Education Enrollment Package

Education Enrollment Package

Student Information

Student Name:

Date of Birth:    Student ID (if assigned):    Grade / Program:

Parent / Guardian Information (if student is minor)

Primary Guardian Name:

Program Enrollment & Payment

Expected Start Date:    Expected End Date or Duration:

Total Tuition: $    Deposit / Enrollment Fee: $

Full payment due prior to start    Monthly installments    Custom installment plan (see office)

Billing Party Name:

Attendance, Conduct & Academic Policies

The student agrees to comply with the institution's attendance requirements, code of conduct, academic integrity standards, and any applicable program-specific rules. Repeated absences, academic dishonesty, or misconduct may result in suspension or dismissal from the program.

By checking the box below, the signer acknowledges receipt of and agreement to the policies set forth in this Enrollment Package.

I acknowledge and agree to the attendance, conduct, and academic policies.

Health, Emergency & Special Needs

Media Release & Privacy

The institution may take photographs, video, and audio recordings of students as part of educational activities and institutional promotion. The signer grants or withholds permission below for the use of such images and recordings for institutional purposes.

I consent to use of the student's image and recordings for educational and institutional materials.    I do not consent to use of the student's image or recordings.

Student records will be maintained and disclosed only in accordance with applicable privacy laws and institutional policy. By signing this form below, the signer consents to release of academic records to authorized guardians, third-party payors where necessary for billing, and to agencies as required by law.

I authorize the release of academic and billing records as described above.

Field Trips & Transportation (if applicable)

I understand that certain program activities may include off-site events or field trips. Transportation may be provided by the institution or approved third parties. Participation is voluntary and subject to the terms below.

I consent to the student's participation in field trips and institutional transportation.    I do not consent to field trip participation.

Withdrawal, Cancellation & Refund Policy

Enrollment is effective upon acceptance by the institution and receipt of any required deposit. Deposits are non-refundable except as required by applicable law. Withdrawal requests must be submitted in writing. Refunds, if any, are determined by the date of written notice and any administrative deductions. Failure to attend does not constitute withdrawal.

By checking below, the signer acknowledges understanding of the institution's withdrawal and refund policy.

I acknowledge and accept the withdrawal, cancellation, and refund policy.

Authorization for Emergency Medical Treatment

In the event of an emergency where the signer or the student cannot be reached, the institution is authorized to obtain emergency medical treatment for the student. The signer agrees to be financially responsible for any medical care rendered. The institution will make reasonable efforts to contact the emergency contact and guardian or student as appropriate.

The signer further certifies that the medical information provided on this form is accurate to the best of their knowledge and that failure to disclose material medical information may jeopardize the health and safety of the student.

Declarations & Acknowledgments

The undersigned certifies under penalty of perjury that the information provided in this Enrollment Package is true, correct, and complete. The institution may rely on this certification in admitting and billing the student. False statements may result in denial of enrollment, disciplinary action, or civil remedies.

Yes, I am 18 years of age or older and am signing on my own behalf.

Certification and Signature

I certify that I am authorized to enroll the student named in this Enrollment Package and that I agree to the terms, policies, and authorizations contained herein. If signing as parent or guardian, I affirm that I have legal authority to act on behalf of the minor student.

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