Enrollment Contract

Parent/Guardian Info
How many students will you be enrolling?
For safety of the student, KBA requires both parents to fill out and agree to emergency contact and pickup persons. A form with those questions may be emailed to them.
I am*

Father/GuardianMother/Guardian
Is either parent/guardian...

KB Staffactive or retired militaryactive clergyKB Admin
Please tell us about your child's parent/guardian arrangement:*
Mother/Guardian Name*

First NameLast Name
Mother/Guardian: Cell Phone*
Please enter a valid phone number.
Mother/Guardian: Email*
example@example.com
Mother's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father/Guardian Name*

First NameLast Name
Father/Guardian: Cell Phone*
Please enter a valid phone number.
Father/Guardian: Email*
example@example.com
Father's Address: If different from Mother's

Street Address

Street Address Line 2

CityState

Zip Code
Whom should we send correspondence to:*
Shareable Directory

Kinetic Bridges distributes a directory on our Parent Portal to it's families for the purpose of facilitating communication between families. Each family may determine if they would like to be in the directory and what information is provided.

Student contact information is not allowed in the directory, nor is this information shared for solicitation or sold. Read the KB privacy policy here.
Would you like to have your information in the shareable directory, and if so, what information may we include?*

Medical, Emergency & Pick-Up Information
Emergency Contacts (other than parent/guardians)*
Health Insurance Information
Hospital*
Permission to Treat and Transport:

In the event of an emergency, Kinetic Bridges will make every reasonable effort to contact parents/emergency contacts as soon as possible.

I hereby give permission for my child to be given emergency treatment, including first aid and CPR by a qualified staff member of Kinetic Bridges. I further authorize and consent to medical, surgical, and hospital care, treatment, and procedures to be performed for my child by my child’s regular physician or hospital when deemed immediately necessary or advisable by the physician to safeguard my child’s health if I cannot be contacted. In such a case, I waive my right of informed consent to such treatment.

I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further authorize Kinetic Bridges to take my child to a hospital, and I agree that I will pay all physician and hospital bills, and Kinetic Bridges shall not be responsible for them. ** Please see Assumption of Risk and Liability Waiver for full liability release.**
Authorized Pick-Up People

(other than guardians listed above)

Kinetic Bridges requires notification in writing when someone other than a parent/guardian pick up a student. In case of emergency, Kinetic Bridges will accept a phone call and release your child to the person(s) indicated below. We check Drivers' Licenses to verify identity.
Authorized Pick-up Individuals*
Mother/Guardian Signature*
Father/Guardian Signature*

Grandparent Information

We LOVE to connect with Grandparents and keep them plugged into all that is happening at KB Academy! You can help us by filling out their information below!
Grandfather #1

First NameLast Name
Authorized to pick up?

YesNo
Grandfather #1 Phone Number
Please enter a valid phone number.
Grandfather #1 Address

Street Address

Street Address Line 2

CityState

Zip Code
Grandmother #1 Name

First NameLast Name
Authorized to pick up?

YesNo
Grandmother #1 Phone Number
Please enter a valid phone number.
Grandmother #1 Address

Street Address

Street Address Line 2

CityState

Zip Code
Grandfather #2

First NameLast Name
Authorized to pick up?

YesNo
Grandfather #2 Phone Number
Please enter a valid phone number.
Grandfather #2 Address

Street Address

Street Address Line 2

CityState

Zip Code
Grandmother #2 Name

First NameLast Name
Authorized to pick up?

YesNo
Grandmother #2 Phone Number
Please enter a valid phone number.
Grandmother #2 Address

