Student Enrollment Form for Kapla CE1

Student Enrollment Form for Kapla CE1

Enrollment Date:   Program Start Date:

Student Information

Date of birth:   Student ID (if assigned):

Parent / Guardian Information

Relationship:   Primary phone:

Secondary phone:   Secondary email:

Emergency Contact & Medical Information

Relation:   Phone:   Alternate phone:

Insurance provider:   Policy number:

Program Selection & Fees

Select Kapla CE1 session (select all that apply):

Morning session
Afternoon session
Full day

Payment plan (choose one):

Full payment due prior to start date
Monthly installments (schedule to be agreed)
Financial assistance / scholarship applied
Other (describe below)

Policies, Consent and Authorizations

Tuition, Fees and Refunds: By enrolling the student in Kapla CE1 I acknowledge and accept that tuition and fees are due according to the selected payment plan. Withdrawals must be submitted in writing at least 30 days prior to the next billing cycle to be eligible for prorated refunds. Kapla reserves the right to terminate enrollment for nonpayment after notice. I understand administrative fees may apply.

Emergency Medical Treatment Authorization: In the event of serious illness or injury when parent/guardian cannot be reached, I authorize Kapla staff to obtain emergency medical care for my child, including transport to an appropriate facility, and to consent to treatment as deemed necessary by medical personnel. I agree to be financially responsible for such treatment.

Confirm authorizations:

I acknowledge and accept the tuition, fees and refund provisions above.
I authorize emergency medical treatment as described above.

Field trips and supervised off-site activities: I consent to my child participating in supervised, local off-site activities and field trips as arranged by Kapla. Parents/guardians will be notified in advance for events requiring transportation beyond walking distance.

Field trip consent:

I consent to supervised local field trips and activities.

Photo and Video Release: I grant Kapla permission to use photographs, video, or other media recordings of my child for educational, promotional or administrative purposes. I understand no personal contact information will be published with images without additional consent.

I consent to use of photo/video of my child as stated above.
I do not consent to photo/video use of my child.

Records, Privacy and Confidentiality: Kapla will maintain student records necessary for enrollment, health and emergency care, and educational administration. Records will be shared only with staff, authorized service providers, and emergency responders as required. By signing, I authorize release of records to third-party service providers engaged by Kapla for educational support or health services.

Acknowledgment of School Policies

I have read, understand and agree to comply with Kapla CE1 policies including attendance, behavior expectations, illness/exclusion criteria, medication administration, and the procedure for withdrawal and tuition refunds. I understand that failure to adhere to policies may result in suspension or termination of enrollment.

Acknowledgment:

I have read and agree to Kapla CE1 policies and terms stated in this enrollment form.

Additional Information

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