ICPA Day Program Registration

ICPA Early Start Registration
Registration Fee Payment Plan

ICPA Early Start Program Tuition - $5988/year

Payment Option – 12 Month Plan

-Deposit - $500/Family (due with Registration)

-9 Months @ - $667

-12 Months @ - $499
Additional Documents for Registration

Scan and Email the following documentation to the school office.
- Photo (6x4 Headshot)
- Birth Certificate
- Current Immunization Form
- Medical Card (Both Sides)
Student Information
Name*

First NameLast Name
M.I.
Birth Date *

MonthDayYear
Gender
Ethnicity
Email Address*
When would you like to start at ICPA?*
What grade will you be in the Fall?*
YesNo
If yes, what year?
Current Residence Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name*

First NameLast Name
Mother's Cell Phone Number*

Area CodePhone Number
Mother's Email*
example@example.com
Father's Name

First NameLast Name
Father's Cell Phone Number

Area CodePhone Number
Father's Email
example@example.com

Emergency Contact 1
Emergency Contact 1 Name*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2
Emergency Contact 2 Name

First NameLast Name
Emergency Contact 2 Phone Number

Area CodePhone Number
Physician and Medical Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.

Previous School
School Name*
City*
State*
Date Started

MonthDayYear
Date Ended

MonthDayYear
How did you hear about ICPA?*

Waiver of Liability

I hereby release, indemnify and hold harmless Inland Conservatory For The Performing Arts, Inc. , its owners, members, advisors, Board of Directors, and all employees and agents of these parties from all liabilities, suits, claims and/or demands of any kind or nature, legal or financial, whether caused in any way by the negligence or not, arising from the participation in or observation of any Inland Conservatory For The Performing Arts, Inc. activity for injuries to any person or property, whether on or off the premises. The student named above does voluntarily participate in any and all Inland Conservatory For The Performing Arts, Inc. activities and that the student and parent/legal guardian understand that certain risks are inherent to and from participation and involvement with Inland Conservatory For The Performing Arts, Inc. and in its various formal and informal activities. These activities include but are not limited to the transportation of students, dance, gymnastics, activities related to operating a musical instrument and activities related to dance and theatrical performance. Inland Conservatory For The Performing Arts, Inc. is not responsible for any lost or stolen property, at any time. Anyone found to be violating any of the rules, codes of conduct, or found to be disruptive to either another individual or group may be asked to leave the premises or off-site location at any time and be refused reentry. Also, I am giving up my constitutional right to have any dispute decided in a court of law before a jury, and instead are accepting the use of arbitration. Further, any irresolvable disputes will be determined by submission to arbitration as provided by California law, and not by a lawsuit or resort to court processes of any kind.
I have read, understood and will adhere to the terms and conditions of the Waiver of Liability: *
Photo/Media Release

I hereby understand and am fully aware that the student named above may be participating in Inland Conservatory For The Performing Arts, Inc. activities in which I and/or the student named above may be photographed or videotaped (the Property) from time to time. I hereby irrevocably grant to Inland Conservatory For The Performing Arts, Inc. perpetually, exclusively, and for all media throughout the world (including print, non-theatrical, home video, CD-ROM, internet and any other electronic medium presently in existence or invented in the future), the right to use and incorporate (alone or together with other materials), in whole or in part, photographs, sound bites, audio recordings and video footage taken as a result of participation in Inland Conservatory For The Performing Arts, Inc. activities. I hereby agree that I will not bring or consent to others bringing claim or action against Inland Conservatory For The Performing Arts, Inc. on the grounds that anything contained in the Property, or in the advertising and publicity used in connection herewith, is defamatory, reflects adversely on me or the student named above, violates any other right whatsoever, including, without limitation, rights of privacy and publicity. I hereby release Inland Conservatory For The Performing Arts, Inc., its owners, members, Board of Directors, and all employees and agents of these parties from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I may hereafter have against Inland Conservatory For The Performing Arts, Inc. in connection with the Property. This agreement shall not obligate Inland Conservatory For The Performing Arts, Inc. to use the Property or to use any of the rights granted hereunder, or to prepare, produce, exhibit, distribute or exploit the Property. Inland Conservatory For The Performing Arts, Inc. shall have the right to assign its rights hereunder, without my consent, in whole or in part, to any person, firm, corporation or organization.
I have read, understood and will adhere to the terms and conditions of the Photo Release: *
Internet Policy

