Registration Form
Date:
Please insert today's date
Enrollment:
When do you plan to begin your enrollment?
If already enrolled, What year did you first enroll?
(Enter 4-digit year that you first attended the Institute eg: 2019)
Student Status (Check One)
Student Information:
First Name:
Last Name:
e-mail Address (required):
Phone Number:
Please include Area Code in the following format: (555) 555 5555
Permanent Address:
Street Address 1:
Street Address 2:
City:
Zip Code:
State:
Mailing Address:
Street Address 1:
Street Address 2:
City:
State:
Zip Code:
References
***New Students only***
Please provide the name of a person acquainted with your academic and/or professional experience. Please include at least one Recommendation Letter. Recommendation letters can be e-mailed to info@pocsinstitute.org. Please have them indicate your name as the student in the letter.
**If you have already completed this step in a prior semester (ie: attendance in Ecumenical College for Bishops ) please continue to submit your registration
Reference #1:
First Name:
E-Mail:
Street Address 1:
Street Address 2:
Last Name
U.S. Phone Number:
Please include Area Code in the following format: (555 555 5555)
City:
State:
Zip Code:
Position
COVID 19 Voluntary Questionare Not Required!
PLEASE READ EACH QUESTION CAREFULLY and answer honestly to the best of your ability.
1.Have you experienced any of the following symptoms in the past 48 hours:
•fever or chills
•cough
•shortness of breath or difficulty breathing
•fatigue
•muscle or body aches
•headache
•new loss of taste or smell
•sore throat
•congestion or runny nose
•nausea or vomiting
•diarrhea
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If you have had any of the above symptoms in the 48 hours preceding the event, DO NOT come to the intensive until symptoms have subsided for more than 48 hours. If you have a chronic medical condition that causes COVID-19-like symptoms, please obtain medical documentation from your primary care physician or call CDC’s Occupational Health Clinic (OHC) at 404-639-3385 to determine whether you can safely be granted access to our Intensive. Fully vaccinated individuals should not access the Watson Homestead facility if they are currently experiencing any of the above symptoms.
2. Are you isolating or quarantining because you tested positive for COVID-19 or are worried that you may be sick with COVID-19?
If you have concerns about being exposed to or sick with COVID-19, please stay home and self-quarantine or isolate. Read more about when you should be in isolation or quarantine (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html). If you have questions about when it is safe to resume your normal activities please call CDC’s Occupational Health Clinic (OHC) at 404-639-3385 or your personal physician.
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To be considered fully vaccinated, you must be ≥2 weeks following receipt of the second dose in a 2-dose series or ≥2 weeks following receipt of one dose of a single-dose vaccine.
3. Are you fully vaccinated OR have you recovered from a documented COVID- 19 infection in the last 3 months?
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4. Have you received a Covid 19 booster vaccination?
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5. Have you been in close physical contact in the last 14 days with:
• Anyone who is known to have laboratory-confirmed COVID-19?
OR
• Anyone who has any symptoms consistent with COVID-19?
Close physical contact is defined as being within 6 feet of an infected/symptomatic person for a cumulative total of 15 minutes or more over a 24-hour period starting from 48 hours before illness onset (or, for asymptomatic individuals, 48 hours prior to test specimen collection).
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If you have been in close contact with someone with COVID-19, you should stay home and self-quarantine for 14 days before returning to your regular activities . Read more about when you should be in isolation or quarantine (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html)
6. Are you currently waiting on the results of a COVID-19 test?
IMPORTANT: ANSWER “NO” IF YOU ARE WAITING ON THE RESULTS OF A PRE-TRAVEL OR POST-TRAVEL COVID-19 TEST
7. Do you expect to travel outside of your home state or outside of the country in the
10 days leading up to the intensive?
Travel is defined as any trip that is overnight AND on public transportation (plane, train, bus, Uber, Lyft, cab, etc.) OR any trip that is overnight AND with people who are not in your household
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Businesses have specific requirements to ensure Personnel stay safe. Watson Homestead may have additional screening requirements or forms to use.
I certify that my responses are true and correct
Payment Information:
Special Intensive pricing due to COVID-19- Omicron variant $207.74 USD per student. You are not completely registered until the course and housing are paid for. Online payments include PayPal fees. There are no housing fees and payments for this intensive. Classes will be conducted online All payments are non-refundable
Upon submission of this form, you will be taken to a page where you can make your payments
Winter Intensive Registration 2022