NEWPORT BEACH CAMPUS Custom Schooling Fill out the registration form below and complete your payment to sign up today! Please, contact us if you need help with the application: email@example.com Step 1 of 5 20% Email* How many students will be enrolling?*123456Are You Working With a Charter? If So, which one?* #1 Student Name*#1 Date of Birth* Date Format: MM slash DD slash YYYY #1 Gender*FemaleMale#1 In which grade is your child?TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/AYour child may register for classes outside of their grade level. However, we enroll based on age-based grade level.#1 For which days would you like to register?*M-F unlimitedMonday - Elective DayTuesday & Thursday - Core AcademicsWednesday - Elective DayFriday - Elective Day#1 Allergies*#2 Student Name*#2 Date of Birth* Date Format: MM slash DD slash YYYY #2 Gender*FemaleMale#2 In which grade is your child?TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/AYour child may register for classes outside of their grade level. However, we enroll based on age-based grade level.#2 For which days would you like to register?*M-F unlimitedMonday - Elective DayTuesday & Thursday - Core AcademicsWednesday - Elective DayFriday - Elective Day#2 Allergies*#3 Student Name*#3 Date of Birth* Date Format: MM slash DD slash YYYY #3 Gender*FemaleMale#3 In which grade is your child?TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/AYour child may register for classes outside of their grade level. However, we enroll based on age-based grade level.#3 For which days would you like to register?*M-F unlimitedMonday - Elective DayTuesday & Thursday - Core AcademicsWednesday - Elective DayFriday - Elective Day#3 Allergies*#4 Student Name*#4 Date of Birth* Date Format: MM slash DD slash YYYY #4 Gender*FemaleMale#4 In which grade is your child?TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/AYour child may register for classes outside of their grade level. However, we enroll based on age-based grade level.#4 For which days would you like to register?*M-F unlimitedMonday - Elective DayTuesday & Thursday - Core AcademicsWednesday - Elective DayFriday - Elective Day#4 Allergies*#5 Student Name*#5 Date of Birth* Date Format: MM slash DD slash YYYY #5 Gender*FemaleMale#5 In which grade is your child?TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/AYour child may register for classes outside of their grade level. However, we enroll based on age-based grade level.#5 For which days would you like to register?*M-F unlimitedMonday - Elective DayTuesday & Thursday - Core AcademicsWednesday - Elective DayFriday - Elective Day#5 Allergies*#6 Student Name*#6 Date of Birth* Date Format: MM slash DD slash YYYY #6 Gender*FemaleMale#6 In which grade is your child?TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/AYour child may register for classes outside of their grade level. However, we enroll based on age-based grade level.#6 For which days would you like to register?*M-F unlimitedMonday - Elective DayTuesday & Thursday - Core AcademicsWednesday - Elective DayFriday - Elective Day#6 Allergies*Specific accommodations needed (only for IEP and 504 students): Name of Primary Parent*Please specify any custody arrangements (if applicable). If N/A, please leave blank.Who is the financially responsible parent or guardian?*Please have that person complete the remainder of this application.Email of Primary Parent:* Cell Phone of Primary Parent*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Second ParentEmail of Second Parent: Cell Phone of Second ParentEmergency Contact Name & Relationship to Student*Emergency Contact Phone*By this electronic signature below, I agree to pay the non-refundable registration fee of $395* Seashore Policies and Release Agreement We are so excited to welcome you to our community. Please read through all the policies and sign below to accept all. Your electronic signature is equally binding as a manual signature.Activity Release I acknowledge and agree as follows: 1. Participation in Seashore Academy is voluntary and is a privilege. 2. I release, absolve and hold harmless Seashore Academy, its owner, officers, agents, volunteers or employees from any and all liability for any claim arising out of traveling to/from, participating in, or which is in some manner connected with, the participation of my child(ren) in any Seashore program or affiliate. 3. Students and parents are required to obey all rules and safety requirements, as well as Seashore standards for respect of persons and property. 