Enrollment Form

Enrollment Form
ADIRONDACK LEARNING ACADEMY
ENROLLMENT AND PROCEDURE

Participation in Adirondack Learning Academy’s program is conditional pending review of all transcripts and documents from previous schools attended.

Adirondack Learning Academy is a curriculum provider that provides a service to families for maintaining academic records for all students participating in our program. Quarterly grade averages are electronically recorded to their record folders. Transcripts are available upon request.

Students and Parents are encouraged to follow the beginning and end dates for assignments. However, students working ahead to obtain early course credits AND students working at a slower pace for reasons pertaining to ill health or as dictated by the student's Individualized Education Program - may work at a pace that suits their needs. Your program fees allow you to access to the learning management system from September of the year you enrolled through August of the following year. It is the responsibility of the student and/or parent to verify that credits obtained from an online homeschool education are transferable.

Thank you for choosing Adirondack Learning Academy.
Student Name *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Last Grade Completed: Please include recent report card/transcript with application *
Current Grade Student is in: : Please include recent report card/transcript with application *
Student Date of Birth *

Month Day Year
Date
Gender *

Male Female
Parent/Guardian's Name *

First Name Last Name
Home Phone *

Area Code Phone Number
Cell Phone *

Area Code Phone Number
Parent Email *
example@example.com

Special Needs Information

PLEASE READ AND ANSWER THIS SECTION CAREFULLY
Has your child ever been in Special Education *
If yes, when?
Please mark all the programs in which your child has participated in:

RSP (Resource Specialist Program) Physical Handicap SDC (Special Day Class) Gifted/Talented SED (Severely Emotionally Disturbed) 504 (Special Services for Disabilities)
Briefly describe the nature of your student's special needs.

ADIRONDACK LEARNING ACADEMY BILLING POLICY

Parents are responsible for the yearly program fee and registration fee.

The initial licensing fee payment of $250.00 includes database setup fee, transcript review and diagnostic testing to ensure proper path for your child’s education. Licensing fees are paid for each academic year your child participates with Adirondack Learning Academy.

Late Payment Fee: A late payment fee of $25 will be charged on the last day of the month for late payments. If payment is not received by the last day of nthe month, your child will be locked out of the database and unable to complete work until your past due balance has been paid. An invoice with late fee included will be sent with an e-payment link.

There is a 14 day trial period. If you withdraw within 14 days of initial log in to your account, you will receive a full refund minus licensing fee.

In case of withdrawal after the initial trial period, a 30 day notice is required to make student grades and records available. If you have paid in advance, you will receive a refund for full semesters where your child did not attend Adirondack Learning Academy. If they attended any portion of a semester the money will not be returned for that semester. Early withdrawal does not terminate this agreement and payment arrangement. The balance of your tuition per semester is due at the time of withdrawal. The withdrawal must be received in writing to generate grade reports.

Refunds are only allowed within the initial trial period - 14 days after registration. If you choose to terminate your enrollment before the time limit is expired, you must submit your withdrawal in writing to receive a full refund minus the $250.00 setup fee. If conditions are met, your refund will be issued on the 15th of the following month.

I understand that I am responsible for the entire amount of each semester’s tuition. I have read and understand the Adirondack Learning Academy Terms of Service, Payment Policy and Refund Policy. I understand that logging into the Adirondack Learning Academy database constitutes use of their services.
Please indicate your billing preference below *

Please invoice me for the full yearly program fees and the licensing fee in one invoice to be paid in full upon receipt. Please invoice me for my licensing fee and break my program fees into equal monthly payments with monthly invoices due on the 16th of each month.
Person's Responsible for Payment Name

First Name Last Name
Person's Responsible for Payment Email
example@example.com
Signature *

Please sign with your finger or tablet pen if using a touch screen. Use your mouse if using a non-touch screen. Clear
Date *

Month Day Year
Date

Please upload your transcript or report card here.

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Enrollment Form

Special Needs Information