Parental Consent and Release for Powerhouse Youth Ministries

CONTACT FORM

DOLPHIN STEM ACADEMY
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number*

Area CodePhone Number
Type of Inquiry*
Have you received a state education tuition grant, or are you paying tuition on your own?

No I have not received a state grant and I will pay tuition myselfTN ESA/TN EFSAZ ESANH ESA CSF
Grade Level(s) for Enrollment
State
Type of school you are transferring from

Public schoolPrivate schoolOnline schoolHomeschool
Reason for transfer

Bullying/harrassmentEducation quality/lack of supportPrefer to learn at homeNeed flexibility/self-pacedLooking for specialized STEM coursesOther
Enter your 'other' reason for transfer
What are you looking forward to at Dolphin STEM Academy?

Teacher supportFlexibilitySelf-paced curriculumLearning from home/travellingSpecialized STEM coursesOther
Enter your 'other' reason for interest in Dolphin STEM Academy
Choose your international student enrollment:

Dual Diploma - enroll in your local school full time, and enroll in Dolphin STEM Academy part-time online to receive a diploma from both schoolsFull-time enrollment at Dolphin STEM Academy online to receive a diploma only from Dolphin STEM Academy
Parent/Guardian Name, Phone, and Email.
Enter Name of Student for Records Request

First NameLast Name
Enter Date of Birth of Student for Records Request
Enter Grade Level for Records Request
Who and where should the records request be sent to?
Enter your question/inquiry information*
The choice is yours! By selecting the 'I agree' choice below, I agree to receive SMS updates, promotions, and offers from Dolphin STEM Academy at the phone number provided. Msg & data rates may apply. Msg frequency varies. Reply STOP to unsubscribe. Messaging Policy https://dolphinstemacademy.com/dolphin-legal/ If you select 'I do NOT agree', you will not receive any SMS updates, promotions, or offers at the phone number provided.*

I agreeI do NOT agree
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CONTACT FORM