Student Admission Consent Form

STUDENT ADMISSION CONSENT FORM

Student Information

Student Name:

Date of Birth:    Student ID:

Primary Phone:    Email:

Grade / Program:    Anticipated Start Date:

Parent / Guardian (if student is a minor)

Relationship to Student:    Primary Phone:

Program Admission & Financial Terms

Program Admitted To:

Enrollment Status: Full-time Part-time

Deposit Amount (due to reserve placement):    Payment Plan Selected: Pay in Full Installments

I acknowledge that admission is conditional on receipt of all required documentation and payment of required deposits. I understand the institution’s tuition refund and withdrawal policies as set forth in the school’s published policies, and agree to be financially responsible for charges assessed in accordance with those policies.

Emergency & Medical Information

Emergency Contact Name:    Relationship:

Emergency Contact Phone:    Secondary Phone:

Medical Insurance Provider:    Policy Number:

Permissions, Releases, and Certifications

Consent for Emergency Medical Treatment: In the event of an emergency where timely contact with me is not possible, I authorize the institution and its authorized representatives to obtain necessary emergency medical treatment for the student. I agree to assume financial responsibility for such treatment.

Authorization to Administer Non-Prescription Medication and First Aid: I authorize institution staff to administer non-prescription medication and first aid as reasonably necessary.

Field Trip and Transportation Consent: I grant permission for the student to participate in institution-sponsored field trips and to be transported by institution-approved vehicles or contractors while under supervision. I understand that specific trip notices will be provided and that additional consent may be sought for higher-risk activities.

Photo and Media Release: I authorize the institution to photograph, record, and use images or recordings of the student for educational, promotional, or informational purposes without compensation, unless I have indicated otherwise.

Release of Records: I authorize the release and exchange of educational records between this institution and prior or receiving educational institutions and agencies as necessary for enrollment, placement, and billing. This release includes transcripts and disciplinary records.

Acknowledgment of Policies

I certify that the information provided on this form is true and complete to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information may be grounds for denial or subsequent revocation of admission. I agree to comply with all institutional rules, codes of conduct, attendance requirements, and academic policies. I understand that the institution may take disciplinary or administrative action for violations of those policies, up to and including dismissal.

I acknowledge responsibility for timely payment of tuition, fees, and other charges assessed by the institution and understand that failure to satisfy financial obligations may result in withholding of records, suspension of enrollment, or referral to collections in accordance with institutional policy.

Data Use and Privacy: I consent to the collection and use of the student's personal information for purposes directly related to enrollment, instruction, health and safety, and compliance with applicable law. The institution will retain records in accordance with its record retention policy.

Additional Information

Certification and Signature

By signing below, I certify that I am authorized to enroll the student where required, that I have read and understood the terms and conditions set forth in this Student Admission Consent Form, and that I consent to all checked authorizations and acknowledgments. I understand that this document becomes part of the student’s official record.

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