GBA Registration Form

Great Beginnings Academy of Orlando

Student Registration Form
Student Information
Student Name*

First NameMiddle NameLast NameSuffix
Social Security Number*
Gender*
Date of Birth*

MonthDayYear
Date
Place of Birth*
Race*
Ethnicity
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Applying for Grade Level*

Great Beginnings Academy of Orlando

Student Registration Form
Parent/Guardian 1 Information
Parent/Legal Guardian 1 Name*

PrefixFirst NameMiddle NameLast NameSuffix
Relationship to Student*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Does the student live with you?*

YesNoPart-Time
Employer*

Great Beginnings Academy of Orlando

Student Registration Form
Parent/Guardian 2 Information
Parent/Legal Guardian 2 Name*

PrefixFirst NameMiddle NameLast NameSuffix
Relationship to Student*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Does the student live with you?*

YesNoPart-Time
Employer*

Great Beginnings Academy of Orlando

Student Registration Form
Emergency Contacts

In case of emergency or school closure, please provide us with names, addresses and phone numbers of contacts if the school is unable contact the parents or guardian. The following individuals are also authorized to pick up my child(ren) from Great Beginnings Academy of Orlando without any additional authorizations during the school year. In the event a person not on this list needs to pick up your child on any given day, you must call the school to notify and a picture ID must be shown, prior to the release of the child.
Emergency Contact #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student*
Emergency Contact #2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student
Emergency Contact #3

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student

Great Beginnings Academy of Orlando

Student Registration Form
Academic History

Previous schools student attended
School Name*
Grades Attended*
Has the student been retained in any grade?*

YesNo
If yes, what grade and please explain*
If not applicable, please enter "N/A".
Has the student been suspended and/or expelled*

YesNo
If yes, what grade and please explain*
If not applicable, please enter "N/A".
Do any of the following apply to the student?*

Learning DisabilityPsychological or emotional difficultiesPhysical impairmentRegular medication required for any reasonN/A
If any of the above is checked “Yes”, comment below (if applicable, indicate the name and frequency of medication).*
If not applicable, please enter "N/A".

Document Submission
Please upload the students Birth Certificate, Latest Physical, Immunization Records, and Previous Schools Transcripts if applicable.*

Cancelof

Great Beginnings Academy of Orlando

Student Registration Form
Custody
In rare instances a child may be designated as “Protected” if a court has issued a restraining order under the Child Welfare Act, the Domestic Relations Act, the Divorce Act, or the Young Offenders Act. Please indicate if the school administration should be aware of any such Court Order for the protection of your child. If yes, please make arrangements to discuss this situation with the school administration. Legal documentation will be required.*

YesNo
Media Release
I hereby authorize the picture taking/videotaping of my child

First Name*   Last Name*

and/or the release of his/her name and achievement(s) for educational and bona fide
related purposes, and consent to the showing of these to any persons. I also authorize the use of videotape/pictures and/or other information in printed matter or other media for presentation of Great Beginnings Academy of Orlando without further consent from me. I agree such pictures and others forms of media shall be the property of Great Beginnings Academy of Orlando.

Signature*   Date*

Great Beginnings Academy of Orlando

Student Registration Form
Parent Partnership Agreement
- School Trips
  I give Great Beginnings Academy of Orlando (GBA) permission for my child to take part in all school activities, including bus trips, sporting activities and school sponsored trips away from the school premises.
- Discipline
  I also believe discipline is necessary for the welfare of each student, as well as for the entire school. I give permission for my child’s teacher and/or GBA administration to make and enforce classroom regulations in a manner consistent with schools policies.
- Student Injury
  I further agree to hold GBA harmless of any liability to my child or any guardian or parent thereof because of injury or alleged injury to my child. Should legal actions, for any reason, be taken against GBA or any employee or agent thereof, on my child’s behalf and the school of its agent not be at fault, I agree to pay any attorney fees, court fees, damages, or costs which either GBA or any employee or its agent should incur to defend itself against such action.
- Financial
  I understand the school will not refund any paid registration fees. Should I choose to withdraw my child from GBA during the school year I agree to give at least two-week notice. I further understand students having attended one day or more of any period will owe the full amount for that period. All financial obligations must be met before any records will be released. The Statement of Cooperation will be effective for as long as my child(ren) attend Great Beginnings Academy of Orlando.
Signature*
Date*

MonthDayYear
Date

Great Beginnings Academy of Orlando

Student Registration Form
Tuition and Fees
By signing below, I acknowledge that I have reviewed and understand the tuition and fee schedule for Great Beginnings Academy of Orlando and agree to assume full financial responsibility for all tuition, registration fees, and any additional charges associated with my child’s enrollment. I understand that tuition is assessed on a quarterly basis and represents a financial obligation to the Academy. If my student attends at least one (1) day during any academic quarter, the full quarterly tuition payment is due and non-refundable, and tuition will not be prorated for partial attendance, withdrawal, dismissal, or scholarship changes. If my student is withdrawn prior to the start of a new quarter and does not attend any portion of that quarter, I will not be held responsible for that upcoming quarterly payment. I agree to provide the school with a minimum of two (2) weeks written notice prior to withdrawing my student; however, failure to provide timely notice does not waive financial responsibility if the student attends at least one day of the quarter. I acknowledge that all registration and enrollment fees are non-refundable and non-transferable under any circumstances. If my child participates in a Step Up for Students scholarship program (including FES-EO, FES-UA, HOPE, or any applicable scholarship), I understand that I am responsible for completing and maintaining all scholarship requirements, approving quarterly scholarship payments in a timely manner, and ensuring continued eligibility. I further understand that if scholarship funds are delayed, reduced, denied, or revoked for any reason, I remain fully responsible for any unpaid tuition balance. I acknowledge that failure to remain current on tuition and fees may result in late fees, suspension of services, withholding of report cards or student records, and/or withdrawal from enrollment in accordance with school policy, and I accept full financial responsibility for any outstanding balance owed to Great Beginnings Academy of Orlando.
Tuition Payment Method*
Step Up Award ID*
If applying for a Step Up for Students scholarship, the Award ID will be provided once your application has been approved. If selecting Private Pay (Self-Pay), please write “N/A” in the space above.
Signature*
Date*

MonthDayYear
Date

Great Beginnings Academy of Orlando

Student Registration Form
Authorization

I/We understand and agree admission and continued enrollment are contingent upon adherence to the school's policies and upon payment of tuition and fees when they are due.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Great Beginnings Academy of Orlando

Student Information

Great Beginnings Academy of Orlando

Parent/Guardian 1 Information

Great Beginnings Academy of Orlando

Parent/Guardian 2 Information

Great Beginnings Academy of Orlando

Emergency Contacts

Great Beginnings Academy of Orlando

Academic History

Document Submission

Great Beginnings Academy of Orlando

Custody

Media Release

Great Beginnings Academy of Orlando

Parent Partnership Agreement

Great Beginnings Academy of Orlando

Tuition and Fees

Great Beginnings Academy of Orlando

Authorization