Student Enrollment Form

Peace Academy

Student Enrollment Form (2024 - 2025)

PEACE ACADEMY

Fully Accredited Private School

Enrollment Checklist

New Student

Returning Student

Birth Certificate

Application Checked

Enrollment Checklist

Immunization Record

Previous School Record

Vission & Hearing Assessment (within past 12 months)

Student Information

Student's Name

Student's Social Security Number

Student's Phone

Date of Birth

Grade (To Enter)

Sex

Male

Female

Hispanic Latin

Yes

Family Contact Information

First Parent / Guardian Name

Phone

Home Address

Second Parent / Guardian Name

Phone

Home Address

Family Work Information

*The following information is being collected to facilitate career, speaking, and mentoring opportunities for students.

Employer (First Parent / Guardian)

Occupation

Highest Degree

Please contact me as a resource for Career Planning

Employer (Second Parent / Guardian)

Occupation

Highest Degree

Please contact me as a resource for Career Planning

Emergency Contact

Name

Relationship to Student

Phone

Can Student Leave School with this contact?

Yes

Name

Relationship to Student

Phone

Can Student Leave School with this contact?

Yes

Medical Information

Food / Substance Allergies

Preferred Hosipital

Child's Doctor

Doctor's Phone

Acknowledgements

I acknowledge that unless I submit a written statement to the contrary, Peace Academy has my consent and support for the following statements:

Peace Academy may provide general first aid and administer over-the-counter medicine when my child(ren) experience nose bleeds, headaches, stomach aches, flu-like symptoms, etc.
Peace Academy may transport and supervise my child(ren) on all field trips off the school campus.
Peace Academy may capture video and still photography, showcase student achievements, and feature live performances throughout the academic year, sharing these promotional activities on its website and social media platforms.
My child(ren) will only be permitted to walk home or be released to the care of their sibling under the age of 18 years after I/we have submitted a written request and received approval from the Peace Academy administration.
My child(ren) may participate in water activities such as: sprinklers, water balloons, splash pools, etc.
My email may be added to the Parent-Teacher Organization (PTO)’s mailing list.

I acknowledge that I have read and understood Peace Academy Parent/Guardian Student Handbook and Student Code of Conduct (available for view at patulsa.org).View Code of Conduct

All rules and regulations included in this handbook and student code of conduct are subject to the interpretation of the Administration. I also reviewed all school rules with our child (ren). I agree to abide by the provisions/rules included in the Parent Handbook and Student Code of Conduct. I agree to comply with school policies and procedures as may be amended from time to time.
Tuition, Registration, and Other Dues: Tuition/Registration is based on a “full school year contract” and is due in full when a student is first enrolled. However, Peace Academy provides the convenience of 10 monthly payments. Parents are responsible for the entire tuition/registration per child. Also, when a child is enrolled at Peace Academy, it is considered a full school year commitment. Registration and tuition costs do NOT include cost of breakfast, lunch, special activities, supplies, field-trips, uniforms, etc.
I agree and commit to make prompt payments as stipulated in the “Fees Schedule” with applicable penalties for late payments.
Monthly payments are due by the 5th day of each month; a penalty fee of $40 will be assessed after the 9th day of the month for non-payment. There will be a minimum $40 charge for any check returned (insufficient funds, account closed, etc.).
I further understand that my child(ren) may not be allowed to attend class due to delinquent payments at the discretion of the school administration. All new students are on probation for first four months.

To the best of my ability, I/we have provided accurate and truthful information on this application for admission.

I understand that incorrect and incomplete information and late or non-payment of fees and /or tuition may result in delays and possible declination of admission. For your application to be accepted, all past due balances must be paid in full and all Registration Fees must be submitted by the deadline. The Registration Fees are non-refundable. I agree and commit to making timely prompt payments as stipulated in the fee schedule.

Your Signature

Today's Date

Thanks for registering!

|

Student Enrollment Form