The Inland Conservatory For The Performing Arts School ("ICPA") believes that it's especially important to protect students' privacy online and encourages parents and guardians to spend time online with their children and participate in their internet activity. Access to the Internet may permit students to receive content or a message from another person that is inappropriate for children. In addition, internet access permits children to interact with others in ways that may lead to disclosure of the child's personal information. Instructing your children on limiting disclosure of their personal information is critical in practicing their safe use of the internet. For these reasons, ICPA requires that students 5-18 years of age obtain parental consent in order to use the internet on campus for education use. ICPA has taken several preventive measures while complying with Federal Law to provide high quality internet filtering solutions to add additional layers of protection. The Federal Children's Internet Protection Act (CIPA) requires that ICPA take active measures to filter inappropriate Internet content. While this system is very comprehensive, it is not perfect. Some inappropriate sites may get through and some legitimate sites may be blocked. ICPA does prescreen the websites students are required to use to complete assignments. However, other sites that students may navigate to are monitored and/or blocked by our internet filtering service. Parental supervision is suggested while students are using the internet off campus.
I have read, understood and will adhere to the terms and conditions of the Internet Policy: *
Touching Policy

Participation in the performing arts may involve physical contact by instructors in the course of teaching, for the purpose of illustrating what is being taught. Further, participation in the performing arts may involve physical contact by other students in the course of rehearsals and performances. ICPA is aware of the difference between appropriate and inappropriate behavior and follows state guidelines regarding training to recognize sexual harassment.
I have read, understood and will adhere to the terms and conditions of the Touching Policy:*
Student Participation Policy

It is acknowledged and fully understood that your student is required to be at ALL student ICPA recitals and ICPA events. Students will receive a full lower grade for every recital or event that the student does not show up for.
I have read, understood and will adhere to the terms and conditions of the Student Participation Policy:*
Cell Phone Policy

It is acknowledged and fully understood cell phones are prohibited on the ICPA Campus including after-school rehearsals and weekend rehearsals. The one and only exception to this policy, is when an instructor has asked the student to use their cell phone or recreational electronic device. Students who violate this policy will have the device confiscated and be subject to behavior consequences. All communication must be arranged from 8:00 A.M. to 5:30 P.M. through the School Office.
I have read, understood and will adhere to the terms and conditions of the Cell Phone Policy:*
Lost and Stolen Property

Inland Conservatory For The Performing Arts, Inc. is not responsible for any and/or all lost or stolen property including cell phones, toys and other prohibited items, at any time.
I have read, understood and will adhere to the terms and conditions of the Lost and Stolen Property Policy:*
Indemnity Policy

Students and Parents agree, for the student and their respective heirs, assigns, and legal representatives, to indemnify, defend and hold The Inland Conservatory For The Performing Arts, Inc. and its parties harmless from and against any and all damages (including damages caused solely by the gross negligence or intentional misconduct of The Inland Conservatory For The Performing Arts parties) that may be incurred or sustained by The Inland Conservatory For The Performing Arts parties arising from or related to any injuries to the student or the student’s acts or omissions.
I have read, understood and will adhere to the terms and conditions of the Indemnity Policy:*
Social Media Response Policy

