2022-23 Special Order Form - Recreational Programs

Directions:

Parents, please note that in order to process your order you will need to complete the first page before clicking on “I’m Done! I want to submit this to my teacher!”. This will bring up a box which will enable you to enter your teachers email address. Your order details will be sent to your teacher for verification and approval.

Date Requested: Date Requested: / MM / DD YYYY
Parent Name: Parent Name: First Last
Parent Phone: Parent Phone: - ### - ### ####
Parent Email:
Mailing Address: Mailing Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contact Name: Emergency Contact Name: First Last
Emergency Contact Phone: Emergency Contact Phone: - ### - ### ####
Current Family Budget Balance:
How many students will this order be for?
Vendor Name:
In order for HCOS to make a purchase from your Recreational Center, we will need you to open an account with them and fill in your username and (temporary) password in the provided spaces below.
Link to your Recreational Account login page:
Family Recreational Center Username:
Family Recreational Center Temporary Password:
Student Name: Student Name: First Last
PO Number:
Name of Teacher: Name of Teacher: First Last
Date of Birth: Date of Birth: / MM / DD YYYY
Grade:
Venue Name:

If you have a username and password to this vendor please include it in the notes below.
Link To Activity:
Type of Lesson:
Start Date: Start Date: / MM / DD YYYY
End Date: End Date: / MM / DD YYYY
Name of class:
Course Code/Number:
Level:
Price: $ Dollars . Cents
Start Time: Start Time: : HH MM AM/PM
End Time: End Time: : HH MM AM/PM
Student Name: Student Name: First Last
PO Number:
Name of Teacher: Name of Teacher: First Last
Date of Birth: Date of Birth: / MM / DD YYYY
Grade:
Venue Name:

If you have a username and password to this vendor please include it in the notes below.
Link To Activity:
Type of Lesson:
Start Date: Start Date: / MM / DD YYYY
End Date: End Date: / MM / DD YYYY
Name of class:
Course Code/Number:
Level:
Price: $ Dollars . Cents
Start Time: Start Time: : HH MM AM/PM
End Time: End Time: : HH MM AM/PM
Student Name: Student Name: First Last
PO Number:
Name of Teacher: Name of Teacher: First Last
Date of Birth: Date of Birth: / MM / DD YYYY
Grade:
Venue Name:

If you have a username and password to this vendor please include it in the notes below.
Link To Activity:
Type of Lesson:
Start Date: Start Date: / MM / DD YYYY
End Date: End Date: / MM / DD YYYY
Name of class:
Course Code/Number:
Level:
Price: $ Dollars . Cents
Start Time: Start Time: : HH MM AM/PM
End Time: End Time: : HH MM AM/PM
Student Name: Student Name: First Last
PO Number:
Name of Teacher: Name of Teacher: First Last
Date of Birth: Date of Birth: / MM / DD YYYY
Grade:
Venue Name:

If you have a username and password to this vendor please include it in the notes below.
Link To Activity:
Type of Lesson:
Start Date: Start Date: / MM / DD YYYY
End Date: End Date: / MM / DD YYYY
Name of class:
Course Code/Number:
Level:
Price: $ Dollars . Cents
Start Time: Start Time: : HH MM AM/PM
End Time: End Time: : HH MM AM/PM
Student Name: Student Name: First Last
PO Number:
Name of Teacher: Name of Teacher: First Last
Date of Birth: Date of Birth: / MM / DD YYYY
Grade:
Venue Name:

If you have a username and password to this vendor please include it in the notes below.
Link To Activity:
Type of Lesson:
Start Date: Start Date: / MM / DD YYYY
End Date: End Date: / MM / DD YYYY
Name of class:
Course Code/Number:
Level:
Price: $ Dollars . Cents
Start Time: Start Time: : HH MM AM/PM
End Time: End Time: : HH MM AM/PM
Note:
Do any of your children listed above have food allergies or medical concerns?

Do any of your children listed above have food allergies or medical concerns? Yes No

When indicating allergies or medical concerns please list the student's name and then the issue.
Food Allergies or Medical Concerns:
Password (Office Use Only)
Parents do not need to complete this field. Your teacher will complete it when finishing your form.
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

2022-23 Special Order Form - Recreational Programs

2022-23 Special Order Form - Recreational Programs

In order for HCOS to make a purchase from your Recreational Center, we will need you to open an account with them and fill in your username and (temporary) password in the provided spaces below.