Academy of Scholars Admissions Forms

Child's Name *

First Name Last Name

Age *

Gender *

Male Female

Ethnicity (Check One)

Black White Hispanic Asian Other

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Parent/Guardian Information

Name *

First Name Last Name

Name

First Name Last Name

Relationship

Home Number *

Area Code Phone Number

Work Number *

Area Code Phone Number

Work Extention Number *

Cell Number

Area Code Phone Number

E-mail *

Emergency Information

Emergency Contact's Name *

First Name Last Name

Relationship *

Phone Number *

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe. *

EMERGENCY HOSPITAL CONSENTEMERGENCY HOSPITAL CONSENT

I authorize Academy of Scholars, Inc. or its representatives to call 911 and summon emergency medical help when in the judgment of said personnel if it is in the best interest of my child. I further authorize responding paramedics to transport my child to the nearest medical facility which will be in the opinion of the paramedics on scene. If medical care is necessary, I authorize treatment of my child. I also agree to pay any medical cost associated with the transportation and/or treatment of my child.

I, Hereby *

I agree I disagree

Medical Release and Authorization

As Parent and/or Guardian of the named child, I understand that every attempt will be made by the attending staff contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Academy of Scholars and its affiliates including Teachers, Staff, Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

*

I agree I disagree

PRIVATE SCHOOL TUITION & FEE SCHEEDULE

2017 – 2018

A $50 non-refundable application fee and a $100 non-refundable registration fee will be due when contract is signed.

COMBINED TUITION & FEES BY GRADE LEVEL

GRADES ANNUAL PAY 10-PAYMENTS ONE-FOURTH PAY

Kindergarten $6,100 $610 $1,525.00

ELEMENTARY $7, 850 $785 $1,962.50

(1^st - 5^th)

MIDDLE $9,500 $950 $2,375.00

(6^th – 8^th)

HIGH $10,310 $1031 $2,577.50

(9^th-10^th)

TUITION PAYMENT OPTIONS:

1. Payment in full (due with contract)

2. 10 Month Pay (ten equal payments paid from August 2016 – May 2017)

3. One-Fourth Pay (three equal payments paid August 2016, November 2016, February 2017 & May 2017)

4. Step-Up, McKay and PLSA Scholarships are accepted. Annual fees will be paid by scholarship disbursements. Fees not covered by scholarship payments can be paid in four or ten equal payments.

(Payments made after the 5^th of the month will be assessed a fee of $25)

UNIFORM FEE:

ANNUAL PAY 2-PAYMENTS

$300 $150

A.M. & P.M. CARE:

BEFORE SCHOOL CARE HOURS 7:15 AM – 8:20 AM

AFTER SCHOOL CARE HOURS 3:45 PM – 5:45 PM

ANNUAL PAY 10-PAYMENTS ONE- FOURTH PAY

A.M. CARE $1000 $100 $250.00

P.M. CARE $2500 $250 $625.00

BOTH $3000 $300 $750.00

DROP-IN SESSION A.M. - $30/SESSION

DROP-IN SESSION P.M. - $60/SESSION

ADDITIONAL FEES:

End of the Year Exam $100

Field trips (varies) $15 - $35 per trip

Textbooks $50 - $100 annual purchase rate

IPADS $50 - $100 annual rental rate

Yearbooks - $20 - $35

*TUTORING IS FREE*

MULTIPLE CHILD DISCOUNT: Discount can only be deducted from registration fee during completion of contract.

Two Kids - $100 OFF

Three Kids - $150 OFF

Four or More - $200 OFF

Click to edit *

I agree I disagree

DISCIPLINE CONTRACT

To Whom It May Concern:

I, the undersigned, agree that attending Academy of Scholars, Inc. is a privilege and I further agree that my child’s well-being and education is top priority to me.

Being that I am a dedicated parent, I want only the best for my child and I am in agreement with the school’s policy concerning discipline.

I agree to the no referral/no suspension policy of the school and I also agree with having the school’s administrators, faculty and/or staff contact me by phone and/or by email if my child, is behaving in a manner that is unsatisfactory.

Please feel free to contact me by phone at or via email between the hours of 8:30 AM – 7:00 PM.

I, am a student at Academy of Scholars, Inc., and it is a privilege to attend this school.

I will conduct myself according to the rules and regulations set forth at Academy of Scholars, Inc. and I am aware of the consequences if I decide to act in a manner that is unacceptable.

Although I will not be suspended or given a referral, I do not want to interrupt my parent/guardian(s) day with my lack of respect for authority or my classmates.

Please Run the Wizard

Click to edit *

I agree I disagree

Please Run the Wizard

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Parent/Guardian Signature *

The Academy of Scholars Enrollment Agreement