Street Address

Street Address Line 2

CityState

Zip Code

Waivers & Releases
Assumption of Risk Liability Waiver & Release

On behalf of my minor child, I hereby give permission for my child to participate in Kinetic Bridges School or programs. I hereby warrant that both myself and my child are familiar with the risks associated with participation in Kinetic Bridges School or activities. I acknowledge that my child’s participation in this program is wholly voluntary.
I do hereby agree and consent to my child’s participation in Kinetic Bridges School or programs during this school year and do assume all risks and hazards which are conducted as part of the associated activities. I hereby release, absolve, indemnify, and hold blameless Kinetic Bridges, its officers, directors, employees, contracted employees, independent contractors, instructors, agents, organizers, and volunteers of any and all liability for damage, injury, or expense of any kind arising out of or connected with my child’s participation in Kinetic Bridges School or programs. I understand that in case of a medical emergency, my own personal medical plan will be used if available; if not, medical aid may be sought while I am being contacted. In the event of any illness or injury, I hereby consent to whatever examination, diagnosis, or treatment and the hospital care from a licensed dentist, physician, and/or surgeon as deemed necessary for my child’s safety and welfare. I understand that the resulting expenses will be my responsibility and not the Kinetic Bridges School or programs, or any affiliates. As a condition of participation in the Kinetic Bridges School or programs by the student named in this application, I acknowledge that I have read this consent form, and knowingly, on behalf of my child, assume all of the risks associated with participating in any way in Kinetic Bridges or its programming.
As consideration for being permitted to participate in the program, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make claim against, sue, or attach the property of the Kinetic Bridges school, program(s), or their Affiliates or the supplier of any of the equipment used in these activities for injury or damage resulting from negligence, failure of care, omission or other acts, howsoever caused by an employee, agent or contractor of Kinetic Bridges School, programs and any affiliate as a result of incidental to my child participation in these activities. I hereby release, to the fullest extent permitted by law, Kinetic Bridges School, programs and the affiliates, from any and all actions, claims, demands, or liabilities that I, my assignees, heirs, distributes, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my son/daughter’s participation in these activities irrespective of whether the same is based on breach of warranty, negligence, strict liability or any other theory or recovery.
Field Trip Release

PARENT/GUARDIAN PERMISSION AND RELEASE OF LIABILITY FOR FIELD TRIP
I understand that although the students will be supervised by (Kinetic Bridges faculty and staff), I do assume the risk in my student’s participation in the event.
I acknowledge that I will not seek to have Kinetic Bridges or KB Academy held liable in the event that any accident, injury, loss of property, or any other circumstance or incident occurs during or as a result of my son’s/daughter’s participation in the field trip. This release of liability includes accident, injury, loss, or damages to the student, as well as, to other individuals or property which may result from the student’s participation in the event. I hereby release and agree to hold harmless Kinetic Bridges, its officials, agents, and employees, from any claims arising out of my son’s/daughter’s participation in the event(s).
I have read and understood and accept all of the statements recited above and accept full responsibility as described.

** Transportation is not provided for field trips so parents will need to transport students to and from field trips. Field Trips are considered enrichment and are encouraged, but not required.
Field Trip Permission*

I DO give my permission for my child to be involved in Field Trips with Kinetic Bridges Academy and agree to the above Field Trip Release statement. I further agree, that I will provide transportation to/from a field trip for my child.I DO NOT give my permission for my child to be involved in Field Trips with Kinetic Bridges Academy and DO NOT agree with the above Field Trip Release statement.
Photography & Video Recording Release

Throughout the school year, there may be times when Kinetic Bridges staff or other organizations may take photographs of students, audio/videotape students, or interview students for school-related stories in a way that would individually identify a specific student. Those images and recordings may appear in publications, Kinetic Bridges Website, Kinetic Bridges Facebook Page, in the news media, or in other organizations-related stories or articles.
Photography & Video Recording Release Authorization*

I hereby GRANT Kinetic Bridges permission to use my child's photograph and/or videotaped image or interview for the purposes previously mentioned. I understand and agree that Kinetic Bridges may use these photos unless I revoke this authorization by notifying the Director of Education in writing. I further grant permission for my child to be photographed, audio/videotaped, or interviewed by other organizations for school-related stories or articles.I DO NOT grant Kinetic Bridges permission to use my child's photograph and/or videotaped image or interview for the purposes previously mentioned. I understand and agree that I may change my authorization by notifying Kinetic Bridges in writing at a later time.
Mother/Guardian Signature*
Father/Guardian Signature*

Faith & Conduct
Kinetic Bridges Statement of Faith

Kinetic Bridges believes and unapologetically teaches that every person is a unique creation; loved by God. Therefore, we treat all people with respect, honor, compassion kindness, dignity, and love as modeled by Jesus Christ. At Kinetic Bridges, we believe in modeling and representing Jesus to the world. Therefore, hateful, harassing behaviors or attitudes directed toward any person or group, for any reason, are not in accordance with Scripture, nor the beliefs of Kinetic Bridges.

