Sequoia Learning Community Application for Admission

Student's Name *

First NameLast Name

Student's Date of Birth*

Date

Gender*

Grade Level for 2025-2026*

Please note: We do our best to update the waitlisted classes as they fill up. If your student needs a class that is waitlisted, please complete the Wait List Sign up on our website.

School Program for 2025-2026*

Student Address*

Street Address

Street Address Line 2

CityState

Zip Code

Parent Information

If mother's info is not applicable (i.e. single parent family), click hereIf father's info is not applicable (i.e. single parent family) click hereIf student lives with a guardian other than mom or dad, click here

Mother's/Guardian #1's Name*

Mother/Guardian First NameLast Name

Mother/Guardian #1 Phone Number

Please enter a valid phone number.

Mother/Guardian #1 Email

example@example.com

Mother/Guardian #1 Occupation

Father/Guardian #2 Name*

Father/Guardian's First NameLast Name

Father/Guardian #2's Phone Number

Please enter a valid phone number.

Father/Guardian #2's Email

example@example.com

Father/Guardian #2's Occupation

Emergency Contact (someone other than mom or dad)*

First NameLast Name

Emergency Contact's Phone Number*

Please enter a valid phone number.

Relationship to student*

Alternate Pick-Ups

You may list up to three additional people that you authorize to pick up your student, other than mom and dad. This information can be adjusted throughout the program year as needed.

Alternate Pick-Up Person #1

Relationship to student

Phone Number

Please enter a valid phone number.

Alternate Pick-Up Person #2

Relationship to student

Phone Number

Please enter a valid phone number.

Alternate Pick-Up Person #3

Relationship to student

Phone Number

Please enter a valid phone number.

Student's Primary Care Provider (Doctor's Name)*

Primary Care Provider's Phone Number*

Please enter a valid phone number.

Does your student have any allergies or dietary restrictions?*

Does your child have any special needs or struggles (medical, behavioral, or educational) that we should be aware of? Any special information you would like to share that is important or will better help us serve your student?

This information will be kept confidential and shared only with appropriate staff as necessary. Any answers given will not be used as a basis of discrimination, but rather will help us to best serve your student and ensure a safe and appropriate learning environment.

Does your student have a 504, IEP, or currently being evaluated for one?*

This does not exclude them from admission, but simply helps us ensure we are equipped to serve your student.

If yes, please explain.

Please provide any information that will help us better understand your student. If your student is not working at grade-level, please explain.

We want to get to know you! Tell us a little bit about why you are homeschooling and how long you've been doing it.*

What are five adjectives that describe your student?*

How did you hear about Sequoia Learning Community?*

MEDICAL RELEASE

I, the parent of the aforementioned student, hereby give and grant to any medical doctor or hospital my consent and authorization to render such aid, treatment, or care to the aforementioned student as, in the judgment of said doctor or hospital, may be required, on an emergency basis, when the need for such treatment is clear and when all efforts to contact me are unsuccessful. It is further understood that any expense incurred for transportation and/or treatment will be the responsibility of the parent of the aforementioned student. I, the parent of the aforementioned student, agree that payment of the expense is wholly my responsibility and that Sequoia Learning Community is not responsible for any costs incurred.

I agree to this medical release.*

I agree

LIABILITY RELEASE

I, the Parent of the aforementioned student, hereby give permission for the aforementioned student to be enrolled in and participate in the activities offered by Sequoia Learning Community. I certify that the aforementioned student is physically, mentally, and emotionally able to participate in the activities in which s/he chooses to participate. I hereby voluntarily release Sequoia Learning Community from any and all liability resulting from or arising from the aforementioned student’s participation in the activities. I understand and agree that I am releasing Sequoia Learning Community as well as the officers, agents, and employees. I understand and agree that this Release of Liability will have the effect of releasing, discharging, waiving, and forever relinquishing any and all actions or causes of action that I and/or the aforementioned student may have or have had, whether past, present, or future, whether known or unknown, and whether anticipated or unanticipated by me or the aforementioned student, arising out of participation in the activities. I understand and agree that by signing this Release of Liability, I am assuming full responsibility for any and all risk of death or personal injury, or property damage suffered by me and/or the aforementioned student while participating in any and all chosen activities sanctioned by Sequoia Learning Community. I understand and agree that by signing this Release of Liability, I am agreeing to release, indemnify, and hold harmless Sequoia Learning Community and its employees from any and all liability or costs, including attorney fees, associated with or arising from participation in the activities. I understand that this Release of Liability will be binding on me, my spouse, my heirs, my personal representatives, my assignees, my children, and any guardian ad litem for said children. I acknowledge that I have read and understand this Release of Liability. I also understand that this Release of Liability is valid for the duration of time that the aforementioned student is enrolled in and participates in the activities of Sequoia Learning Community.

