DUAL ENROLLMENT AGREEMENT: SPRING 2021

This form is only for students who have completed Chaffey College's application and received their 7-digit Chaffey College ID#. 

  • If you need to apply to Chaffey College learn how to do so from a quick and easy how-to video available HERE. You will receive your Chaffey College ID# in 48-72 business hours after completing the application via e-mail. 
  • Please note that sections with a red asterisk (*) must be completed to submit the form.

This form is also NOT the High School Partnership (HSP) form for HSP no-cost courses offered through high schools in FUSD, CJUHSD, CVUSD, and UUSD. You may have to pay for books and some fees (usually between $15-20/semester) if you register for classes approved through this form. For information on the HSP process, click HERE.

Your current high school

Please upload a current Private School Affidavit and a Transcript signed and dated by the Director or Principal Officer. Your Director or Principal Officer will also be required to digitally sign and type their name below.

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Director/Principal Officer: Please type your name below if you approve this student to enroll in the courses listed on this agreement form*
Date/Time of homeschool administrator electronic signature*
:  
TYPE THE NAME OF YOUR HIGH SCHOOL PRINCIPAL OR COUNSELOR BELOW

Students who are homeschooled and not connected with a school district, private school, or charter school cannot complete this online form and must complete/submit the following documentation via e-mail to the Admissions and Records Department at admissions.staff@chaffey.edu

  1. High School Partnership/Dual Enrollment Agreement and Waiver of Liability, Assumption of Risk, and Indemnity Agreement 
  2. homeschool affidavit to admissions.staff@chaffey.edu 

If your homeschool is affiliated with a school district, private school, or charter school please select "Other" from the "Which High School Do You Attend?" options and complete the online form.

STUDENT INFORMATION

Student's Name*
Date of Birth*
This is provided 72 hours after applying to Chaffey College. It is a 7 digit number starting with 0. Do not include initials or a CCC ID#.
Student's Address*
Do not use e-mails provided by schools
Grade Level*
Please select the grade that you will be in when taking the Chaffey course. If you are taking a Summer course, please indicate the grade that you will be in the upcoming fall semester.

RECOMMENDED COURSES

Dual Enrollment Courses - These are Chaffey College courses taught at one of the three (3) Chaffey College Campuses or online.

Please watch a quick Course Limitations Tutorial.

Please review Chaffey's Schedule of Classes website.

If you would like to review all course descriptions use Chaffey's Catalog Course Descriptions section

Please enter the course/s you would like to register for and the number of units associated with that course. Your High School Counselor/Designee will determine if you are eligible and should take the course/s. If there are any concerns or updates to your course/s they will inform you.

STUDENT AGREEMENT

For full details regarding the High School Dual Enrollment Program please visit our Dual Enrollment Canvas Shell.

Admission requirements for high school students are:

  • Be in the 9th-12th grade

I understand that I will be held to the following student responsibilities:

  1. I may not enroll in more than 11 units in any Fall/Spring semester, or 6 units in Summer term.
  2. I must pay for all applicable fees associated with my courses at the time I register, or I may be dropped from my course(s).
  3. I should complete the online Dual Enrollment Orientation.
  4. My High School Counselor/Designee will discuss any issues with the selected degree-applicable courses and/or my eligibility to take the courses. 

I understand that the classes I take will be a part of my official permanent college record and may impact my university/college admissibility.

Did you read and understand the responsibilities above?*
Use your mouse or finger to draw your signature above
Student's Signature Date*

SPRING WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

PARENT/GUARDIAN CONSENT

I give my consent for my child to be enrolled at Chaffey College as a special part-time student. I understand that my son/daughter is being considered for admission as a college student and will abide by all college rules, regulations, and deadlines. I understand that costs for community college courses are the responsibility of the student. In compliance with the Family Education Rights and Privacy Act, I understand that Chaffey College may share my academic information with the k12 governing board designee associated with the high school noted in this form and that Chaffey College will not release any student records other than directory information to any other entity or individual, including the parent(s), without the written consent of the student. 

WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

Hereinafter called the “Activity,” I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue the Chaffey Community College District, its officers, employees, and agents from liability from any and all claims including the negligence of the Chaffey Community College District, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the High School Partnership/Dual Enrollment Program (the Activity). 

