Admissions and Enrollment Form

Admissions and Enrollment Form
Before submitting this admission and enrollment form, please be sure to familiarize yourself with the tuition information.

Real Life Agile Learning Center is solely supported through the tuition paid by its families. In determining our tuition process, we’ve focused on a few important ideas — trust, access, and responsibility. The culture of an ALC is rooted in trust. We are committed to developing relationships of trust with students, among the facilitators, and certainly with our families.

Real Life Agile Learning Center seeks to be available to people based on right fit, not income level, so we offer reasonable tuition fees in the form of a membership. We are always reviewing our tuition process to make sure we’re being responsible to our current enrolled families and to the future health of the school. Our flexible approach and accessibility can be expanded by generous donations from various individuals and organizations. If you would like to make a tax-deductible donation to Real Life Agile Learning Center, you can use PayPal or send us a check. Thank you! :)
How many students will be attending?*
i.e. 2 (If there are more than 5, please let us know in the comments at the end of the form.)
Student 1
Student 1 Name*

First NameLast Name
Student 1 Birth Date*

MonthDayYear
Date
Student 1 Grade in school*

Student Information
Student 2
Student 2 Name*

First NameLast Name
Student 2 Birth Date*

MonthDayYear
Date
Student 2 Grade in school*
Student 3
Student 3 Name*

First NameLast Name
Student 3 Birth Date*

MonthDayYear
Date
Student 3 Grade in school*
Student 4
Student 4 Name*

First NameLast Name
Student 4 Birth Date*

MonthDayYear
Date
Student 4 Grade in school*
Student 5
Student 5 Name*

First NameLast Name
Student 5 Birth Date*

MonthDayYear
Date
Student 5 Grade in school*

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Parent or Guardian Info
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Confirm Email*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
The Basics
How did you hear about us?*
Records Request/Enrollment Confirmation
When you withdraw your child from their previous school, they may require an enrollment confirmation/records request from Real Life ALC. Please include the name of the previous school and their address or email here.
Records Request/Enrollment Confirmation
What attracts you most to the Agile Learning Center?
We require a paid trial week for new students to ensure mutual compatibility. Please enter a week that works for you and your child.

MonthDayYear
Date
Agreement to pay trial week tuition
Tuition for a trial week will be charged according to your stated tuition.
I agree and will pay a week's tuition for my child at the beginning of the trial week.*

I agree and will pay a week's tuition for my child at the beginning of the trial week.I require the drop-in option, and agree to pay for a trial drop-in.
Student Agreement

These questions are to be answered by the student. (It's fine for the parent to type or enter the information for younger students, but the answers should come from them.)
An ALC is an environment where students of every age are free to direct their own learning and activities, yet this freedom comes with responsibilities. I understand that I am expected to: 1) Treat others with respect (whether student, volunteer, staff or parent), 2) Behave appropriately for a shared space such that I don't interfere or disrupt others' learning activities, 3) Participate in making, honoring and enforcing agreements and structures of the community, and 4) Help solve conflicts when they arise.
I understand and agree to these responsibilities.*

I understand and agree to these responsibilities.I don't understand or don't agree to these responsibilities.
Parent Questionnaire
Philosophy Agreement

I understand that the ALC provides a real-world learning environment for students to develop self-direction, self-motivation and self-knowledge and as such never requires students to attend specific classes or produce specific work. The school will support students' requests for learning, but does not direct learning activities according to any curriculum. The School Meeting may make certain activities mandatory for the smooth operation of the school. Currently these are: morning meetings, end of day meetings, clean-up, fire drills, change-up meetings, and appearing when a complaint has been filed. Beyond these, the choices are up to each child.
Philosophy Agreement:*

I understand, support and agree to this philosophy & extent of freedomI do not agree with this approach to learning
Tell us about your child. Personality? Challenges? Interests?
Why do you think ALC will be a good fit for your child's learning needs?
Describe your child's prior schooling. Please include names/dates/schools attended/reason for leaving.
Emergency Contact and Medical Information