I agree to this liability release.*

I agree

MEDIA RELEASE

Enrollment in Sequoia Learning Community requires your authorization to reproduce through printed, audio, visual, or electronic means all activities in which the aforementioned student has participated. Enrollment in any one of our programs acknowledges authorization, which will enable us to use specially prepared materials to (1) train instructors and/or (2) increase public awareness and promote the continuation and improvement of our program through the use of newsletters, mass media, displays, brochures, flyers, websites (including social media sites), etc.

Media & Publicity Authorization and Release:

I, the parent of the aforementioned student (herein referred to as “student”) authorize and grant Sequoia Learning Community and its authorized representatives, the right to print, photograph, record, and edit as desired, the biographical information, name, image, likeness, and/or the voice of the above-named student on audio, video, film, slide, or any other electronic and printed formats, currently developed, (known as "Recordings"), for the purposes stated or related to the above.

I understand and agree that the use of such Recordings will be without any compensation to the student or the student’s parent(s).

I understand and agree that Sequoia Learning Community and/or its authorized representatives shall have the exclusive right, title, and interest, including copyright, in the Recordings.

I understand and agree that Sequoia Learning Community and/or its authorized representatives shall have the unlimited right to use the Recordings for any purposes stated or related to the above.

I hereby release and hold harmless Sequoia Learning Community and its authorized representatives from any and all actions, claims, damages, costs, or expenses, including attorney's fees, brought by the student and/or student’s parent(s) which relate to or arise out of any use of these Recordings as specified above.

I have read and understand the Media & Publicity Authorization and Release, and I agree to accept its provisions.

I agree to this media release.*

I agree

TUITION AGREEMENT

Financial Obligation: I understand that all tuition and fees (herein referred to as “Charges”) incurred with Sequoia Learning Community for the enrollment and activities of aforementioned student are due and payable by the fifteenth (15th) day of each month for the following month and that I am solely liable for payment of all Charges, regardless of payment method. I am also aware that a $40 late fee will be added if payment if not received by the first of the month. If we decide to withdraw aforementioned student from the program, I am aware that a thirty-day written notice is required to be made to the director and that I am responsible for the Charges incurred during the period between when the written communication occurs and the end of the thirty-day period. I also understand that non-attendance does not relieve my financial liability.

Approved Payment Methods: I understand that I am obligated to complete payment through an approved payment method, defined herein, to cover all Charges by the fifteenth (15th) day of each program month for the following month. Approved payment methods include: credit card, cash, check, Venmo or Sequoia Learning Community's receipt of a charter school purchase order or certificate. Receipt of a charter school purchase order or certificate is required no later than the first (1st) day of each month. If the charter school subsequently fails to pay for the Charges, I understand that I am responsible for the Charges incurred. Failure to make payment by the first (1st) day of each month could result in a fee assessment and/or dismissal of aforementioned student from the program.

2025-2026 Program Year Tuition Schedule: Tuition for the 2025-2026 program year is $2,970.00. Tuition will be paid in monthly installments of $330, due on the 15th of each month for the following month, beginning August 15, 2025 through April 15, 2026.

I have read and agree to the Tuition Agreement and understand that I am financially responsible for all Charges incurred with Sequoia Learning Community.

I agree to this tuition agreement.*

I agree

Date Signed

Date

My Products*

Application FeeThis fee is non-refundable.

$50.00 Quantity

Enter coupon

Total

$0.00

Credit Card

Sequoia Learning Community

Class Availability:

Credit Card