Clone of Ayat Academy 2026-2027 Enrollment Form

Ayat Academy High School Enrollment Form

2026-2027
Date

MonthDayYear
Date
CHILD INFORMATION:
Child Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Gender
Class applying for
Grade for 2026-2027
Home School Charter
Does your child have any allergies?
Please list any allergies your child has (food, medication, environmental) and any emergency instructions (e.g., EpiPen, medication, avoidance measures):
Household & Custody Information
Student lives with
Legal Custody Arrangement:
Is there a custody or court order the school should be aware of?
PARENT/GUARDIAN INFORMATION:
Parent/Guardian 1

First NameLast Name
Relationship to Student
Parent/Guardian 1 Phone Number

Area CodePhone Number
Parent/Guardian 1 E-mail
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Employer
Parent/Guardian 2

First NameLast Name
Parent/Guardian 2 Phone Number

Area CodePhone Number
Relationship to Student
Parent/Guardian 2 E-mail
example@example.com
Parent/Guardian 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Occupation
Employer
Emergency Contact
Name

First NameLast Name
Phone Number

Area CodePhone Number
Transportation & Departure Authorization

Student transportation method
How will your student arrive and depart from Ayat Academy?
I give permission for my student to leave campus independently at the end of their session.
I understand that once my child has left the Ayat Academy premises, the academy is no longer responsible for their supervision.
Student Driver Information

Complete this section only if the student drives themselves.
Vehicle Make
Vehicle Model
Vehicle Color
License Plate Number
Driver's License Number
Authorized Pick-Up Person

(List individuals authorized to pick up the student)
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Behavioral & Support Information
Does your child receive counseling or behavioral support?
Are there any behavioral, emotional, or learning concerns Ayat should be aware of?
Media & Technology Consent
I consent to my child being photographed/video recorded for internal school use.
I consent to limited use of photos/videos for school website or social media.
I understand students may use school-approved technology and agree to the Acceptable Use Policy.
Parent / Guardian Agreement
By completing and submitting this form, you are officially registering your child for the 2026/2027 academic year. Please Zelle the required fees to complete registration and hold your child's spot.

Tuition & Fees for the 2026–2027 School Year:

Registration and Supply Fee: $295

Monthly Tuition: $495 (10% monthly discount per sibling)
Tuition Deposit: $990

*The tuition deposit is non-refundable and will cover two months of tuition. It will be applied to the final two months of the school year or to the two months following a withdrawal notice, if applicable. Ayat Academy does not retain this deposit.

Total Due at Registration: $1,285

Pay via Zelle: ayatacademyorg@gmail.com
Signature (Printed Name)
Should be Empty:

Ayat Academy High School Enrollment Form

CHILD INFORMATION:

Household & Custody Information

PARENT/GUARDIAN INFORMATION:

Emergency Contact

Transportation & Departure Authorization

Student Driver Information

Authorized Pick-Up Person

Behavioral & Support Information

Media & Technology Consent

Parent / Guardian Agreement