Student Registrations

STUDENT REGISTRATION

Institution Name:

Student Information

Date of Birth:    Student ID:

Gender: Male Female Non-binary/Other    Pronouns:

Primary Phone:    Email:

Parent / Guardian Information

Relationship:    Phone:    Email:

Relationship:    Phone:    Email:

Emergency & Medical Information

Relationship:    Phone:

Primary Care Physician:    Phone:

Enrollment Details & Financial Responsibility

Program / Course of Study:    Anticipated Start Date:

Tuition Amount:    Payment Plan: Full payment Installments Scholarship assistance

Financial Responsibility Statement: By signing this form I accept financial responsibility for charges assessed for the enrolled term including tuition, fees, and any returned check or collection costs. Failure to satisfy balances may result in withholding of records and denial of future enrollment privileges.

Permissions, Releases, and Acknowledgments

Emergency Medical Authorization: I authorize school personnel to obtain and consent to emergency medical treatment for the student if I cannot be reached. I understand I am financially responsible for such treatment.

Photo/Media Release: I grant permission for the school to photograph or video the student and to use such images for educational, promotional, or archival purposes without compensation. I do not grant permission

Educational Records and Records Release: I authorize the release and exchange of academic and health records between prior and current institutions as necessary to effectuate enrollment, placement, and provision of services. This authorization is limited to records necessary to support the student's enrollment and is governed by applicable student privacy law.

Transportation Permission: I authorize the student to use school-provided transportation and to participate in off-campus activities supervised by school staff. I do not authorize

Residency and Attendance: I attest that the residence information provided is true and correct. Misrepresentation of residency for the purpose of enrollment may result in disenrollment and assessment of tuition for nonresident status.

Conduct and Discipline Acknowledgment: I acknowledge that the student is required to comply with the institution's code of conduct and policies. The institution retains the authority to discipline students for violations of stated policies, including suspension or dismissal where appropriate.

Prior Education / Additional Information

Certification

Certification: I certify that the information provided on this Registration Form is true, accurate, and complete to the best of my knowledge. I understand that any willful misrepresentation or omission of material facts may be grounds for denial of enrollment or immediate disenrollment. I acknowledge that by signing I accept the policies, releases, and financial obligations set forth in this document.

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