Mathisi Academy Enrollment Application
STUDENT INFORMATION
Child's Name
*
First Name
Middle Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT INFORMATION
Mother's Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Mother's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Father's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Allergies/Illnesses/Medications:
*
Medical Consent
I give permission to the staff of Mathisi Academy to administer first aid, escort my child to a hospital, physician or other medical care provider in the event of a medical emergency.
Signature
*
Date
*
/
Month
/
Day
Year
Date
Scheduling Needs
Days:
*
Monday
Tuesday
Wednesday
Thursday
Friday
Care needed:
*
Full time
Part time
After school
Before School
Before and After
Drop Off Time
*
Hour Minutes
AM
PM
AM/PM Option
Pick Up Time
*
Hour Minutes
AM
PM
AM/PM Option
Parent/Guardian Statement of Agreement for Policies and Procedures
Please read and check off each policy to agree.
Type a question
I give permission for my child to take part in all school activities, including school sponsored trip away from the school premises.
The school deserves the right to dismiss any student who does not abide by school policy.
I agree to participate in parent meetings and all school activities.
I agree to meet tuition responsibilities in a timely manner.
I understand that if tuition is delinquent my child can be dismissed from school until payment in received or dismissed permanently.
I agree to provide all necessary fees for extracurricular school activities as directed by Mathisi Academy.
I agree to cooperate and support home activites.
I will participate/send a family representative to the any conferences held on behalf of my child. I understand that these conferences are mandatory and I will abide by this policy.
I understand that regular attendance and promptness is important to educational success. I agree my child(ren) will be prompt daily to school and if absences are frequent, to contact school office immediately.
Signature
*
Date
*
/
Month
/
Day
Year
Date
Signature
Date
/
Month
/
Day
Year
Date
Submit
Submit
Should be Empty: