Enrollment Form

Admissions Form

We are excited to have your child (ren) enrolling with Rising Stars Learning Academy. Please fill out the information below. This information will be kept on file and in your child's school record. *Please note that enrollment is conditional and dependent upon the principal and the student's teacher review of the student's previous school record, a second interview AND the successful completion of one month in our school. At any time, the principal reserves the right to dismiss the student. The second interview is to get to know the student more and assess any learning deficiencies that may exist.*
Are you a past or current victim of domestic violence? Briefly and confidentially explain. Input N/A if this does not apply to you. We take extra care to protect our families of domestic violence. Please note, information is kept confidential.*
Child's Name*

First NameMiddle InitialLast Name
Preferred Name*
Child's Birth Date*

MonthDayYear
Child's Current Grade Level*
Child's Upcoming School Year Grade Level*
Child's Name

First NameMiddle InitialLast Name
Preferred Name
Child's Birth Date

MonthDayYear
Child's Grade Level
Child's Upcoming School Year Grade Level
Child's Name

First NameMiddle InitialLast Name
Preferred Name
Child's Birth Date

MonthDayYear
Child's Grade Level
Child's Upcoming School Year Grade Level
Child's Name

First NameMiddle InitialLast Name
Child's Grade Level
Child's Birth Date

MonthDayYear
Child's Name

First NameMiddle InitialLast Name
Child's Birth Date

MonthDayYear
Child's Current Grade Level
Name of student (s) current school (if student does not attend a school, you may list the words home school or N/A)*
We foster a bully free zone. Are there any incidents in which we should know about?*
Does your rising star have or has had any physical, behavioral and/or learning disabilities?*

NoYes, in the pastYes, currently do
Please explain the disability that your child has OR HAD as well as please let us know if the child has a current or has had in the past (5 years) learning plan (IEP, 504 PLAN, LEARNING AGREEMENT) in place or prescribed medications...if none, please enter n/a*
Parent Name*

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent's Phone*

Area CodePhone Number
Parent/Guardian Number

Area CodePhone Number
Parent's E-mail Address*
Parent/Guardian E-mail Adress
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name of other authorized individuals who can pick up, drop off & answer/ask questions about your Rising Star. In the event that someone else, other than persons you list on this form, will be picking up your child, a photo id will be required to be shown from the person, as well as prior authorization from the parent to allow the release of your child. This "authorization" can come in form of a verbal conversation, phone call, e-mail, note sent with child or phone text. Verbal communication from your child ALONE will NOT allow the release of your child!*

If there are special requests that you would like for the school to honor, that is vital to the safety or health of your child (ren), please list those requests here. Please note, that if there are any court ordered agreements that you have, please upload them below, mail or e-mail a copy of such documents to us so that we can have on school record. Our mailing address is 2500 Regency Parkway, Cary NC 27518. Our e-mail address is rsps@rsla.us.*
You may upload any documents here. This may include records, immunization forms, court documents, medical documents, etc.

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Tuition Fee

Payment is due the first business day of each month. Please make all cashier's checks & money orders out to Rising Stars Learning Academy. If you prefer to pay in cash, please let us know. We accept electronic payments for Tuition via the following link https://checkout.square.site/buy/CCOPKQOD66RKQACCUJPR6UDH. Please note: DO NOT MAKE PAYMENTS OF ANY KIND UNTIL WE HAVE OFFICIALLY ENROLLED YOUR FAMILY AND/OR GIVEN YOU THE GREEN LIGHT TO MOVE FORWARD TO THE NEXT STEP IN THE ENROLLMENT PROCESS! If you are paying via state funds (scholarship), please make sure that you monitor your emails closely as there will be steps that you need to take, to ensure that we receive your tuition funds. Once you have paid your seat reservation fee deposit and are accepted to the school, please make sure that you choose our school as the choice of school, on the scholarship application.
Tuition and Payment Statement: *All seat reservation and Tuition fees are non-refundable! There are exceptions to this policy and they include the following: military PCS, death or chronic illness of the student and/or parent or legal court ordered reason. Please check the box below signaling that you understand this statement.*

I understand and wish to proceed
Tuition Fee Payment Method:*

Cashier's CheckMoney OrderCashCredit/debit cardNC ScholarshipTuition Free Program (option for those who received the Congratulations e-mail)

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Admissions Form

Tuition Fee