Yearly Education Set

Yearly Education Set

Student Information

Student Name:

Date of Birth:    Student ID:

Student Age 18 or older:    If not, primary guardian must complete below.

Parent / Guardian Information

Emergency Contact & Medical Information

Emergency Contact Name:    Phone:

Authorization for Emergency Medical Treatment:

By checking the box below, I certify that I authorize school employees or agents to seek emergency medical treatment for the student if the parent/guardian cannot be reached. I understand reasonable attempts will be made to contact listed contacts prior to rendering non-emergency care. I accept responsibility for costs not covered by insurance.

I authorize emergency medical treatment:

Permissions & Releases

Field Trip Participation (includes walking excursions and supervised transport).    If not permitted, explain:

Transportation by school-approved vehicles:

Media Release (photographs, video, publications for educational or promotional use):

Release of Academic Records to Authorized Persons:

Academic Policies Acknowledgement

I acknowledge that I have reviewed and understand the institution's academic policies including attendance requirements, academic integrity, code of conduct, grading procedures, and disciplinary processes. I understand that failure to comply may result in disciplinary action up to and including suspension or expulsion.

I confirm receipt of and agreement to the academic policies:

Tuition & Payment Agreement

Total Annual Tuition:

Payment Plan (select one): Annual Semester Monthly

Late Payment Fee and Collection: Late payments will incur a late fee and failure to pay may result in suspension of enrollment. This agreement creates a contractual obligation to pay the amounts selected and any collection costs and reasonable attorney fees incurred to collect unpaid tuition.

Withdrawal and Refund Policy: Withdrawals must be submitted in writing. Refunds, if any, will be calculated according to the institution's refund procedure. Registration or non-refundable administrative fees will not be returned.

Additional Programs / Services

Certification and Legal Attestations

I certify under penalty of perjury that the information provided in this Yearly Education Set is true, complete, and correct to the best of my knowledge. I authorize the institution to use the information for enrollment, emergency response, billing, and educational services. I understand providing false or misleading information may be grounds for denial of enrollment or disciplinary action.

I consent to communication from the institution concerning academic, medical, and emergency matters via the contact information provided. I further acknowledge that the institution may contact designated emergency contacts if I cannot be reached.

Signing as: Parent/Guardian Student (18 or older)

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