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Emergency Notification Form

The Emergency Notification Form (ENF) is required for all students under the age of 18. The ENF needs to be completed once a calendar year by a parent/legal guardian.
Please note that the request for medical information is voluntary. If you plan to send the student with medication, the student must know how to self-administer any medication they require while under our supervision. It is required that a consent for Self-Administration of Medication form found at www.jccc.edu/youth be reviewed and completed by a parent/guardian.
Persons with disabilities who desire support services may contact Access Services for Students with Disabilities office, 913-469-3521 or accessservices@jccc.edu.

Johnson County Community College Hold Harmless Agreement


I hereby register my child to participate in the youth program to be held at Johnson County Community College. I hereby release the college, its trustees, officers, employees and agents from any and all liability for all injuries or damages suffered while participating, preparing to participate or otherwise engaged in activities connected with this program. The undersigned agrees to assume all risks, and recognizes that despite the exercise of reasonable safety precautions by Johnson County Community College, injury is possible whenever one engages in physical activity. If an emergency arises, I authorize emergency treatment or hospitalization when deemed necessary by college personnel. I hereby authorize Johnson County Community College to show and reproduce the name, photograph or photographs, pictures and film taken of the student mentioned above for the purpose of promoting the college, its curriculum and programs. I have read and understand the Youth Enrollment Procedures, the Student Code of Conduct (www.jccc.edu/youth), and this JCCC Hold Harmless agreement.

Safety and Security


Classroom and campus safety are of paramount importance at JCCC. Helpful resources and information concerning safety and security are found at this link: Police and Safety.

Student Code of Conduct


Youth program participants are subject to JCCC’s Student Code of Conduct , as applicable. Specifically, but without limitation: our policy requires that disruptive students be removed from class. If necessary, we will call parents for early pick up. Tuition refunds are not granted to students who are permanently removed from class.

By completing and submitting this form you are confirming that you are a parent/legal guardian of the student and that you have read and understand the Hold Harmless Agreement, Safety and Security and the Student Code of Conduct.
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