Grade 9 Enrollment Form

GRADE 9 ENROLLMENT FORM

School Name:    Enrollment Date:

Student Information

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

Primary Telephone:    Alternate Telephone:    Student Email:

Parent / Guardian Information

Relationship:    Phone:    Email:

Relationship:    Phone:    Email:

Emergency Contact & Medical Information

Relationship:    Phone:    Alternate Phone:

Physician Name:    Phone:    Health Insurance:

Academic History

Current GPA:    IEP / 504 Plan: Yes

Enrollment Details & Services

Program Type: Full-time Part-time    Entry Program / Track:

Expected Start Date:    Requested Homeroom / Counselor:

Transportation Required: Bus Parent drop-off Walk

Financial Responsibility

Tuition / Fees (if applicable):    Payment Plan Requested: Monthly Per Semester Annual

By submitting this enrollment form the undersigned acknowledges responsibility for payment of applicable tuition and fees and agrees to the school's published fee schedule and refund policies. The undersigned further agrees that failure to remit fees when due may result in withholding of academic records and/or suspension of student services.

Authorization, Release & Policies

Certification of Information: I certify that the information provided on this enrollment form is true and complete to the best of my knowledge. I understand that falsification or omission of material information may result in denial of enrollment or administrative withdrawal.

Records Release: I authorize the release and exchange of educational records between the student's prior schools and this school for the purpose of placement, scheduling, and continued education. I understand that official transcripts and health records may be requested as necessary for enrollment.

Emergency Medical Treatment: In the event of sudden illness or injury, I authorize school personnel to seek emergency medical treatment for my child and to release relevant medical information to emergency responders and treating medical personnel. I agree to be financially responsible for any emergency treatment provided.

Code of Conduct & Attendance: I have read and understand that the student is expected to comply with the school's code of conduct and attendance policies. I acknowledge that disciplinary or attendance violations may result in sanctions up to and including suspension or dismissal in accordance with school policy.

Media Release: I consent to the use of my student's photograph, image, or work in school publications, displays, and promotional materials unless I otherwise specify in writing.

Privacy & Use of Information: The school will collect and maintain student records for educational and administrative purposes. Information will be used in accordance with applicable privacy laws and school policies. By enrolling, I consent to the collection and use of the information provided on this form for official school purposes.

Additional Information

Consent and Signature

By signing below, I affirm that I am the parent or legal guardian of the student named on this form, that I have authority to enroll the student, and that I accept and agree to the authorizations, acknowledgments, and policies set forth above.

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