Parent/Guardian InformationParent/Guardian 1 Last Name *Parent/Guardian 1 First Name *Parent/Guardian 1 Email Address *Parent/Guardian Phone Number *Parent/Guardian 1 Relationship to Student *Please select an option below.MotherFatherGrandmotherGrandfatherOtherParent/Guardian 1 OccupationSpecial skills or talents the parent/guardian is wiling to share with L.O.L.A.?Do you have additional parents/guardians you would like to add? *Please select an option below.YesNoADDITIONAL PARENT/GUARDIAN INFORMATIONParent/Guardian 2 Last NameParent/Guardian 2 First NameParent/Guardian 2 Email AddressParent/Guardian 2 Phone NumberSTUDENT INFORMATIONStudent Last Name *Student First Name *Student Date of Birth *Student T-Shirt Size *Please select an optionYouth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLProgram(s) Applying For (select all that apply): *LOLA Littles AM Only (2-Day)LOLA Littles Full Day (2-Day)Kinder Prep PM Only (2-Day)Kinder Prep Full Day (2-Day)2-Day University (K - 9th)3rd Day Tuesday Add-OnStudent Mailing Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePlease list any allergies, medical conditions or and/or medication needs below:With whom does the student live? *Mother & FatherMother OnlyFather OnlyMother & StepfatherFather & StepmotherGrandparentsOtherParents are: *Please select an option below.MarriedDivorcedSeparatedWidowedPreferred Name/NicknameGender *Please select an option below.MaleFemalePlease indicate which level your child has mastered: *Please select an option below.Potty Trained & Ready for Pre-KPre-KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeHas your student been professionally tested or evaluated? *Please select an option below.YesNoIf yes, please indicate by whom and what the diagnosis was:Please attach a copy of your student's most recent 504 Plan or IEP for review (if applicable):Choose FileNo file chosenDelete uploaded fileWhat is the primary language spoken at home? *Please provide a brief description of your child's personality and favorite activities: *Please share any student academic or social strengths you would like us to be aware of:Please share any student fear(s), habit(s), or educational challenges that we need to be aware of:Do you have an additional student you would like to add? *Please select an option below.YesNoStudent 2 Last Name *Student 2 First Name *Student 2 Date of Birth *Student 2 T-Shirt Size *Please select an optionYouth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLProgram(s) Applying For: *LOLA LittlesKinder Prep2-Day University3rd Day Tuesday Add-OnStudent 2 Mailing Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePlease list any allergies, medical conditions or and/or medication needs below:With whom does the student live? *Mother & FatherMother OnlyFather OnlyMother & StepfatherFather & StepmotherGrandparentsOtherParents are: *Please select an optionMarriedDivorcedSeparatedWidowedPreferred Name/NicknameGender *Please select an option below.MaleFemalePlease indicate which level your child has mastered: *Please select an option below.Potty Trained & Ready for Pre-KPre-KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeHas your student been professionally tested or evaluated? *Please select an optionYesNoIf yes, please indicate by whom and what the diagnosis was:Please attach a copy of your student's most recent 504 Plan or IEP for review (if applicable):Choose FileNo file chosenDelete uploaded fileWhat is the primary language spoken at home? *Please provide a brief description of your child's personality and favorite activities: *Please share any student academic or social strengths you would like us to be aware of:Please share any student fear(s), habit(s), or educational challenges that we need to be aware of:Do you have an additional student you would like to add? *Please select an optionYesNoStudent 3 Last Name *Student 3 First Name *Student 3 Date of Birth *Student 3 T-Shirt Size *Please select an optionYouth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLProgram(s) Applying For: *LOLA LittlesKinder Prep2-Day University3rd Day Tuesday Add-OnStudent 3 Mailing Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePlease list any allergies, medical conditions or and/or medication needs below:With whom does the student live? *Mother & FatherMother OnlyFather OnlyMother & StepfatherFather & StepmotherGrandparentsOtherParents are: *Please select an optionMarriedDivorcedSeparatedWidowedPreferred Name/NicknameGender *Please select an option below.MaleFemalePlease indicate which level your child has mastered: *Please select an option below.Potty Trained & Ready for Pre-KPre-KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeHas your student been professionally tested or evaluated? *Please select an optionYesNoIf yes, please indicate by whom and what the diagnosis was:Please attach a copy of your student's most recent 504 Plan or IEP for review (if applicable):Choose FileNo file chosenDelete uploaded fileWhat is the primary language spoken at home? *Please provide a brief description of your child's personality and favorite activities: *Please share