2021/2022 Enrichment Academy Registration

Student Name *

First Name Last Name

Parent Name *

First Name Last Name

Parent Name

First Name Last Name

Parent email *

example@example.com

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Cell Phone *

Area Code Phone Number

Emergency Contact

First Name Last Name

Emergency Contact Number

Area Code Phone Number

I understand every effort will be made to contact a parent or emergency contact. If we cannot be reached, I give my consent for the emergency room physician to treat my child. **Add signature *

Clear

**IF YOU SELECT A CLASS THAT HAS A WAIT LIST, YOU DO NOT NEED TO PAY FOR THESE UP FRONT IF YOU ARE A NEW FAMILY**

**CLASSES WITH LARGE WAIT LIST MAY HAVE A POSSIBILITY OF OPEN ANOTHER CLASS!**

Tuesdays 9am-10am

Let's Read Book Club: Eric Carl (Age 4-7) $40 per month *CLASS FULL* Lego Story Starters (Age 8-12) $40 per month IF SELECTED, YOU WILL BE PUT ON THE WAIT LIST. CURRENTLY 0 ON WAIT LIST ASL 3 (Age 11+) $40 per month Photography 101 (13+) $40 per month

Tuesdays 10am-11am

World Geography with Flat Stanley (Age 4-7) $40 per month Bibliovores: Beyond the Civil War (Age 5-11) $40 per month ASL 1 (Age 11+) $40 per month Psychology (Age 13+) $40 per month

Tuesdays 11am-12pm

Storybook Stem (Age 4-7) $40 per month * CLASS FULL* Cook with Books (Age 4-8) $40 per month IF SELECTED, YOU WILL BE PUT ON THE WAIT LIST. CURRENTLY 1 ON WAIT LIST *CLASS FULL* Rocket Science (Age 8-12) $40 per month IF SELECTED, YOU WILL BE PUT ON THE WAIT LIST. CURRENTLY 0 ON WAIT LIST HS Health/Personal Finance-Both Semesters (13+) $40 per month High School Health-1st Semester (Age 13+) $40 per month Personal Finance-2nd Semester (Age 13+) $40 per month

Thursdays 9am-10am

*CLASS FULL* Art Lab (Ages 5-11) $40 per month IF SELECTED, YOU WILL BE PUT ON WAIT LIST. CURRENTLY 9 ON WAIT LIST. POSSIBILITY OF OPENING ANOTHER CLASS DUE TO HIGH WAIT LIST. *CLASS FULL* Jr Lab Science: Marine Biology (Ages 6-11) $40 per month IF SELECTED, YOU WILL BE PUT ON WAIT LIST. CURRENTLY 2 ON WAIT LIST CSI: Crime Scene Investigation (Ages 11+) $40 per month Video Editing (Ages 11+) $40 per month

Thursdays 10am-11am

*CLASS FULL* Tinker Lab (Ages 5-11) $40 per month IF SELECTED, YOU WILL BE PUT ON WAIT LIST. CURRENTLY 1 ON WAIT LIST *CLASS FULL* Magic Science (Ages 9-12) $40 per month IF SELECTED, YOU WILL BE PUT ON WAIT LIST. CURRENTLY 0 ON WAIT LIST Strategy Games (Ages 11+) $20 per month Science Lab: Marine Biology (Age 12+) $40 per month

Thursdays 11am-12pm

* CLASS FULL*Home school PE (Ages 5-11) $20 per month IF SELECTED, YOU WILL BE PUT ON WAIT LIST. CURRENTLY 4 ON WAIT LIST Jr Strategy Games (Ages 8-10) $20 per month Life Skills (Ages 12+) $40 per month High School Art (Ages 12+) $40 per month

**Monthly fees are charged: August-November & January-April
RETURNING STUDENTS: Insurance payment required to hold classes
NEW STUDENTS: Registration and insurance payment PLUS first month tuition required to hold classes
Payment Options:
·       ALL CHECKS MAY COLLECTED at the beginning of the year & cashed on or after the 5th of the month
·       PAY IN FULL BY SEMESTER
·       CREDIT CARD **A $3 per class convenient fee charged
·       PAYPAL: enrichmentacademyoftn@gmail.com

Checks made payable to: Enrichment Academy
AND MAILED TO:
                  Katie Horky
                  c/o Enrichment Academy
                  2297 Dewey Drive
                  Spring Hill, TN 37174

**a $30 fee will be charged for all returned checks

One Time Payments *

New Family Registration (one time per family) $30 Insurance Fee $10

DISCOUNT APPLIED for every 3rd $40 class enrolled. Discount may be applied for ALL classes enrolled Tuesday and Thursday. Discount also accrues amongst siblings.

EXAMPLE:

$40 class

$40 class $30 class

Discounts Applied **Please indicate if carried over from sibling submission.

Total Monthly Price *

ENRICHMENT ACADEMY
Financial Commitment Letter
2021-22 School Year

By registering with Enrichment Academy, we are committing to provide your student with a high quality educational experience. By signing this commitment letter, you agree to be responsible for the monthly payments assigned to the classes your child(ren) is registered for. Withdrawal after July 15, 2021 does not void the financial obligation. A DROP FEE WILL BE ASSESSED IN THE EVENT YOU DECIDE TO DISCONTINUE CLASSES WITH ENRICHMENT ACADEMY. The drop fee will not exceed more then 50% of tuition still owed for the year, but an evaluation of current circumstances may result in a lower drop fee decision.

The yearly registration fee and insurance fee is non-refundable. Post-dated checks for each month will be deposited on, or around, the fifth of each month (they will NEVER be deposited before the 5th). I understand that a returned check of $30 will be charfed in event a check is returned.

I understand the above financial obligation and agree to provide payment in full or pay a drop fee in the event of class discontinuation.

Parent's Signature *

Clear

YOUTH LIABILITY RELEASE AND WAIVER

In consideration of being allowed to participate in any way in Enrichment Academy’s related events and activities, the undersigned:
1.     Agree that the parent(s) and/or legal guardian(s) of the participant should inspect the facilities and equipment to be used, and if the parent or guardian believes anything is unsafe, he or she should immediately advise supervisor of such condition(s) and refuse to participate
2.     Acknowledge and fully understand that each member/participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions, or negligence but the action, inaction, and negligence of others, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.
3.     Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death
4.     Release, waive, discharge and covenant not to sue Enrichment Academy its affiliated clubs, their respective administrators, directors, and other employees of the organization, other members/participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors or premises used to conduct the event, all of which are hereinafter referred to as “releases”, from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise.

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTATNTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY

Parent Signature *

Clear

PHOTO & SOCIAL MEDIA RELEASE FORM
We photograph and video many of our classroom activities and love to share them with our school community. Please tell me whether or not you permit the following to be done with pictures/videos of your child.

I give/withhold my permission for classroom photographs and/or videos of my child to be shared in the following ways:

Type a question *

Submitted to the annual yearbook No. Permission not given for annual yearbook Posted to Enrichment Academy's Facebook Page No. Permission not given for Facebook Posts Posted to Enrichment Academy's website No. Permission not given for website posts

Parent Signature *

Clear

COVID-19 WAIVER & ALLERGY INFO

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Enrichment Academy LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Enrichment Academy LLC can not guarantee that the student will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families.
I voluntarily seek services provided by Enrichment Academy LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19.

Parent Signature *

Clear

Please inform us of any allergies or medical conditions your child may have.

WE HAVE A NEW MEETING PLACE FOR NEXT YEAR AT

PEACE LUTHERAN CHURCH!!

USD Amount to hold classes

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.