Second Form: Enrollment Application 2019-2020

Exceptional Village Academy

Application Form 2025 - 2026
Student Information
Student First name*
Student Middle
Student Last name*
Male or female?*

FemaleMale
Date of Birth *

MonthDayYear
Date
Student's Age*
What grade will the student be in for the 2025 - 2026 school year?*
Local Pubic School District where student resides (GA Residents only) all other states type N/A*
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the student immunized?*

YesNoOut of date immunizations
Student Email (Must be different than parent email)*

Confirmation Emailexample@example.com
What are the students hobbies and interests?*
Please provide us with any other information about the student that you feel is important for us to know:
Why do you want to be a part of Exceptional Village Academy? (Please have the student answer this question)*

Parent/Guardian Information

Please enter the student information again for all parent guardian information if you are, or will be over 18 by the first day of classes and will be overseeing your own education and tuition payments.
Primary Parent / Guardian (Invoiced Parent)
Parent First Name*
Parent Last Name*
Parent Relationship to child*
Parent Street Address*
Parent City*
Parent State*
Parent Zip code*
Parent Cell Phone*
Parent E-mail address*
Second Parent Guardian to receive information about child

First NameLast Name
Second Parent Cell Phone Number

Area CodePhone Number
Second Parent Email
example@example.com

Tuition Information
Tuition fees for 2025 -2026 are:

One child - $85 per week

Two children - $65 per week per child if two students are enrolled from the same household.

Three children or more - $50 per week per child if three or more students are enrolled from the same household.

Tuition is billed weekly via emailed invoice on Tuesdays before the upcoming school week and is payable upon receipt. All invoices must be paid to gain entrance in class or to receive assignments.
Tuition Policy NoticeIf my child is accepted and I choose to enroll him/her at Exceptional Village Academy, I understand that all tuition payments will be non-refundable, even in cases of absence or withdrawal for any reason. I also understand that families are required to provide at least 30 days’ written notice if a student needs to withdraw from the school.*

I agree
Upon acceptance and enrollment to Exceptional Village Academy, the undersigned agrees that Exceptional Village Academy has the right to exclude from school any student who is deemed, in the sole and exclusive discretion of the Administration, to be interfering with the health, safety, or educational development of himself or herself or of any other student(s) attending the school. By clicking "Accept," both parent(s)/guardian(s) and student agree to adhere to all policies, rules, and regulations of the school, from time to time established.*

Accept
Tuition Agreement 2025-2026
By clicking "Accept", you are acknowledging that you have carefully read this Tuition Agreement, and in full understanding, accept and agree to the terms as stated.*

Accept
Agree and Submit
By completing the following information, you are digitally signing that you have filled out this form and agree to any and all aforementioned financial and educational policies of Exceptional Village Academy.*

I agree
Name of person completing this form:*
Signature of person completing this form.*

Clear
Todays Date*

MonthDayYear
Date
Should be Empty:

Exceptional Village Academy