TRUE NORTH HYBRID ACADEMY ENROLLMENT FORM Please enable JavaScript in your browser to complete this form. – Step 1 of 5 Learner's Information Learner's Name * Preferred Name Date of Birth * Grade * Address * Address Line 1 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState Zip Code Parent/Guardian Name * Phone Number * Email * Alt. Phone Number Emergency Contact Name Relationship *ParentGrandparentAunt/UncleSiblingOther FamilyFriend Phone Number Next Additional Information Is this learner currently enrolled in a charter school? Yes No Do you plan to use charter funds from this charter for tuition? Yes No Please note that charters will not cover registration fees Charter Fund Disclaimer Any fees not covered by the charter are the family’s financial responsibility. Enrollment in the program is a commitment, and as such, we ask that students not discontinue attendance solely due to insufficient charter funds. If unexpected circumstances arise, we are happy to work with families to explore payment plans or potential scholarship opportunities to ensure continued participation. Note: It is the family’s responsibility to communicate with their charter school and confirm funding approval before enrollment. Please sign below if you understand and agree. Signature Clear Signature Charter Name *Choose one…Heartland Charter SchoolMonarch River/Yosemite ValleyERCLC – Main Program (Charter funds not available in this program)ERCLC – Vendor ProgramOther Are there any traditional holidays, celebrations, etc., that your family is opposed to participating in? * Yes No Please explain further: * Does the learner have any allergies or food restrictions? * Yes No Please tell us more about the allergy/ies. What type of reaction do they have (if any)? (ie. itching, swelling, behavior changes, intestinal distress, anaphylaxis, etc.) * Does the learner have any other medical issues or learning/social differences that we should be aware of? * Yes No Please explain further: * What are your child's goals for their time at True North? * What are your primary goals for your child while attending True North? Program Policy Agreements COMMITMENT True North – Wild Hearts Adventure Co. has a one-semester commitment. After the one-semester commitment, the Parent may withdraw the Student from the program at any time, for any reason, with thirty (30) days’ written notice. Notice may be given through email or withdrawal form submission only. Text message, social media message, verbal notice, etc. is not accepted. Parent will remain responsible for any tuition amounts due prior to and during the thirty (30) day period regardless of Student attendance. I understand and agree I do not agree PAYMENTS Tuition is annual and may be paid upfront (totaling $3,000) or split into 9 equal monthly payments (equal to $325/mo) to be billed from September through May in addition to a $75 initial deposit due upon registering. Parents are charged the annual or monthly payment fee regardless of Student attendance. As such, no credits, discounts, makeup days, or refunds are provided for sick days, vacation days, calendar holidays, professional development days, half-days, or other missed days. Monthly tuition is due on the last day of the month prior to the month of attendance. If payments are not received by the 10th of the month, a $30 late fee will be added to the invoice. I understand and agree I do not agree CHARTER FUNDS Families electing to use charter school funds for tuition are solely responsible for ensuring that their charter school will cover the full cost of participation. Any portion of tuition or fees not covered by the charter remains the financial obligation of the enrolling family. Enrollment constitutes a commitment to the program, and as such, we ask that learners do not plan to withdraw solely due to lack of charter funds. Withdrawal due to insufficient charter funding does not relieve the family of their financial responsibility. If unforeseen circumstances arise, the program may, at its sole discretion, offer payment plan arrangements or scholarship opportunities; however, such accommodations are not guaranteed. It is the responsibility of the enrolling family to verify funding availability with their charter school prior to enrollment. Failure to secure sufficient funding does not exempt the family from tuition obligations. I understand and agree I do not agree SUSPENSION AND TERMINATION We reserve the right to suspend or terminate any student from the program, at our sole discretion. Some reasons a student may be discharged include misconduct, inappropriate behavior by either the student or a family member, any behavior by either the student or family that violates any True North – Wild Hearts Adventure Co. policy, and non-payment. Should a student be involuntarily discharged or expelled from the program, the family forfeits all payments for tuition. Field #105 (copy) * I understand and agree I do not agree AGREEMENT By signing below, Parent acknowledges that this Agreement is between True North – Wild Hearts Adventure Co. and the undersigned Parent to enroll Student at True North – Wild Hearts Adventure Co.. Signature * Clear Signature Date * Next Release of Liability Student Name * Parent/Guardian Name * By signing below, Parent represents and acknowledges that Parent is the parent or legal guardian of the student identified above (“Student”) with legal authority to agree to the terms and conditions of this Authorization. Parent consents to the Student’s participation in the program operated by True North – Wild Hearts Adventure Co., including their attendance at True North – Wild Hearts Adventure Co.. Parent forever releases, acquits, discharges, and covenants to hold harmless True North – Wild Hearts Adventure Co. and its agents, employees, officers, directors, successors, and assigns of and from any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses, and compensation on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which Parent may now have or may hereafter have that result from or relate to the Student’s participation in the Program or engagement in related activities unless such injury, loss, or damage is due to the gross negligence of True North – Wild Hearts Adventure Co. “Related activities” include but are not limited to activities sponsored by, carried out by, or otherwise involving Program or a related third-party, such as after-hour or weekend program events, field trips, excursions, and community service activities. Notwithstanding anything contained in this Authorization to the contrary, no personal liability shall accrue against any individual officer, director, member, partner, fiduciary, employee, agent or representative of True North – Wild Hearts Adventure Co., or any heir, personal representative, successor or assign of the foregoing with respect to any matters arising under this Authorization. Parent assumes liability for and shall indemnify and hold harmless True North – Wild Hearts Adventure Co. from and against any and all losses, damages, penalties, liabilities, claims, actions, suits, costs, and expenses, including reasonable attorney’s fees, whether in law or in equity, of any kind or nature whatsoever, imposed upon, incurred by, or asserted against True North – Wild Hearts Adventure Co. in any way directly or indirectly relating to or arising out of any negligent or other wrongful act or omission of the Student. The provisions of this paragraph shall survive the termination of Student’s participation in the Program. In signing this Authorization, Parent acknowledges and represents that Parent has read the foregoing Authorization, understands it, and signs it voluntarily. Parent executes this Authorization for full, adequate, and complete consideration. Parent understands that Parent is permanently giving up the right to sue. Parent hereby asserts that participation is voluntary and that Parent knowingly assumes all risks. Parent has carefully read this agreement, has carefully considered it, and attests that Parent fully understands and knowingly and voluntarily accepts its terms in their entirety and without reservation, including the release of all known and unknown claims. Signature * Clear Signature Date * Next Medical Emergency I, * Parent/Guardian Name on behalf of my child, * Child’s Name authorize the staff of True North – Wild Hearts Adventure Co. who are trained in the basics of first aid/CPR to give my child first aid/CPR when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached and a delay would be dangerous to the health of my child, I hereby authorize the program to transport my child to a medical care facility and to secure necessary medical treatment for my child. Signature * Clear Signature Date * Next Media Release I hereby give my consent for photographs, audio recordings, academic work, and/or video recordings taken of my minor child(ren) by True North – Wild Hearts Adventure Co. staff or designee, during the course of classes or other True North – Wild Hearts Adventure Co. events, to be used to share in social media posting and for other promotional purposes to be determined by True North – Wild Hearts Adventure Co.. Media Consent * Yes, I give my consent. No, I do not give my consent. Parent/Guardian Signature * Clear Signature Date * Previous Submit
