully ask you or parents and caregivers to inform CTA, prior to the start of the program, of any special needs which may require special accommodations, so we can work together to support you/ your child in reaching your/ their full potential.
CUSTODIAL RIGHTS
Court Orders - If parents are separated or divorced, the parent/ guardian completing this registration must inform CTA if custodial rights are joint or sole. If relevant court order(s) exist regarding custody of a minor, CTA requires a current signed copy of court order(s) with your registration/ application. In the case of joint custody, CTA must have written consent from each parent on file in order to add, edit or delete names to Emergency Contacts and Authorized Pick Ups. This condition may be applicable in other areas as well. Otherwise, only the parent having sole custody as identified in the signature below may make changes.
Waiver Signature and Agreements
Waiver Signature and Agreements
I have read, understand and agree with all of the policies as stated in this document and I have discussed the expectations of behavior with my child/ ward. I understand that CTA has the authority to revoke my/ my childs right to participate in CTA programs for behavior which is not in keeping with the mission of CTA or for failing to follow the policies/ procedures of CTA. My signature below indicates that I agree to adhere to all policies, procedures and the mission of CTA.
The parent/ guardian signing above represents by executing this document that he or she has the full authority to give permission for the minor child to participate in this program and intends unconditionally for CTA of the Triangle to rely upon this representation for all purposes related to the program.
Please contact CTA if you have questions or concerns about any of the policies defined under Waivers and Permissions.
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Click the Agree button and sign below to complete the registration. *
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CTA COVID-19 Waiver Form"
CTA COVID-19 Waiver Form
ASSUMPTION OF RISK, WAIVER AND RELEASE OF LEGAL CLAIMS, COVENANT NOT TO SUE, AND INDEMNIFICATION AGREEMENT
By signing below, you (and your parent/guardian if you are under 18) agree to the following terms and conditions contained in this Assumption of Risk, Waiver and Release of Legal Claims, Covenant Not to Sue, and Indemnification Agreement (the “Agreement”).
Assumption of Risk
You know and understand the scope, nature, and extent of the risks involved in participating in physical training and activities including, but not limited to, strength and conditioning training, speed and quickness training, plyometric training, recovery and regeneration training and performance training, swimming, team activities, rehabilitation, reconditioning, sports nutrition, lifetime sports, team sports, including supplement and nutrition provision, and all activities similar to or incidental thereto (collectively, the “Company Activities”), and that these risks include, but are not limited to, the following: damage to property, bodily harm or injury, including but not limited to permanent paralysis, and/or death.
You further acknowledge and understand that there is a risk that by engaging in Company Activities you (or your child) can contract COVID-19 while at the facilities of Community Technical Assistance, Inc. (CTA) and its subsidiaries (the “Company”). You also acknowledge that due to their physical nature, the Company Activities carry a greater risk than other activities of exposure to COVID-19. Even when all reasonable precautions are taken, there is an unavoidable risk of exposure to COVID-19.
You agree that the Company and the Released Parties (defined below) are not responsible for these and other unexpected occurrences and that you will participate in the activities under this Agreement at your own risk. You voluntarily, freely and expressly choose to incur all risks associated with the Company Activities, including contraction of COVID-19, understanding that those risks may include personal harm or injury, illness, damage to property, and/or death.
Waiver and Release of Legal Claims
In consideration of being allowed to participate in the Company Activities, for yourself, parents, legal guardians, heirs, executors, and your administrators, you do hereby forever waive, release, and fully discharge the Released Parties (as defined below), and each of them, from any and all claims, liabilities, actions or causes of action of any kind or character whatsoever arising from or as a result of personal injury, death, and/or property damage, which you may have, or which hereafter may accrue to you, as a result of you service and duties as an independent contractor under this Agreement.
The “Released Parties” shall mean the Company, including its, site locations / partners, directors, members, managers, board members, officers, officials, employees, representatives, and agents, and any of the Company’s parent companies, affiliated companies, subsidiaries, predecessors, successors, or assigns.
You understand and agree that your waiver and release fully discharges in all ways and for all time the Released Parties from and against any and all liabilities of any kind whatsoever arising in, from, during, or as a result of you participating in the Company Activities, whether at law or in equity, whether known or unknown, whether contingent or absolute.
You understand that this waiver and release covers liabilities, claims and actions caused entirely or in part by any acts or failures of the Company (or its directors, members, managers, board members, officers, officials, employees, representatives, and agents) including, but not limited to, negligence, mistake, or non-supervision.
Covenant Not To Sue
You agree not to sue the Released Parties or to join in any lawsuit or legal proceeding, including a collective or class action, or take any other action which seeks to pursue or enforce any claim, demand, cause of action, suit, or liability which has been released herein.
You further agree that your parents, legal guardians, heirs, executors, administrators, personal representatives, and/or anyone else claiming on your behalf by reason of injury to your person or property, or your death, shall not institute any lawsuit or legal proceeding, or take any other action which seeks to pursue or enforce any claim, demand, cause of action, suit, or liability which has been released herein. Should any such suit or action at law or otherwise be instituted against any of the Released Parties, you agree that such Released Parties shall be entitled to recover attorneys’ fees and expenses incurred in defense of such suit or action, including any appeals therefrom.
Indemnity Against Third Party Claims
You agree to indemnify, save and hold harmless the Released Parties from any and all losses, claims, liabilities, actions, or proceedings of every kind and character, including attorneys’ fees and expenses, which may be instituted or claimed by any other persons or organizations and which arise directly or indirectly from your participation in the Company Activities, whether resulting from the negligence and/or other fault, either active or passive, of any of the Released Parties or from any other cause.
Representations and Acknowledgement
By signing below, you acknowledge and agree that you (and your parent/guardian if you are under the age of 18) have carefully read this Agreement, and fully understand its contents. You are aware that this Agreement contains a release and waiver of liability and a waiver of all your rights and claims for damages that you (and others claiming through you) may have that exist now or may arise in the future as a result of injury to your person or property, or your death, that you may sustain by engaging in the activities under this Agreement.
You further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made. The laws of the State of North Carolina shall govern the interpretation and construction of this Agreement.
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Click the Agree button and sign below to complete the registration. *
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I understand this is a legal representation of my signature.
Clear
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