Please enter contact information for person to alert in case of an emergency.
Emergency Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship*
Please list any food allergies, medication allergies, and/or medical conditions that we should be aware of. If none, please enter N/A.*
Releases
Medical Release

As the legal guardian, I give consent to Real Life ALC to provide all emergency medical and dental care prescribed by a licensed physician (M.D.), Osteopath (D.O.), or Dentist (D.D.S.) required to treat any conditions that are necessary to preserve life, limb and wellbeing of dependent.
Medical Release*

I agreeI disagree
Photo Release

Please be advised that your child's photograph or video may be taken at various school functions events, and for our yearbook. Do we have your permission to post these pictures on our website, social media sites, and/or printed promotional materials?
Photo Release*

YesNoOther
Off-Campus Release

I understand that my child may have opportunities to walk to close-by places, such as the park or to stores. BY CLICKING "I AGREE" ON THIS FORM I AM AUTHORIZING A MINOR STUDENT TO EXIT THE SCHOOL WITHOUT REAL LIFE ALC STAFF SUPERVISION. Real Life ALC will require participants to follow Off-Campus sign‐out and sign‐in procedures, but will not monitor a participant’s whereabouts after they leave the property. The decision to agree to this Off-Campus Release is solely a parental decision. Students who do NOT have parental permission to leave the campus will not be allowed to do so unless supervised by a Real Life ALC staff member, or unless signed out by an authorized adult (see Authorized Adults Release). Real Life ALC planned activities/outings will be chaperoned by Real Life ALC staff and will not require an Off-Campus Release (see field trip release). I allow our (my) child to leave the campus and accept responsibility for and hereby waive, release, and discharge Real Life ALC and its officers, directors, members, agents, representatives and employees from any claim, demand, or cause of action arising out of or in connection with any incident that may occur while he/she is away from the supervision of Real Life ALC staff. We (I) understand that Real Life ALC cannot monitor where students go when given this privilege. We (I) also agree to indemnify and save harmless Real Life ALC and its officers, directors, members, agents, representatives and employees from all claims for loss, damage, or injury sustained by us (me) or by our (my) child whether the same be caused by the negligence of Real Life ALC and its officers, directors, members, agents, representatives, or employees, or otherwise. I grant Campus exit privileges.
Off-Campus Release:*

I AgreeI do not give my child permission to go off campus without supervision, and my child agrees and will not go off campus without supervision.I have two or more children, and have different agreements with each.Other
Please explain your Off-campus agreements:
We Recommend: Teaching Children to Walk Safely as They Grow and Develop: A guide for parents and caregivers
Trampoline Waiver
I give my child permission to play on the trampoline at Real Life ALC. I acknowledge that use of a trampoline can be dangerous and may result in serious injury. I assume full liability for any accidents involving my child on the trampoline.
Trampoline Waiver:*

I AgreeI do not give my child permission to use trampoline, my child agrees and will not go on trampoline.
Pool and Sunscreen Waiver
I give my child permission to swim in the pool at Real Life ALC, with the understanding that they will alert an adult to be present while he/she is doing so. I acknowledge that swimming can be dangerous and may result in serious injury. My child is aware that failure to follow policies will result in the loss of pool use privileges, with reinstatement of privileges at the sole discretion of Real Life ALC. I grant my child my permission to participate in pool use. I understand the Pool Rules [alert an adult to be present, no pushing, and no running] and have explained them to my child. During outside activities, there is potential for sunburns. I will provide a bottle of sunscreen with my child/ren's name on it, swimming suit, and towel. (Hats and water are also recommended, however Real Life does have filtered ice water.)
Pool and Sunscreen Waiver:*

I AgreeI do not give my child permission to use the pool, my child agrees and will not go in the pool.
Enrollment and Tuition
Real Life is currently accepting students on a membership basis. Tuition is due by the 5th of each month. We ask that whatever amount you enter below, you commit to pay that amount each month. What monthly tuition amount can you commit to for each child you are enrolling?
I can commit to*

Part-time membership at $100 per month/200 per family (covers 4 days per month, additional days are $25 each.)Full-time membership at $400 per month/500 per familyI need financial assistanceOther
I can commit to paying this amount per month (please enter what you can comfortably pay each month):*
Real Life ALC has rolling admissions. What is your desired enrollment date?

