Clone of Albany - 2026 Summer Registration Form (New Student)

Tilden Preparatory School

1475 N Broadway #200

Walnut Creek, CA 94596

registrationwc@tildenprep.com

www.tildenprep.com

(925) 933-5506
2026 Summer Registration Form

Walnut Creek Campus - NEW STUDENTS
If your student has attended Tilden previously, please fill out a 2026 Summer Returning Students Form.

Student Information
Full Name*

First NameMiddle InitialLast Name
Student's Birthdate*

MonthDayYear
Please upload a recent image of your student for their Tilden profile.*

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Student's Email Address*
Student's Cell Phone Number*
Sex/Gender*
Pronouns*

She/Her/HersHe/Him/HisThey/Them/TheirsOther
Student's Birthplace*

CityStateCountry (e.g., USA)
Name of Current/Previous School*
Current Grade Level*
Expected Year of High School Graduation*
In an effort to share what is happening in our community, Tilden takes photos at events and shares these photos through our newsletters, website, social media, etc. If you would NOT like us to use your student's image, please check here:

Please do not use my student's image.
How were you referred to Tilden?*
Please tell us more about how you were referred to Tilden.
Parent/Caregiver Information
Parent/Caregiver 1 - Full Name*
Parent/Caregiver 2 - Full Name
Parent/Caregiver 1 - Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Parent/Caregiver 2 - Address (If Different)

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Parent/Caregiver 1 - Email*
Parent/Caregiver 2 - Email
Parent/Caregiver 1 - Home Phone
Parent/Caregiver 2 - Home Phone
Parent/Caregiver 1 - Work Phone
Parent/Caregiver 2 - Work Phone
Parent/Caregiver 1 - Cell Phone*
Parent/Caregiver 2 - Cell Phone

Academic Accommodation Needs
If your student has an IEP, 504 plan, or Neuropsych report, it is required that we get this information to ensure that we can best meet the needs of each individual student. Please select whether your student has any of the following:

IEP504 PlanNeuropsych ReportAdditional DocumentationN/A
Please upload any additional documentation you'd like to provide so that we can best meet your student's needs.

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Please share any additional information about your student’s learning style, interests, or special circumstances, as well as any suggestions for successful learning strategies that would help us provide the best learning environment for your student.
Behavioral & Disciplinary History

To help us better understand and support each student, please share any relevant history of behavioral or disciplinary concerns your child has experienced in their current or previous school(s). This information will be used to assist us in determining whether we can provide the required support for your child and to allow us to plan appropriate supports and strive to ensure a successful transition.
Has your child had any behavioral or disciplinary incidents, interventions, or support plans (e.g., suspensions, behavior contracts, counseling referrals) in the past? If yes, please describe the circumstances, dates (if known), and any strategies or supports that were effective.

Acknowledgements
Handbook Acknowledgement

Parent Acknowledgement

I have reviewed the current Parent Student Handbook 2025-26 for Tilden Preparatory School and I agree to abide by the rules outlined therein.
Parent Name*
Parent Signature*

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Date*

MonthDayYear
Policies & Fees Acknowledgement

I have reviewed the Policies & Fees Summer 2026 document for Tilden Preparatory School and I agree to abide by the policies outlined therein.
Parent Signature*

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Date*

MonthDayYear
Transcript Release

I hereby authorize Tilden Preparatory School to release my/my child’s transcripts to designated schools or institutions upon my written request. I have read and agree to abide by Tilden's Transcript Policy.
- We require two business days for processing transcripts.
- I understand that 1 courtesy transcript is provided for part-time students, and 5 are provided for full-time graduating eighth or twelfth-grade students. All additional transcripts will be billed at $10/transcript.
- For college applications, transcripts can be sent electronically via Parchment. Tilden can provide official transcripts in sealed envelopes, but they must be addressed and mailed by the family.
- Official transcripts are sent directly from Tilden Preparatory School to middle or high schools upon request.
- We require parents to approve their student's transcript before we send it.
- Questions regarding transcripts can be sent to transcriptswc@tildenprep.com.
Parent Signature*

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Date*

MonthDayYear
Student Signature (if over 18)

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Date

MonthDayYear
Group Classes

Though our instruction is primarily one-to-one, parents may choose to coordinate their own small group classes of up to three students per group. Students should have similar learning styles and paces to progress through the material effectively.

Tilden reserves the right to split up students if the teacher feels that they are not working well together, or if one student is struggling to keep pace with another. All students must follow the same class schedule and must coordinate any planned absences in advance to coincide with each other.
I am interested in a group class and have coordinated with another student or students.
Name(s) of other student(s) in the group:
Vacation and Absences

All student absences are billed at the full session rate. We are not able to make courses inactive to accommodate vacations. If a family chooses to schedule a vacation when a student is actively enrolled in a course, students are welcome to attend classes remotely.

To notify us that a student will be absent, parents/caregivers are required to email the student's teacher(s) and school administration before the start of a scheduled class.

Walnut Creek Campus: studentabsenceswc@tildenprep.com

Student may not cancel their own classes. Email only (not a phone call) from a parent/caregiver is required. To find a teacher's email address, log in to the progress reporting system. For instructions, please consult the current Parent Student Handbook 2025-26.

I understand and agree to the Vacations and Absences Policy.
Signature*

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Date*

MonthDayYear
Tilden Community Mailing List

At Tilden, we are always looking for new ways to build relationships between students, parents/caregivers, and families within our community. We are now offering voluntary participation in a Tilden Community Mailing List, community updates sent regularly via email.

As part of these community updates, you and your student's first names would be shared along with those of other participating Tilden families so that you may connect and continue building relationships both in and outside of school.
I would like to participate in the Tilden Community Mailing List, and agree to have my first name, my student's first name, and my email shared as part of these updates.
Please provide an email address for voluntary participation in the Tilden Community Mailing List:
Transportation Acknowledgement

Walnut Creek Campus: Stopping to drop off a student in the thoroughfare in front of the school is strictly prohibited. All student drop off or pick ups must be at a metered parking spot, parking lot, local parking garage, or library lot.

Payment Information

Your student will only be scheduled after we have received both the completed registration form and your $500 scheduling deposit.
- To make a payment by ACH, please use the following link: WALNUT CREEK ONLINE PAYMENT PORTAL.
- To make a payment by VISA credit card, please call our Walnut Creek office at 925-933-5506. Please note that there is a 3.5% service fee.
How did you submit payment?*

I called in to make a VISA payment.I used the Online Payment Portal to make an ACH/e-check payment.
The last four digits of the transaction number are:*
If you call to pay with a VISA credit card, an admin member can provide the transaction number.

Authorization for Release of Information
I/We, parent/cargiver name(s)* , give permission for the Head(s) of School and Director(s) of Tilden Preparatory School to exchange information regarding student name* with the following persons and/or agencies:
Name, Address, Phone/Fax/Email
Email
I hereby release the above persons and/or agencies from any and all legal liability, which may result from the communication of the information referred to above.
Signature*

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Date*

MonthDayYear
Relationship to Student*
Signature

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Date

MonthDayYear
Relationship to Student

Student Emergency Information Form

Please fill out completely and sign where indicated. In a major emergency, it is school policy to retain students at school for their safety. This form will be used by the school staff when students are released to go home.
Please download and complete the Student Emergency Information Form below.
Please attach your completed Student Emergency Information Form.*

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