2025-2026 Enrollment Form

Cornerstone Enrollment

2025-2026
New FamilyReturning FamilyPrevious Cornerstone Family (3 years or less since a child in your family attended)
Parent Information

Parents / Guardians - If there is only one Parent/Guardian please leave the 2nd blank.
1st Parent/Guardian *

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Relationship to Student*
2nd Parent/Guardian

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship to Student
Student Information
Student *

First NameLast Name
Grade for the 2025/2026 school year*
Date of Birth*

MonthDayYear
Date
Please list any medical conditions or learning disabilities we should be aware of that might affect your student while at Cornerstone. PLEASE NOTE this form ONLY goes to our study hall monitor for emergencies. If your child has a medical issue that will manifest itself in class, please alert your tutor directly to discuss the management plan.
Allergies*
Health/Learning Concerns*
Does your student use an EpiPen, inhaler, or other medical device? It is your responsibility to alert the study hall monitor and tutors where to find this in an emergency.
Does your student use a Medical Device?*

YesNo
What type of Medical Device*
For the 2025-26 school year, have you already completed an enrollment form for another student

YesNo

Insurance / Physician Information
Insurance Company*
Policy Number / Group #*
Primary Care Physician Name & Number*

Emergency Contacts
Emergency Contacts*

Cooperative Agreements
Have you and your student(s) read and do you agree to follow the Cornerstone Handbook.*

Yes
Have you and your student(s) read and do you agree with the Cornerstone Statement of Faith?*

Yes
Do you understand that Cornerstone is not replacing your responsibility in meeting the state’s requirements?*

Yes
Do you understand that your student’s education is ultimately your responsibility? Therefore, you must ensure that all work is complete and submitted in a timely manner.*

Yes
Do you understand that anyone caught plagiarizing or found to be breaking any rules of Cornerstone may be expelled from Cornerstone without a refund?*

Yes
Do you understand that Cornerstone is a true cooperative, and that you as a family will be required to attend the mandatory Parent/Tutor Night meeting in the beginning of the school year in early September?*

Yes
Do you understand that you are responsible for your volunteer duties throughout the year as explained in the handbook?*

Yes
Do you understand that, due to various situations such as tutor illness, snow days, etc., tutor sessions might be conducted over the internet using distance learning tools?*

Yes

Legal Agreements
As legal guardian, I do hereby grant and authorize CORNERSTONE TUTORIAL the right to take and use photos of my child for the purpose of publishing in the Cornerstone yearbook. Yearbook photos are usually taken by the photography instructor and students enrolled in the photography class; however, some photos are also submitted by Cornerstone students/families. If you do not wish for your child to be photographed for the yearbook, please check the appropriate box. While your student’s name and your request will be given to each tutor and to the yearbook tutor, we also expect for you, the parent, to have a conversation with your student regarding your wishes. We expect for your student to remove themselves from photographs that are being taken for yearbook purposes. These are not limited to, but might include, headshots, class photos, spirit day photos, holiday celebration photos, and any other photos taken on the premises for yearbook purposes. As is the case in any social setting, Cornerstone cannot prevent parents or other students from taking photos on their own and using them for personal or social media purposes.*

I agree to the aforementioned statementI DO NOT agree to the aforementioned statement. I DO NOT want my child's photo taken for the yearbook.
I hereby release and hold harmless CORNERSTONE TUTORIAL from any and all liability, causes of action and/or claims which I, my heirs, successors, personal representative and assigns may make while acting on behalf of me or my estate.*

I agree to the aforementioned statement
Parent/Legal Guardian hereby agrees that submission of this form constitutes a legal signature.*

I agree to the aforementioned statement
Signatory Name*

First NameLast Name
Signatory Email*
example@example.com
Signature*

Clear
Today's Date*

MonthDayYear
Date

ATTENTION PARENTS:

Once you hit submit you will be given the link and password to your next step.

HOWEVER, if you have multiple children, you must hit submit and then start a new enrollment form for each student. All Enrollment Forms must be complete before moving to the next step.

FAILURE to do so WILL NOT hold your students placement in those classes.
Should be Empty:

Cornerstone Enrollment

Parent Information

Student Information

Insurance / Physician Information

Emergency Contacts

Cooperative Agreements

Legal Agreements