Elementary School Application Form

OLLAS ACADEMY K-6 REGISTRATION FORM

Complete the registration form below to sign your child up for the upcoming school year.
Child's Name*

First NameLast Name
Child's Birth Date:*

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState

Zip Code
Last School attended*
School Name
Child's Teacher's Name*

PrefixFirst NameLast Name
Current Grade Level*
Grade
Mother's/Guardian's Name*

First NameLast Name
Mother's/Guardian's Cell Phone Number:*

Area CodePhone Number
Mother's/Guardian's E-mail*
example@example.com
Father's/Guardian's Name*

First NameLast Name
Father's/Guardian's Cell Phone Number:*

Area CodePhone Number
Father's/Guardian's E-mail*
example@example.com
Any Medical Issues We Should Know About?*
Church
Is a parent in the military?*
Military Parent
Are there any security/custody issues with this child?*
If you answered "YES" to the question above, please help us to know the security/custody issues for the safety of your child.
Security/Custody Issues
Does the child have any special needs (ADD, Asperger’s, Dyslexia, etc.)*
If you answered "YES" to the question above, please list the special needs of the child. (ADD, Asperger’s, Dyslexia, etc.)
Special Needs
Does your child have any allergies? (peanuts, chocolate, etc.)*
If you answered "YES" to the question above, please list your child's allergies.
Allergies
Emergency Contact #1*

First NameLast Name
Phone Number*

Area CodePhone Number
Emergency Contact #2*

First NameLast Name
Phone Number*

Area CodePhone Number
In addition to those listed above (Guardian, Parents, & Emergency Contacts), please list the individuals who are also allowed to pick up your child from Good News Club®. List Name's & Phone Numbers*
Allowed to pick up child.
Please list any individual who is NOT allowed to pick up your child from Good News Club®.
NOT Allowed to pick up child.
My child will get home after school by:*

Parent/Guardian will pick up after school.My child will walk home after school.My child will attend aftercare program.My child will ride the bus.
My child is allowed to attend school at Ollas Academy, daily Monday through Friday during school school. I understand it is my responsibility to pick up my child at 5:00 PM.*

I hereby grant permission for my child to attend Ollas Academy in Miami.
Name*

First NameLast Name
Method of Payment
PARENT/GAURDIAN: Ollas academy does not provide transportation to the students. Parents must arrange transportation to the Academy's location and must pick up each child promptly at end time. Our policies do not allow Ollas Academy teachers or helpers to remain after school. Please be prompt in picking up your child so it does not jeopardize our Academy in utilizing the facilities inside the school. Thank you for understanding.
This is not an activity of the school or the school district.
OPTIONAL Photography & Video Release Form

Photography & Video Release
Ollas Academy may, from time to time, document the activities of the school with photos or videos. I hereby assign and grant to Ollas Academy, its subsidiaries and successors, and assign the unqualified right to the ownership, use and proceeds of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational and promotional purposes.

I hereby grant permission to take photos and/or videos of my child during Good News Club®.I do NOT grant permission to take photos and/or videos of my child during Good News Club®.
Name*

First NameLast Name
How did you hear about Ollas Academy?
Should be Empty:

OLLAS ACADEMY K-6 REGISTRATION FORM

OPTIONAL Photography & Video Release Form