4. I hereby give my approval for the participation of my child(ren) in any and all Seashore programs. Medical Release In the event of a medical emergency, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of my child(ren). Permission is also granted to Seashore Academy and its affiliates including its owner, teachers, staff and volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility. I understand that Seashore does not have a nurse on site. In the case any special medical needs, such as regular insulin injections, I may make special arrangements with Seashore staff to administer treatment. In the case of allergies, I must train my child to avoid sharing food (Seashore discourages this practice, but we cannot be responsible if a child accepts a food item to which he/she is allergic.) This release is authorized with the purpose of authorizing medical treatment for the protection of my child(ren) in my absence.Photographic Release Seashore Academy often takes photographs or videos of child(ren) during its classes, activities and events. I grant permission without compensation that these photographs or videos may be used in to promote Seashore Academy. Seashore agrees to not identify me or my child(ren) by name, or release any other personal information without additional written permission from me.Transportation Release I realize that I always have the right to drive my own children to/from field trips and/or after-school programs and camps. In the event that I do not pick my child up on time or do not provide my own transportation to an event, I hereby grant permission for Seashore Academy staff, owner, employees and volunteers to transport my child; there will be no charge for this transportation.Financial Agreement Registration Fee, non-refundable I hereby enroll my child(ren) in Seashore Academy. I understand that I am responsible for making payments until any charter funds arrive (if applicable), at which time Seashore will apply these funds to my account, and issue me a refund check for overpayment (if applicable). I agree to pay the tuition and fees as outlined. I understand and acknowledge that Seashore Academy is a learning center of limited enrollment, and that in accepting this enrollment and tuition agreement form together with the non-refundable registration fee, Seashore agrees to provide a place for my child(ren). I understand that a late fee of $100 on any past due balance shall be charged for any payments not made by the 20th of the month due per the designated installment plan. I also understand that the returned check fee is $25 per returned check or failed transaction. I further understand and agree that the registration fee is non-refundable. I understand that Seashore Academy may offer to accept applicable instructional funds on behalf of charter schools for my child(ren), but that I remain financially responsible for all fees if/when charter funds are not successfully obtained for any reason. Once charter funds are deposited by Seashore and there is an overpayment on my account, Seashore will issue a refund. The undersigned parents or guardians hereby agree that Seashore Academy shall at all times have the right with or without cause in its sole discretion to dismiss or expel the above-named student(s) or refuse to enroll such student(s) for any succeeding school year. Should a child be dismissed, I understand that I must continue to pay tuition in full for the remainder of the academic year ending in June 2021. Tuition is due on the first day of each month. No reduction or reimbursement is made for the withdrawal, dismissal, or absence of a student during the term for whatever reason, excepting the death or incapacity of my child(ren). I further specifically agree to waive any claim against Seashore Academy for any losses or damages in any way associated with Seashore’s refusal to enroll the above-named student(s) for any succeeding school year. In the event it becomes necessary to institute legal action to reinforce the terms of this agreement, I agree that the matter shall be determined only by binding arbitration, according to the rules of the American Arbitration Association and, in the event that the school prevails in such action, I will pay the reasonable costs of that action, including reasonable attorneys fees incurred. By my electronic signature(s) at the bottom of this application, I certify that I have read and understood the terms stated in this agreement and its addendum and agree thereto. Any cancellation request must be made in writing to firstname.lastname@example.org. Phone or text requests will not be honored. ZOOM cancellations shall be processed the Saturday following the request. Full time students' cancellation requests will be honored after the 60 day written notice.Termination of Enrollment Seashore Academy reserves the right to accept, deny or terminate enrollment of students solely at its discretion. The following are some (but not all) reasons that Seashore Academy would be inclined to terminate enrollment: delinquent or non-payment of tuition, behavior problems by student, parent, family member or student, or repeated failure to pick up a sick child within an hour of being notified. Parents wishing to withdraw their child(ren) must provide 60 days’ written notification of such, and will be responsible for payment during this period. In the event of a dismissal, all financial obligations must continue to be met for the remainder of the school year. Behavior Policy (Parents & Students) At Seashore Academy, we encourage self-control and personal responsibility through positive reinforcement for good behavior. Out of respect for others, we do not tolerate disruptive behavior. Seashore remains the right to discipline, suspend and/or expel students for behavior problems of the student, his/her parents or family members. The Card Reward/Discipline System Students start each school day with a GREEN card. If a student’s card is turned to YELLOW, he/she sits a time out during the next free play time (recess