Student Enrollment Permission Form

STUDENT ENROLLMENT PERMISSION FORM

By completing and signing this form, the undersigned authorizes enrollment and related authorizations for the student named below. This form provides specific consents for enrollment, emergency medical treatment, transportation, media/publication, and release of records as detailed in the sections that follow.

Student Information

Student Name:    Date of Birth:    Student ID:

Enrollment Details

Anticipated Start Date:    Enrollment Status: Full-time Part-time

Payment Plan: Monthly One-time Financial assistance applied

Parent / Guardian Information

Emergency Contact & Medical Information

Permissions and Consents

Consent to Enroll: I authorize enrollment of the student named above in the program specified on this form and consent to the student participating in all regularly scheduled academic and extracurricular activities unless otherwise restricted in writing.

Emergency Medical Treatment: If emergency medical care is required and I cannot be reached, I authorize program representatives to obtain necessary medical treatment for the student, including transportation to a medical facility. I understand I am financially responsible for such care and hereby release and hold harmless the program and its staff for actions taken in good faith to obtain care.

Transportation Consent: I authorize the student to be transported by program-designated vehicles or third-party carriers for program-related activities, field trips, and emergency transport.

Media / Image Release: I grant permission for the program to photograph, record, or publish images and/or recordings of the student for educational, promotional, or archival purposes. I understand no compensation will be provided and that the program will exercise reasonable discretion in use.

Release of Records: I authorize the release and exchange of educational, health, and placement records between the student's prior school, current school, program administration, and placement partners as necessary for enrollment, placement, and provision of services.

Financial Responsibility & Acknowledgement

I acknowledge financial responsibility for tuition, fees, and incidental costs associated with enrollment unless otherwise agreed in writing. I understand that failure to satisfy financial obligations may result in administrative action including suspension or withdrawal of enrollment.

Policies Acknowledgement: I have received, read, or been provided access to the program's written codes of conduct, attendance expectations, and health/safety procedures and agree that the student will comply with these policies. I understand that noncompliance may result in disciplinary measures.

Certifications, Release, and Indemnity

By signing below I certify that I am the parent or legal guardian of the student named on this form, that the information provided is true and complete to the best of my knowledge, and that I have authority to grant the consents contained herein. I agree to indemnify and hold harmless the program, its employees, agents, volunteers, and representatives from and against any claims, liabilities, losses, or expenses arising from the student's participation in program activities except to the extent caused by the program's gross negligence or willful misconduct.

Sign Now