We desire to provide a Biblical model for students, families, and our community. To provide this model, we uphold the following statements of belief. All administration, teachers, and staff must fully subscribe to the following statements of belief. Although parents may not fully agree with each element of this statement, all teachers will unapologetically teach consistently with these beliefs, and may not teach in a way that contradicts these beliefs. At times, it may be necessary to discuss secular concepts at age-appropriate levels for students so they may learn how to defend their faith in a secular world.
- The Holy Bible/Scripture is the inspired Word of God. It is infallible, whole, and complete. The Holy Bible is fully sufficient to guide, rule, and instruct our lives and our walk of faith.
- Jesus Christ is the Son of God, born of a virgin birth as revealed in the New Testament. He is fully God, fully man, and infallible. He alone lived a perfect life, free of sin; thereby providing forgiveness and redemption to all mankind through His bodily death and bodily resurrection. Forgiveness is a free gift, unable to be bought or earned. It is freely given to all who seek the Lord's mercy, confess and forsake their sin, and enter a saving relationship with Jesus.
- All board members, staff, administrators, and teachers shall be dedicated Christians who seek the Lord, and His will for their lives, and have a vibrant, saving relationship with Jesus. Further, they will behave in accordance with the belief that they are a temple of the Holy Spirit.
- We believe Creation is a literal account as recorded in Genesis. God is the creator and sustainer of life; therefore all life is sacred upon creation. God is infallible and creates each individual as male or female according to His immutable purposes.
- "Marriage" only has one meaning. As Scripture indicates, marriage is the union of one biologically created male and one biologically created female in an exclusive union. Marriage is a holy union, therefore sexual intimacy is to only occur between a man and a woman who are married to each other. Any intimate or sexual acts committed outside of marriage (including but not limited to adultery, fornication, homosexuality, bisexuality, bestiality, incest, rape, pedophilia, and use of pornography) are contrary to the teachings of the Bible. No sexual activities should be engaged in outside of marriage between a man and a woman.
These statements do not fully exhaust the extent of our beliefs. The Bible itself, as the inspired and infallible Word of God, is the sole and final source of all that we believe. For the purposes of K.B. Academy's function, practices, policies, and disciplines, the Board of Directors is considered the final interpretive authority.
Parent/Student Regulations and Code of Conduct

We understand that admission to Kinetic Bridges is a privilege, not a right, and that any behavior, either on or off-campus, which is not consistent with Kinetic Bridges' standards as stated in the Student/Parent Handbook, Statement of Faith and Beliefs could result in the loss of that privilege to be determined by the Directors and/or Board of Directors at any time during the year. I understand admission is for a term of one school year and does not guarantee automatic admission for future school years. We have read and agree to abide by the Kinetic Bridges Statement of Faith and Beliefs and the current Student/Parent Handbook in their entirety. We understand our actions and the actions of our child/child(ren) enrolled in Kinetic Bridges programs must be in compliance with these statements. We recognize that Kinetic Bridges reserves the right to dismiss any student (without a tuition reduction or remission) in the event he/she or members of his/her immediate family engage in conduct that Kinetic Bridges considers to be detrimental to the learning environment or reputation of Kinetic Bridges, that fails to support policies or regulations, or that prevents Kinetic Bridges from fulfilling its mission. Dismissal may occur at any point in the school year. We understand that the basis for dismissal can include, but is not limited to, a violation of the current Student/Parent Handbook, failure to maintain acceptable academic standards as outlined in school policy, or a single on or off-campus act.

We agree to be bound by the conditions of enrollment expressed in this Contract and to support Kinetic Bridges in the administration of the policies and in the enforcement of all regulations.

This contract shall be governed by the laws of the State of Missouri. The undersigned agrees to pay reasonable costs for the collection of past-due accounts, including professional fees. We understand that each provision of this Contract is severable and independent, and will remain in full force and effect, without regard to the ability to enforce any other provision(s). In signing this Contract on our behalf and on the behalf of all others having a parental and/or guardian relationship to the student, we agree to all the terms of the Contract.
7th - 12th Grade Statement of Compliance (Student): I blank (student) agree to abide by the Kinetic Bridges student/Parent Handbook Code of Conduct and Statement of Faith and Beliefs in their entirety.
7th-12th Grade Student Signature
7th-12th Grade Student Signature
7th-12th Grade Student Signature
7th-12th Grade Student Signature
K-6th Grade Statement of Compliance (Parent/Guardian): I understand my child must abide by the Kinetic Bridges Student/Parent Handbook Code of Conduct and Statement of Faith and Beliefs in their entirety and have gone over these expectations with my child.
Mother/Guardian Signature*
Father/Guardian Signature*
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option

Nondiscrimination
Kinetic Bridges does not discriminate against students or families with respect to race, creed, ancestry, gender, age, physical disability, political service or affiliation, color, or national origin. For Federal racial composition reporting purposes, please indicate your child's race and ethnicity. (Check all that apply)

CaucasianAfrican AmericanAsianNative AmericanPacific IslanderOther
Acknowledgment of Nondiscrimination

Kinetic Bridges does not discriminate against students or families with respect to race, creed, ancestry, gender, age, physical disability, political service or affiliation, color, religion, or national origin.