any student academic or social strengths you would like us to be aware of:Please share any student fear(s), habit(s), or educational challenges that we need to be aware of:Do you have an additional student you would like to add? *Please select an optionYesNoIf you have more than 3 children you would like to apply for, please fill out an additional application.Additional InformationPreferred Hospital (In Case of Emergency): *Emergency Contact Name (First, Last) - other than parents/guardians listed above: *Emergency Contact Phone Number *How did you hear about Lavender Oaks Learning Academy? (please be as specific as possible) *Authorized Pickup Person (First, Last) - other than parents/guardians listed above: *Additional Authorized Pickup Person (First, Last) - other than parents/guardians listed above:Additional Authorized Pickup Person (First, Last) - other than parents/guardians listed above:Please include my child(ren) in the School Directory. *Please select an option below.YesNoIf Yes - Please provide the preferred Student Name(s), Phone Number, Email Address and Mailing Address you would like shared in the school directory.POLICIES & WAIVERSLiability Waiver *LIABILITY WAIVER - I hereby certify that my child(ren) is/are in good physical condition and do/does not suffer from any disability that prevents or limits his/her participation in all activities conducted by Lavender Oaks Learning Academy. I acknowledge that Lavender Oaks Learning Academy will not assume any responsibility or liability for personal injury or damages caused by the injury. I acknowledge that Lavender Oaks Learning Academy is hosted on a farm and the property owner will not assume any responsibility or liability for personal injury or damages caused by the injury. In the event Lavender Oaks Learning Academy is unable to reach a parent, guardian or any emergency contact, I hereby give permission for my child(ren) to be transported to the nearest hospital for treatment in case of an accident or emergency. I hereby further authorize(s) any of the staff or employees to provide for, approve and authorize health care at hospital.PHOTO/MEDIA RELEASE - I hereby grant and authorize undefined the right to take, edit, copy, publish, distribute, and make use of any and all pictures or video taken of my child(ren) to be used in and/or for legally promotional materials and digital communications. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of Lavender Oaks Learning Academy and will not be returned. *I agreeI do not agreeFinancial Committment *FINANCIAL COMMITMENT - Enrollment in Lavender Oaks Learning Academy is a 9 month tuition commitment, with 9 equal payments being due on the 1st of each month (September through May). Tuition Invoices will be sent by email each month and payments may be made by personal check, ACH, or credit card. Monthly tuition and fees collected are non-refundable and non-transferable. Sibling Discount - Families having more than one sibling concurrently enrolled in L.O.L.A., and who keep their account current, will receive a $25/month discount for each additional sibling. Accounts not paid on time, or carrying a balance, are not eligible for this discount. Late Fees - A 10% late fee, calculated based on monthly tuition, will be assessed on the the 5th of each month with a $10 daily accrual for each additional day late. If your account is not in good standing by the last day of the calendar month, your student(s) will not be allowed to attend school again until the account is brought current. Withdrawal - In the event you must withdraw your student(s) from L.O.L.A. a 30-day written notice is required. You will be billed your final tuition on the regular day of the next month, once your 30-day withdrawal notice has been received. All past due and current balances are considered due and payable upon withdrawal. All accounts must be in good standing without a past due balance. Refund Policy - Refunds are ONLY available for tuition that has been paid in full. In order to be eligible for a refund, you must provide written notification to Lavender Oaks Learning Academy requesting to withdraw from the program following our withdrawal policy. Refunds are calculated based on the remaining months left in the school year, minus any prepayment discounts used through the "Withdrawal Date” (which is the last day of the next month after the 30-day notice has been received). Cancellation Policy - We understand plans change. We will gladly issue a refund of the curriculum and supplies portion of any enrollment fees paid for any cancellation requests received more than 30 days before the start of the program. No refunds on cancellation notices received less than 30 days before the first day of the program.Application Fee CheckoutYou must submit your $50 Application Fee to complete your Application.Would you like to take advantage of our Pay In Full or ACH Autopay Discounts? *Please select an option below.Yes, I'd like to Pay In Full and receive 10% off my total annual tuition.Yes, I'd like to enroll in ACH Autopay and receive 5% off my monthly tuition.No thank you.Submit