Assumption of Risks: Participation in the Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death. 

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD CHAFFEY COMMUNITY COLLEGE DISTRICT HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in the Activity and to reimburse them for any such expenses incurred. 

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California including Education Code Section 72640 and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. 

Acknowledgment of Understanding: I have read all previous paragraphs, including the waiver of liability, assumption of risk, and indemnity agreement, know, fully understand its terms, acknowledge these and other risks that are inherent to the Activity, and understand that I am giving up substantial rights, including my right to sue. I acknowledge my participation is voluntary, that I knowingly assume all such risks, and that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the extent allowed by law. 

In the event of any illness or injury, I give full authority to the district staff to obtain such medical treatment and/or surgery from a licensed physician/surgeon, paramedic or hospital as deemed necessary for the welfare of my child. I acknowledge that I fully and completely understand the potential risks that may be associated with this Activity and that my child’s participation is strictly voluntary. 

Additional Information - Supervision of Minors: Chaffey College assumes no responsibility for the supervision of minor students outside the classroom setting. Parents are responsible for providing transportation and ensuring their children are supervised before and after class, and if or when a class is cancelled or dismissed earlier than the scheduled time. Chaffey College will not call the parent/guardian if a student is absent, nor will we verify attendance. 

Course Content: College is an adult environment with minimal supervision. Discussion topics and course materials are generally designed for adult students and may not be appropriate for younger students. Course content will not be altered to accommodate younger students. 

Release of Academic Information: In compliance with the Family Education Rights and Privacy Act, I understand that Chaffey College may share my academic information with the k12 governing board designee associated with the high school noted in this form and that Chaffey College will not release any student records other than directory information to any other entity or individual, including the parent(s), without the written consent of the student. 

Internet Usage: Many courses required computer lab work or research projects that could involve the Internet. Chaffey’s computer network provides access to the Internet in classrooms, labs, and the library. The College does not block access to specific Internet sites. As a result, it is possible for your son/daughter to reach an Internet site that you may feel contains inappropriate material. 



Did you, the student, read and understand the Waiver of Liability, Assumption of Risk, and Indemnity Agreement Guidelines?*
Use your mouse or finger to draw your signature above
Did you, the parent/guardian, read and understand the Waiver of Liability, Assumption of Risk, and Indemnity Agreement Guidelines?*
Parent's/Guardian's Name*
Parent's/Guardian's Signature Date*

EMERGENCY INFORMATION

EMERGENCY CONTACT

In the event of accident or sudden illness, Chaffey College will attempt to contact the emergency contact at the phone number(s) listed below. Please list a designated contact.

Emergency Contact's Name*

HEALTH INSURANCE

Please include the student's health insurance information below.

TRANSPORTATION - OMNITRANS GO SMART

Chaffey College offers the Omnitrans Go Smart Program, which enables you to ride any of Omnitrans’ fixed route buses with your Chaffey College Student ID Card for a per-semester fee of $8 for a part-time student. If you interested in this participating in this program please complete the steps below:

  1. Register for a course
  2. E-mail admissions@chaffey.edu
  3. Pay $8 fee
  4. Complete the "Student ID Card Request" form located in MyChaffey Portal.

Template for admissions@chaffey.edu e-mail:

My name is John Smith. My student ID number is 0123456. My date of birth is 01/01/2004. I would like to participate in the Omnitrans Go Smart Program and agree to pay the $8 fee.

To learn more about the program please feel to visit Go Smart Frequently Asked Questions.

ELIGIBILITY VERIFICATION

High School Counselor/Authorized School Designee

Below are the minimum eligibility requirements for high school students:

  • Be in the 9th-12th grade
Is the student enrolled in the 9th-12th grade at your high school?*
Do you recommend the student be permitted to take the college level degree applicable courses indicated previously?*
I do not recommend the student be permitted due to:*
Do any of the recommended courses have a requirement (prerequisites/co-requisite) in-order to register for the course/s? To view college course pre-requisites in the catalog use this link: https://www.chaffey.edu/catalogandschedule/docs/catalogs/2020-2021-courses.pdf*
Were any of the recommended courses changed/updated by you the High School Counselor/Designee?*
By typing my full name below I affirm the accuracy of the information given in this agreement and provide my electronic designee signature verification.*
Authorized School Designee Declaration Date:*
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