Heart Academy 2010-2011
Student: _______________________________________ Date of Birth: ____/____/____
Address: ________________________________________________________________________
City: _______________________________ State: ______ Zip: ____________
Parents’ (or Guardians’) names: ________________________________________________________
Home phone: (____)____________ Email address: _______________________________
Dad’s cell/daytime #: (___ )__________ Mom’s cell/daytime #: (___ )__________
Heart Academy’s Discipline Plan is as follows: 1st Offense: Teacher(s) will contact the parent. 2nd Offense: Parent will come to Heart Academy for a conference & will sit with the child in class(es) the next Wednesday that the child attends Heart Academy. 3rd Offense: Child is dismissed from Heart Academy. I have read & understand Heart Academy’s discipline policy: Parent’s signature: __________________ Student’s signature: ___________________
($40+_____) Facility fee (per family) & $20 Administration fee per student total $_______________
($20 supply fee) General Music Class (ages & up) 9:00 Monthly tuition=$20
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($20 supply fee) Middle / High Science Fair (Grades 6-12) 10:00 Monthly tuition=$15
($20 supply fee) Intermediate Band (by audition) 10:00 Monthly tuition=$15
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($20 supply fee) Elementary Science Fair (Grades K-5) 11:00 Monthly tuition=$15
($10 supply fee) Journalism / Public Speaking (Grades 9-12) 11:00 Monthly tuition=$10
($10 supply fee) American History (Grades 6-9) 11:00 Monthly tuition=$10
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($20 supply fee) Drum Corps (11á) 12:30 Monthly tuition=$15
($25 supply fee) SAT/ACT Preparation Class (Grades 10 – 12) 12:30 Monthly tuition=$15
($15 supply fee) Elementary Art (ages 6-14) 12:30 Monthly tuition=$15
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($15 supply fee) High School Art 1:30 Monthly tuition=$15
($20 supply fee) Elementary Drama (Grade 1-5) 1:30 Monthly tuition=$20
($20 supply fee) Elementary US Geography (Grades 3-8) 2:30 Monthly tuition=$10
($35 supply fee) High School Drama 2:30-4:00 Monthly tuition=$20
Signed Medical Release Form Total: $ ____