Summer Enrollment - Ascent Advantage Academy

Name

Summer Registration

Student Name

Student Address

Date of Birth

Age

Grade

Parent/Guardian

Address

Phone

I, parent/guardian of registered student do hereby enroll him/her in the Ascent Advantage Academy Summer Program.

Registration

By checking this box, I agree to the terms above.

REGISTRATION / ATTENDANCE My student will attend the weeks & times checked below.

Check all that apply

July 29th – August 2nd

August 5th – August 9th

Check Time Attending

1:00-3:30 PM

Check the FOUR Classes Wanted *

Reading Improvement

Writing Lab

Math Fun & Games

Science

Arts & Crafts

Hand Sewing

OR concentrate on a topic by choosing only 2 or 3 of the above.

COST: $75.00 per week, per half day session.

My total cost is:

I agree to pay all fees incurred on or before the first day of instruction. I also agree to fill in the Student Warrant and Medical Release Forms.

Registration

By checking this box, I agree to the terms above.

Student Character Warrant

Parent or Guardian

Student

STUDENT CHARACTER

I, Parent of the above named student, do warrant that heretofore my student has been of good character and that he or she is of no threat to the physical, or mental- emotional safety, morals and well-being of other students, the staff, or the buildings and grounds associated with Ascent Academy.

I warrant that my student is not a user of illegal drugs.
I warrant that my student is not a user of alcoholic beverages.
I warrant that my student is of decent moral character and that he or she dresses modestly and speaks modestly.
I warrant that my student is not violent.
I warrant that my student is not taking any medication which may alter his or her mind, inducing violent or erratic behavior.

I also warrant that he/she lives the standards of the Ascent Advantage Academy as expressed in the pamphlet, “For the Strength of Youth,” published by the Church of JESUS CHRIST of Latter-day Saints.

I also agree to immediately apprise the Academy if any of the above warrants are no longer true and valid.

Should any of my above warrants prove false, I agree to immediately pay damages of $10,000.00 to Beehive LDS Schooling, LLC. These damages are in addition to any others the court may judge I owe to persons or entities involved.

Should the above-named student cause damage to anyone or anything present, I assume full financial responsibility to repair and rectify said damage.

Services

By checking this box, I agree to the terms above.

This contract was signed in the City of St. George, Utah on:

Signed Date *

Emergency Medical Release Form

Name of Student

In the case of an emergency, please contact:

Parent/Guardian Name

Phone Number

Address

If Parents-Guardians cannot be reached:

#1 Parent/Guardian Name

#1 Phone Number

Relationship

#2 Parent/Guardian Name

#2 Phone Number

Relationship

Medical

Doctor

Phone Number

Address

Student Allergies or Special Conditions

We, parents or guardians of the above-named student do hereby grant Ascent Advantage Academy and its agents authority to obtain medical assistance for our child as deemed needful.

check box page 5

By checking this box, I agree to the terms above.

check box page 5

We also agree that he/she may receive a priesthood blessing, if deemed necessary.

Check, if appropriate

This contract was signed in the City of St. George, Utah on:

Signed Date *