Kinetic Bridges is unapologetically a Christian-based organization and our officers, directors, committee members, employees, and volunteers may fully proclaim the Gospel as written in the Holy Bible. We believe all humans are created equal and all are worthy of love, honor, and respect.
Mother's Signature Acknowledging the Nondiscrimination Statement*
Father's Signature Acknowledging the Nondiscrimination Statement*

Tuition, Payments & Withdrawal
Preferred Payment Schedule.*

12 Monthly PaymentsSemester Payments (Due now and December) $50 DiscountFull Year Tuition (Due now) $100 Discount
Withdrawal Policy

Should it become necessary to withdraw your student(s) from one of our programs, the following policy be adhered to:
- Cancellation Deadline
  - Parents can cancel enrollment by providing written notice no later than June 1st.
- Post-Deadline Cancellation:
  - If cancellation occurs after June 1st, parents must:
    
    Give at least 30 days written notice
    
    Attend a mandatory meeting, if requested (at the discretion of the director team)
- Financial Obligations:
  - With proper notice: Parents are responsible for the semesters remaining tuition.
  - Without proper notice: Parents must pay the full tuition for the academic year (an academic year is August-May), regardless of the child's attendance status.
  - All fees incurred before withdrawal are due and subject to collections.
- Consequences of Non-Payment:
  - Delayed tuition payments can lead to:
    
    Student suspension or dismissal from Kinetic Bridges programs
    
    Late fees
    
    Other potential consequences
It is imperative to understand that once an enrollment agreement is entered into with Kinetic Bridges, the obligation to adhere to the stipulated financial commitments is binding. Specifically, if Parent(s)/Guardian(s) do not provide a formal notification of withdrawal prior to the prescribed deadline date, they are unequivocally obligated to fulfill the payment of tuition for that semester. This obligation holds irrespective of the student's attendance or non-attendance in the class or program. The policy is designed to ensure financial stability and planning efficacy for Kinetic Bridges and to foster a commitment to the educational process for the enrolled families.
Policy for Changing Between 3-Day and 5-Day Enrollment Plans

We understand that family needs may evolve throughout the school year. To accommodate these changes while maintaining the financial stability of our programs, we allow families to switch from the 3-day program to the 5-day program at any time, provided space is available. However, transitioning from the 5-day program to the 3-day program will incur financial obligations due to the commitment made for faculty, resources, and scheduling.

Switching from 3-Day to 5-Day Enrollment
- Parents may request a switch from the 3-day program to the 5-day program at any time.
- The change will be effective at the start of the next month.
- Tuition will be adjusted accordingly for the remainder of the academic year.
Switching from 5-Day to 3-Day Enrollment
- Parents who wish to move their student from the 5-day program to the 3-day program must submit a written request at least 30 days in advance of the end of the semester.
- If the request is approved, the change will take effect at the beginning of the next semester.
- Financial Obligation: Parents are required to pay the remaining tuition for the semester at the 5-day rate, regardless of the student’s attendance. No refunds or prorated adjustments will be issued for reducing enrollment mid-semester.
- If written notice is not provided 30 days in advance of the end of the semester, parents may be responsible for tuition for the remainder of the academic year at the 5-day rate.
- Any outstanding fees or tuition balances must be settled before the enrollment change takes effect.
By enrolling in Kinetic Bridges Academy, families acknowledge and agree to these financial commitments, which allow us to provide consistent, high-quality education for all students.
(Mother) I acknowledge I have read, understand and agree to adhere to Kinetic Bridges' withdrawal policy and program switching stated above. I fully understand if I choose to withdraw from Kinetic Bridges, I remain obligated to complete my financial obligation according to the above detailed policy. *
(Father) I acknowledge I have read, understand and agree to adhere to Kinetic Bridges withdrawal policy and program switching stated above. I fully understand if I choose to withdraw from Kinetic Bridges, I remain obligated to complete my financial obligation according to the above detailed policy.*
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
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Payment
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Credit Card Details
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Credit Card Number	Security Code
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Parent/Guardian Info

Enrolling Students

Medical, Emergency & Pick-Up Information

Permission to Treat and Transport:

Grandparent Information

Waivers & Releases

Faith & Conduct

Nondiscrimination

Tuition, Payments & Withdrawal

Payment