Alef Academy Registration Form
Returning Student
Student Name
*
First Name
Last Name
My address is the same.
*
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
My home phone number is the same.
*
Yes
No
Home Phone:
*
Please enter a valid phone number.
My cell phone number is the same.
*
Yes
No
Parent #1 Cell Phone:
*
Please enter a valid phone number.
Parent #2 Cell Phone:
*
Please enter a valid phone number.
Is there anything you would like to let us know about your child?
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Updates
Update my Emergency Contacts:
*
Yes
No
Emergency Contacts
Contact #1
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to child
*
Work Phone
*
Please enter a valid phone number.
Cell Phone
*
Please enter a valid phone number.
This contact is also authorized to pick up my child from school.
*
Yes
No
Contact #2
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to child
*
Work Phone
*
Please enter a valid phone number.
Cell Phone
*
Please enter a valid phone number.
This contact is also authorized to pick up my child from school.
*
Yes
No
Contact #3
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to Child
*
Work Phone
*
Please enter a valid phone number.
Cell Phone
*
Please enter a valid phone number.
This contact is also authorized to pick up my child from school.
*
Yes
No
Pediatrician Information
Update my Pediatrician Information:
*
Yes
No
Doctor's Name
*
First Name
Last Name
Name of Practice
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Dentist Information
Update my Dentist Information
*
Yes
No
Dentist Name
*
First Name
Last Name
Name of Practice
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
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Statement of Authorization
Emergency Medical Treatment - I hereby give my consent to Alef Academy to call a doctor or emergency medical service and for that doctor or emergency service to provide emergency medical or surgical treatment to my child.
*
Yes
No
Sun Screen - I hereby give my permission for staff to apply Sunscreen to my child prior to outside play.
*
Yes
No
It is the parent’s responsibility to provide sunscreen with a minimum SPF of 15. In the event that my child’s sunscreen is not readily available
*
My child may use the sunscreen provided by the school
I do not want my child to use any other sunscreen other than the one he or she brings.
Name of sunscreen and the SPF Number:
*
Initials:
*
I hereby give permission to The Alef Academy to post my child's allergy information in the visible area of classrooms so that it is accessible to all staff.
*
Yes
No
Other
I hereby give permission to The Alef Academy to print our address and phone number on the class list, which will be distributed to my child's class and in the school phone directory which will be distributed to all Alef Academy families.
*
Yes
No
Other
Photo Release - I hereby grant my permission for my child's photo to be taken and displayed in classrooms, hallways, or stored in a file.
*
Yes
No
Other
Media Release - I hereby grant my permission for my child's photo to be taken and used in newsletters, flyers, and/or for any other advertisement purposes.
*
Yes
No
Cot Permission - I herebygive my consent for my child to sleep on a cot during naptime. (18 months or older)
*
Yes
No
I understand that tuition is due a month in advance:
*
Yes
No
I understand that if it becomes necessary to withdraw or change my child's schedule, notice must be given in writing one month in advance. Tuition will be charged for one month after the date of notification of the withdrawal or change.
*
Yes
No
I have read the Parent Handbook. I understand all of the policies and procedures and agree to abide by them.
*
Yes
No
Signature:
*
Clear
Date:
*
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Tuition & Schedule
I would like:
*
Please Select
2 Day: HALF DAY
2 Day: FULL DAY
3 Day: HALF DAY
3 Day: FULL DAY
5 Day: HALF DAY
5 Day: FULL DAY
I would like Before Care 8-9
*
Yes
No
I would like Before Care:
*
Please Select
2 Day: Tuesday & Thursday
3 Day: Mon, Wed, Fri
5 Day: Mon - Fri
I would like After Care 3-5
*
Yes
No
I would like After Care:
*
Please Select
2 Day: Tuesday & Thursday
3 Day: Mon, Wed, Fri
5 Day: Mon - Fri
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Tuition
TUITION POLICY: An annual registration fee of $250 is due with the application. A deposit of month's tuition is required to keep your child's spot. This deposit will be applied to the last month’s tuition. All deposits are non-refundable.
I have read and agreed to the Tuition Policy
Registration Fee
*
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Alef Academy Student Registration
$
250.00
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Credit Card Details
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Last Name
Credit Card Number
Security Code
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