MonthDayYear
Date
If you are choosing a part-time membership, please pick the days of the week you'd ideally like. Keep in mind that consistency and constancy both provide the best agile learning experience for your child. It is difficult for friendships, projects, and culture to develop at the school when a child does not have a consistent schedule.
Half day or full day?

Half Day AMHalf Day PMFull Day
Which days?

MondayTuesdayWednesdayThursdayFridayDrop-in/variable
Tuition Agreement

Tuition is due on the 1st of each month. There is a 10% discount If you pay for a full semester, and a 20% discount if you pay for a full year. If you choose to pay month to month, you will be required to pay your first and last month's tuition installments upon admission. Please see "Tuition" on the "Admissions Information" tab.
Tuition schedule

I will pay at the beginning of each month, and I will remit my first and last month's tuition.I will pay at the beginning of each semester, with a discount of 10%.I will pay at the beginning of each year, with a discount of 20%.Other
Before and After Care

Before/Aftercare is $6 per hour per child. Payment for Before/Aftercare is due on the Friday of each week to pay for days attended during that week. Before/Aftercare can be used at anytime.
Will you require before or after care? This is available for an additional fee of $6/hr per child.

Before (8am to 10am)After (4pm to 6pm)
Before/Aftercare payment

I will pay for the days attended during the week each Friday.I do not need before or after care.
Financial Assistance

ALC is funded by tuition. The current full time tuition is described on the "Tuition" page under the "Admissions Information" tab. Financial assistance and scholarships may be available in the form of tuition adjustments (sliding scale) and through McKay Scholarship Program, Florida Tax Credit Scholarship, Gardiner Program, and others.
Agreement:

I am paying the full tuition and NOT applying for financial aid.I would like to apply for financial aid.I am an unschooler/homeschooler and interested in exploring my options.I am paying what is comfortable for my familyOther
If you intend to enroll your student full-time you agree to submit all required documents (see below).
(1) This Information Sheet (Done when clicking submit online).

(2) Birth Certificate -- a copy.

(3) Health Exam (Form DH 3040) -- must be current information (no more than 1 yr old). Please Note: If your religious convictions conflict with requirement (3a) you may submit a letter taking an exemption from this requirement.

(4) Immunization Record (Form DH 680) -- must be current information (no more than one year old). Please Note: If your religious convictions conflict with requirement (4a) you may submit Form DH 681 (Religious Exemption from Immunizations Form). You may obtain this form from your local health department.

Rule 64D-3.046 Florida Administrative Code: https://www.flrules.org/gateway/ruleno.asp?id=64D-3.046

KEEP COPIES FOR YOUR RECORDS
Agreement*

I AgreeI am not enrolling my student full-timeI am enrolling as a homeschooler and do not require these forms
What tuition rate will you need?
Have you discussed tuition with the school yet?*

Yes, and I know what I will pay.Yes, and we're still working out the amount.Not yet.
If so, what tuition did you agree to pay/can you pay?
Do you have any questions or comments for us?
Parent/Guardian participation:

We encourage and request parent participation in certain aspects of running the school. Please select which of the following ways you may be willing to help out (to be confirmed with director). This section is required if you are requesting financial assistance.
I can offer (select all that apply):

Facilitation on-siteSpace for community gatheringsClass/activity offering(s)Leading or participating in a committeeDoing social mediaRecruitment for the schoolChaperoning field tripsProviding transportation for field trips and outings
Should be Empty:

Admissions and Enrollment Form

Student 1

Student 2

Student 3

Student 4

Student 5

Parent or Guardian Info

The Basics

Student Agreement

Parent Questionnaire

Emergency Contact and Medical Information

Releases

Enrollment and Tuition

Tuition Agreement

Before and After Care

Financial Assistance

If you intend to enroll your student full-time you agree to submit all required documents (see below).

Parent/Guardian participation: