TEC Academy Enrollment

*Student's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

I am this child in the following TEC Academy Programs

TEC Academy (Meets Fridays 9-11)TEC Academy "Arts" (Meets Mondays 9-11)TEC Academy 2 Day Program (Includes both Monday and Friday classes 9-11

*Student's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

I am this child in the following TEC Academy Programs

TEC Academy (Meets Fridays 9-11)TEC Academy "Arts" (Meets Mondays 9-11)TEC Academy 2 Day Program (Includes both Monday and Friday classes 9-11

*Student's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

I am this child in the following TEC Academy Programs

TEC Academy (Meets Fridays 9-11)TEC Academy "Arts" (Meets Mondays 9-11)TEC Academy 2 Day Program (Includes both Monday and Friday classes 9-11

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.

Tell us a little about this student. (Interests, goals, challenges, etc.)

I understand that I am signing up my child/children for a full semester of TEC Academy and am responsible for payment in full of the entire semester, regardless of my child's attendance. I can pay in installments, however payment is due in full before semester's end.

YES

MINOR (CHILD) PHOTO RELEASE I give The Enrichment Collaborative LLC permission to take/use the photographs of my child for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, web content and social media. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by THE ENRICHMENT COLLABORATIVE LLC. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless THE ENRICHMET COLLABORATIVE LLC and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from TEC Academy sessions.

In case of injury to said child, I hereby waive all claims against THE ENRICHMENT COLLABORATIVE LLC including all teachers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature

TEC Academy Registration

Student Information