I hereby understand and am fully aware that ICPA is not responsible for the social media activity that students engage in while in on campus and away from campus. Further, any form of cyberbullying is prohibited and is in violation of ICPA school policies and standards. Any student that uses social media platforms to cause hurt, harm or distress to another student will be disciplined, suspended and further dismissed.
I have read, understood and will adhere to the terms and conditions of the Social Media Response Policy:*
Non-Refundable Policy

I hereby understand and am fully aware that all ICPA fees and payments, of any kind, are non-refundable.
I have read, understood and will adhere to the terms and conditions of the Non-Refundable Policy:
Withdrawal Policy

I hereby understand and am fully aware that Parents who wish to withdraw the Student from ICPA, for any reason, will have to pay the full balance of what is owed from the enrollment and tuition fee payment agreement immediately. No transcripts will be given until the tuition fee has been fully paid. Further, any irresolvable disputes that may arise will be determined by submission to arbitration as provided by California law, and not by a lawsuit or resort to court processes of any kind. If arbitration processes or mediation processes are engaged, then all fees associated with such processes will be paid by parent and/or the undersigned regardless of the mediation outcome.
I have read, understood and will adhere to the terms and conditions of the Withdrawal Policy:*
Off Campus Lunch Policy

I hereby understand and am fully aware that ICPA off-campus lunch permission is a privilege, not a right. This permission is extended to 8th-12th grade students as long as they exercise good school and community citizenship. A student with parental permission and final approval from Professor Coleman may leave the school campus ONLY during a scheduled lunch period. Further, this permission may be revoked by the student's parent or Professor Coleman at any time. By signing the “Off-Campus Lunch Permission Form”, you are agreeing to release ICPA from any and all responsibilities regarding your student's conduct while off campus. Parents are responsible for their child's whereabouts, conduct, and welfare while away from campus. It is also understood that your child will be un-supervised while away from school premises. Failure to demonstrate overall good school behavior and excellent community citizenship while away from ICPA campus will cause the revocation of the student’s off campus permission and may be disciplined, suspended and further dismissed.
I have read, understood and will adhere to the terms and conditions of the Off Campus Lunch Policy:*
Full Year Tuition Policy

I hereby understand and am fully aware that the tuition for ICPA is an annual cost that covers the entire school year (3 Trimesters - September through August). I also understand the tuition payment option is a courtesy and is not in place of the full tuition for the school year. Further, the yearly tuition cost for ICPA is not inclusive of any other fees such as costumes, field trips, event tickets including recitals, plays or ICPA in-house events.
I have read, understood and will adhere to the terms and conditions of the Full Year Tuition Policy:*
Off-Campus Walking Policy

I hereby understand and am fully aware that students, with the supervision of ICPA Staff, will occasionally walk across the street to the park for lunch and physical activities.
I have read, understood and will adhere to the terms and conditions of the Off-Campus Walking Policy:*

Upload All Documents

Required Documents
- Photo - 4x6
- Birth Certificate
- Medical Insurance Card (Both Sides)
- Immunization Card (No COVID Vax Required)
Upload All Documents*

Cancelof
NoIf "Yes" please enter how much money is available for the entire school year
If Yes provide the name of the program that you are using? Name of Charter School or Specialty Program
How much money is available for the entire school year? $ Amount for the entire school year
I also want to enroll Sibling 1 First Last Name Sibling 1 Age Sibling 1 Grade in the Fall Sibling 1 Birthdate
I also want to enroll Sibling 2 First Last Name Sibling 2 Age Sibling 2 Grade in the Fall Sibling 2 Birthdate
Pay the full tuition ($5988.00/school year -Sept 6 to Aug 1)Make installment payments for 9 months($667/month)Make installment payments for 12 months($499/month)
I need after school care (2:30p - 5:30p) $50/weekI don't need after school care
Next Steps:
After you submit this registration form our Front Office Staff will set an in-person meeting with you to finalize the tuition agreement.

Auditions are not required for Early Start Students

Orientation is August 31, 2022 @ 6p

School Starts September 6, 2022

Thank You!
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ICPA Early Start Registration