Student Info & Forms

Student Info & Forms

Student Information

Parent / Guardian Information

Primary Contact Name:

Emergency Contact

Medical Information & Authorization

Allergies (including reaction and required intervention):

Current Medications & Dosages (administering medication at school requires separate authorization):

Emergency Medical Treatment Authorization:

I authorize authorized school personnel or designated agents to obtain and consent to emergency medical or surgical care for the student named above when I cannot be reached. I understand that reasonable attempts will be made to contact me prior to treatment when practicable. I agree to be financially responsible for any emergency medical services rendered.

Enrollment & Program Selection

Financial Responsibility & Payment Plan

Tuition Amount (per term or as agreed):

Select Payment Plan:

Financial Agreement and Refund Policy: By enrolling, the signer accepts responsibility for all tuition and fees assessed for the enrolled program. Withdrawals and refunds are governed by the institution's published refund schedule; partial attendance does not constitute withdrawal. Past-due accounts may result in withholding of records and collection action. Any payment arrangement not satisfied may be accelerated at the institution's discretion.

Consents, Releases & Authorizations

Media Release: I grant to the educational institution the right to photograph, record, and publish images or video of the student for educational, promotional, and informational purposes. I understand that no compensation will be provided and that identifying information will be limited unless separate written consent is provided.

Field Trip / Off-Site Activity Authorization: I authorize the student to participate in authorized off-site activities and supervised field trips. I understand that the institution will provide supervision and reasonable precautions, but I release the institution from liability for ordinary negligence in the course of such activities to the extent permitted by law.

Administration of Medication: I authorize school personnel to administer prescribed medication in accordance with written instructions from the prescribing health provider. Medication must be supplied in original labeled containers and accompanied by a signed medication consent form where required.

Release of Educational Records: In accordance with applicable law, I authorize the release of the student's educational records, including transcripts and disciplinary records, to designated third parties for purposes related to transfer, placement, scholarship eligibility, and program administration unless I indicate otherwise in writing.

Academic Policies & Conduct Acknowledgment

Attendance, academic honesty, and conduct policies have been provided to me. I understand that failure to comply with published policies may result in disciplinary action up to and including suspension or dismissal. I acknowledge responsibility for reviewing and complying with the institution's attendance, grading, and code of conduct policies.

Special Accommodations

If the student requires accommodations for disability or special educational needs, please describe the required accommodations below and attach supporting documentation.

Certification

By signing below, I certify that the information provided on this form is complete and accurate to the best of my knowledge. I accept financial responsibility as indicated, consent to the authorizations checked above, and agree to indemnify and hold the institution harmless from claims arising from my failure to disclose relevant medical or legal information. I understand that falsification of information may result in administrative action.

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