2024/2025 Registration Application

Emergency Information/Medical Release/Liability Waiver Form

This form is necessary for any prospective student at Beavercreek Freedom Academy. Please complete this form and return it with application. The prospective student will not be fully registered without this form signed by a parent or guardian. Please fill out the requested information completely and list any additional information that may be important should an illness or injury occur.
Participant Information
- Student's Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Notes - Anything additional you would like for us to know
- Student's Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Please list any known allergies and the appropriate action required.
- Notes - Anything additional you would like for us to know
- Student's Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Notes - Anything additional you would like for us to know
- Please list any known allergies and the appropriate action required.
- Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/Guardian Name (1)
  
  First NameLast Name
- Email
  example@example.com
- Relationship to Student
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Place of Employment
- Parent/Guardian Name (2)
  
  First NameLast Name
- Relationship to Student
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Place of Employment
- Home Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Emergency Contacts
  
  Please include two non-parents
- (1) Name
  
  First NameLast Name
- Relationship to Student
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Additional Phone Number (if applicable)
  Please enter a valid phone number.Format: (000) 000-0000.
- (2) Name
  
  First NameLast Name
- Relationship to Student
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Additional Phone Number (if applicable)
  Please enter a valid phone number.Format: (000) 000-0000.
- (3) Name
  
  First NameLast Name
- Relationship to Student
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Additional Phone Number (if applicable)
  Please enter a valid phone number.Format: (000) 000-0000.
- (4) Name
  
  First NameLast Name
- Relationship to Student
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Medical Treatment Consent
  
  In the event that neither I nor the additional designated emergency contacts can be reached, I authorize and consent for my child to receive any and all health care services available from and deemed necessary by the staff of Beavercreek Freedom Academy and their associated provider agencies/treating physicians.
- I consent to the following checked items, if deemed immediately necessary to safeguard my child's health:
- Notes
- Parent/Guardian Signature
- Date
  
  MonthDayYear
  Date

Minor Photo Release Form
Dear Parents/Guardians,

Beavercreek Freedom Academy will be taking photographs of events and activities held during the schol year. Some of these photographs may include your child/children. Therefore, we are requesting your permission to use these photographs for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising and web content. This permission includes both print and online sites.
Please indicate below if you choose to allow Beavercreek Freedom Academy to use photographs with your child or children in this manner:
Parent Signature
Date

MonthDayYear
Date
Parent's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
- Student's Name
  
  First NameLast Name
- Student's Name
  
  First NameLast Name
- Student's Name
  
  First NameLast Name
- Should be Empty:

Emergency Information/Medical Release/Liability Waiver Form

Participant Information

Emergency Contacts

Medical Treatment Consent

Minor Photo Release Form