Student Enrollment Management Form

STUDENT ENROLLMENT MANAGEMENT FORM

STUDENT INFORMATION

Date of birth:    Student ID (if assigned):

Anticipated start date:    Expected end date/term:

Primary phone:    Email:

PARENT / GUARDIAN INFORMATION

Relationship:    Phone:    Email:

EMERGENCY & MEDICAL INFORMATION

Relationship:    Phone:    Alternate phone:

Individualized Education Program (IEP) / 504 plan: Yes    If yes, describe required accommodations:

PREVIOUS EDUCATION

Last grade completed:    Transcript provided:

DOCUMENTS AND RESIDENCY

Documents submitted (check all that apply):

Birth certificate    Immunization record    Proof of residency    Photo ID

TUITION, FEES, AND PAYMENT

By enrolling, the undersigned agrees to the school fee schedule and payment obligations described below. Failure to meet payment obligations may result in denial of attendance and/or withholding of records until obligations are met.

Payment plan selection:
Full payment due prior to start date
Monthly installments (refer to school schedule)
Financial aid application pending

POLICIES, AUTHORIZATIONS, AND ACKNOWLEDGMENTS

Enrollment acceptance is conditional upon verification of submitted documentation, availability of space, and compliance with applicable academic and conduct standards. The school reserves the right to place the student in the program or grade level it determines appropriate based on records and assessment.

Tuition and fee obligations are the legal responsibility of the person or entity signing below. Withdrawal after the start date may result in partial or no refund as determined by the published withdrawal policy. The undersigned agrees to pay all collection costs, including reasonable attorney fees, for enforcement of delinquent obligations.

Attendance and academic standards: Students are expected to attend regularly and to comply with the student code of conduct. Failure to meet attendance or academic standards may result in administrative action, including probation or dismissal.

Medical authorization: In the event of an emergency requiring medical treatment, the undersigned authorizes the school to obtain necessary medical treatment for the student. Reasonable efforts will be made to contact the parent/guardian prior to treatment when practicable.
Authorize emergency medical treatment:

Release of records and privacy (FERPA-type acknowledgement): The undersigned authorizes the school to obtain and release educational records to prior schools and to other educational institutions or agencies as required for enrollment, placement, or as authorized below. To release records to specific third parties, list names and relationship:

I consent to the release of records as listed above:

Media release: I authorize the school to use photographs, video, or other media including the student's name, for school promotion, educational publications, and internal communications unless I withhold consent by checking below.
Withhold media release:

Transportation and field trip consent: I authorize the student to participate in school-sponsored field trips and to travel via school-approved transportation unless I withhold consent below.
Withhold field trip participation:

ACKNOWLEDGEMENT (SIGNER MUST READ AND INITIAL)

I certify that the information provided in this enrollment form is true, complete, and accurate to the best of my knowledge. I understand that falsification of information may be cause for denial of enrollment or immediate withdrawal.

Initial to acknowledge:

I further acknowledge receipt of the school’s code of conduct and fee schedule and agree to abide by applicable policies while responsible for any financial obligations incurred on the student's behalf.

Signer authority: The undersigned confirms they have legal authority to enroll the student and to obligate payment of tuition and fees where applicable.

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