or lunch). During a timeout, students sit apart from the play area (but still under adult supervision) for a period of time equivalent to the student’s age (a 5 year old student sits a 5 minute time out, 8 year olds sit an 8 minute timeout, etc.) If a student turns their card to RED, another timeout is assigned, and a note is sent home to inform parents about the behavior that prompted turning their card to red. Teachers reserve the right to have a student turn a card directly to red, or contact the parents immediately if a student’s behavior warrants immediate action. The Director reserves the right to assign alternate consequences for behavior if necessary, including suspension or expulsion. Students can also earn a BLUE card for excellent behavior or achievement. Blue cards are rare and greatly celebrated. SCHOOL RULES Follow directions. Treat others with kindness and respect. Keep hands, feet, and objects to yourself. Respect the property of others and share. No toys or balls from home are to be brought to school. No cell phones or electronic devices are to be used during on school grounds or during Seashore program hours for any purpose unless a teacher has specifically assigned this as part of the classroom work. Uniforms are required. (Please see Uniform Policy) Include others Uniform Policy I understand and agree that Seashore students must wear the official Seashore Uniform. The official uniform is available on Land's End, (search for Seashore Academy Uniform) and acceptable substitutes are available from Old Navy School Uniforms, Costco.com and amazon.com. Seashore uniforms consist of solid color red, white and navy blue polo shirts along with khaki or blue pants or skirts. Acceptable sweaters, fleeces and jackets must be free of any logos except for the Seashore logo. The goal of the uniform policy is to keep students focused on academic development. Please keep socks, shoes and accessories simple and free of lights or logos. Socks and shoes must be worn every day. Sandals, heels, as well as shoes with sounds or wheels are not permitted. Should an item of clothing or accessory be deemed inappropriate or distracting, the student will be given a written warning and the parents notified. Please purchase clothes from: the Lands End Seashore Catalog or Old Navy Uniform Store. Parent Communication Parent-teacher conferences may be scheduled in October and in March. If you wish to speak with your child’s teacher, please make an appointment with the Director via email. Our teachers are busy supervising the safety of many children and families during instructional time as well as before and after school. Dedicated time to address questions and concerns allows for more thoughtful communication between families and school staff. Parents and extended family members are welcome to observe classes. To minimize distractions, we do not allow younger siblings into the classroom. Observations need to be scheduled via email with 48 hours' notice, at a mutually convenient time, be limited to 20 minutes in duration, not more than twice per month. Parental volunteers are not permitted to be in the classroom. To protect the privacy of the school community, video recording of students is not permitted except during formal presentations. Please refrain from taking photos of children who are not your own. Posting photos of other children on social media is strictly forbidden. Pick Up Policy If someone other than the legal parents are to pick up a student, notification must be given via email 24 hours prior. In addition, all drivers need to present a government ID to staff. If any student is not picked up at the end of the school day, the student will be transported to the after-school program. There is no charge for the transportation, but the family will be billed twice the amount typically charged for drop-in after-school participation. If a child is not picked up at the end of the after-school program, there will be a 10 min. grace period and a $1/min charge thereafter. Please be sure that your security code word (that you created at the time of registration) is shared with anybody authorized to pick up your child, including your spouse.What is your family security code? (This will be kept confidential)*Food Policy Students shall pack a healthy snack and lunch each day. Seashore Academy is a nut-free school, and while at Temple Bat Yahm, we ask that children abstain from consuming pork. We discourage children from sharing food. If parents wish to bring class treats for their child's birthday, we encourage non-food options such balloons, stickers, or pencils. If food treats for the class are brought, they must be distributed at the end of the school day outside the temple gates at pick up time. Signature*By signing below, you acknowledge that you have read, understood and agree to all of the policies, releases and the financial agreement. Your electronic signature below will have the same effect and be as equally binding as a manual signature. You are also agreeing to be responsible for all aspects of the above policies for the child(ren), if enrolled, including tuition payments. Registration Fee* Price: $395.00 This is a one-time paymentPay with your credit card (Stripe)* Card Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.