Welcome to NeuroCatalyst Academy!
We’re excited that you’re considering joining our community of learners. Please complete the form below so we can get to know your child and family better.

📧 neurocatalystacademy@gmail.com
📞 480-504-1816
🌐 www.neurocatalystacademy.org

We proudly welcome all family types, learning styles, and neurodivergent identities.

📸🏾 Media Consent & Release Form
I, the undersigned parent/guardian, hereby grant NeuroCatalyst Academy permission to photograph, record, or video my child during school activities, events, and programs.

These images and videos may be used for educational documentation, school displays, social media, and promotional materials that represent NCA’s mission and programs.

I understand that my child’s name and personal details will never be publicly shared without my direct written consent.

⚕️🏾 Injury & Liability Waiver
I, the undersigned parent/guardian, understand that while NeuroCatalyst Academy takes every reasonable measure to ensure safety, participation in school activities, field trips, physical education, and other programs carries some inherent risks.

By signing below, I acknowledge that:

I release and hold harmless NeuroCatalyst Academy, its staff, affiliates, and volunteers from any claims, damages, or injuries arising from my child’s participation in NCA activities.
In case of accident or emergency, I authorize NCA staff to seek appropriate medical care for my child and contact me immediately.
I assume full responsibility for any medical costs incurred as a result of such care.
This waiver remains in effect for the duration of my child’s enrollment unless revoked in writing.

📘🏾 Handbook Acknowledgment & Agreement
I acknowledge that I have received, reviewed, and understand the NeuroCatalyst Academy Family Handbook, which includes policies regarding:

Attendance, behavior, and communication
Health and safety protocols
Academic expectations and learning support
Parent involvement and community values
I agree to follow all NCA guidelines and support my child’s participation in alignment with NCA’s values of equity, respect, and growth.

💵🏾 Tuition & Funding Agreement
I, the undersigned parent/guardian, understand that NeuroCatalyst Academy operates as a private, tuition-based program that also accepts ESA funds, scholarships, and approved third-party funding sources.

By signing this agreement, I acknowledge and agree to the following:

• I am responsible for ensuring tuition is paid in full by the due dates listed in my child’s enrollment invoice or funding plan.
• I understand that tuition covers instructional materials, enrichment programs, and facility use, and is non-refundable except under documented special circumstances approved by the NCA Director.
• If utilizing ESA or scholarship funds, I agree to submit all required forms and maintain active eligibility status.
• I understand that late payments or funding delays may result in temporary suspension of enrollment or activity participation until resolved.
• I will communicate promptly with NCA regarding any changes to my funding source or financial circumstances.

✅🏾 Final Acknowledgment, Review, & Signature
Please review all information you have provided carefully before submitting this form.

By signing below, I acknowledge and agree that:

1. All information provided in this enrollment form is true, complete, and accurate to the best of my knowledge.
2. I have read, understood, and agree to the policies and terms outlined in the following documents and sections:
   • Media Consent & Release
   • Injury & Liability Waiver
   • Family Handbook Acknowledgment
   • Tuition & Funding Agreement
3. I understand that NeuroCatalyst Academy, LLC reserves the right to deny or withdraw enrollment if false, misleading, or incomplete information is provided.
4. I understand that participation in any school-related activities is voluntary and may involve inherent risks, and I release NeuroCatalyst Academy, LLC, its staff, contractors, and affiliates from any and all liability to the fullest extent permitted by law.
5. I understand that all fees, deposits, and tuition payments are subject to the terms stated in the Tuition & Funding Agreement, and I am responsible for ensuring timely payment.
6. I understand that by signing this form electronically or physically, my signature constitutes a legally binding agreement between myself and NeuroCatalyst Academy, LLC.

⚖️ This agreement is made between the undersigned parent/guardian and NeuroCatalyst Academy, LLC. All policies, waivers, and consents described herein are legally binding upon submission of this form.