Noto

Enrollment Form

Guardian’s First Name*

Guardian’s Last Name*

Email*

Phone Number*

Adress*

Student First Name*

Student Last Name*

Student Phone Number

Address*

Student’s Date of Birth *

Age*

Grade*

Last School Attended*

Does your child have an IEP/Learning Plan? *

Yes

If yes, explain.

Emergency Contact/Contacts*

Does your student have any allergies/medical conditions? *

Yes

If yes to any allergies/medical conditions, what are they and any medicines that they take daily/for the condition?

In the event of a medical emergency, I authorize Brighter Minds Academy staff to contact emergency services and take necessary steps to ensure my child receives medical care.*

Tuition Payment/Agreement*

Elemetary School - $325/12 months w/$200 registration

Middle School - $350/12 months w/$200 registration

High School $400/12 months w/$200 registration

Other - $280/12 months w/ $200 registration

Payment Policies • Tuition payments are due on the 15th of each month on autopay (unless needing a different date). • Payments 10 days late or more will incur a $50 late fee. • Accounts 25 days past due may result in temporary suspension of services until the balance is resolved. I understand that tuition represents a commitment to the program and agree to follow the payment policies.*

Please select one:*

Yes, I give permission for my child to appear in photos or videos used for school promotion.

No, I do not give permission for my child to appear in photos or videos.

Payment Info*

Signature*

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