ENROLLMENT FORM

 

TODAY’S DATE________________________________EXPECTED ENROLLMENT DATE_____________________

STUDENT'S LAST NAME____________________________________FIRST________________________M.I.____

HOME ADDRESS_____________________________________________________________________________

CITY________________________________________________________STATE_______ZIP________________

DATE OF BIRTH________________________________PLACE OF BIRTH________________________________

PRIMARY LANGUAGE(S)_______________________________________________________________________

SCHOOL___________________________________________________________________GRADE__________

STUDENT’S INTERESTS_______________________________________________________________________

 

PARENT(S) or GUARDIAN(S) NAME(S)____________________________________________________________

CELL PHONE___________________________________HOME PHONE________________________________

EMAIL_____________________________________________________________________________________

EMERGENCY CONTACT

NAME_____________________________________________________________________________________

RELATIONSHIP_________________________________CELL PHONE__________________________________

 

ANNUAL STUDENT/ NEW ENROLLMENT FEE: $40 cash____ check____

 

LIABILITY WAIVER

By signing this document I (we) agree to the following terms: In case of illness or accident, The Russian-American School is authorized to secure emergency medical treatment at my expense. The Russian-American School reserves the right to dismiss any participant who does not show respect for the facility, including but not limited to: property, equipment, policies, other students and staff. Students who are dismissed will not be given a refund of fees paid. The Russian-American School assumes no responsibility for personal property that is either in or out of classrooms. By signing this Russian-American School Enrollment Form, I (we) hereby waive any and all claims against the Russian-American School. I understand that use of the facilities and equipment at The Russian-American School may involve risk of bodily injury or property damage and I agree to assume any such risks. I understand that it is up to me to consult physicians and other professionals to make sure that the child registered above can safely participate in activities and events at The Russian-American School. I also understand and agree that by signing this Agreement, I am giving up my (or the minor for whom I sign) right to make any claim against The Russian-American School, its employees and volunteers, including the right to sue them, for bodily injury or property damage or any other loss that I might suffer while using the Russian-American School facilities and services, except as limited by law.

 

PHOTOGRAPHY

Occasionally we take photos of class activities and events for our website and parents. Please place your initials if you allow the Russian-American School to place photos of the student, named on this form, on our website.

___The Russian-American School may use the listed student’s photo for website and media purposes.

 

NAME OF PARENT/GUARDIAN

PLEASE PRINT___________________________________________________DATE_______________________

 

SIGNATURE OF PARENT/GUARDIAN_____________________________________________________________