Academy for Keener Minds

Application
Registration Forms - PDF Format

_____________________________________________________________________________
Name                                                                             Date of Birth
_____________________________________________________________________________
Street AddressPhone Number
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City, State, Zip                                                                      Social Security Number
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Fathers Name                                                                    Mothers Name
______________________________________________________________________________
Fathers Employer                                                             Employer
______________________________________________________________________________
PositionWork PhonePosition                                                  Work Phone

Parents marital Status:
Married____ Widowed____ Divorced_____Separated____

Please Initial

______I agree to pay a $50.00 registration fee.

______I understand that Registration and testing fees are non-refundable.

______I agree to pay a replacement cost for lost or damaged score keys.

______I agree to pay __________ tuition every month.

______I understand that tuition is due before paces are delivered.

______I agree to attend a Checkpoint meeting once every three weeks.

______I agree to turn in all tests at Checkpoint meetings.

______I understand that tests are graded at Checkpoint meetings only.

______I understand that there will be a $10.00 fee charged on all returned checks.

______I hold a GED or High School Diploma.

I agree to maintain the integrity of the School name by giving my child the opportunity to study, the necessary parental guidance to accomplish deadlines, and the educational support necessary to ensure my child's success. _________ (Initials)

I understand the schools rights to dismiss any child who does not maintain the standards and/or meet the deadlines set forth in the Checkpoint each month. (Initials)________

I understand the schools rights to dismiss any child for non-payment of fees, tuition, bad behavior (as determined by the school), or pace charges. (Initials)________

By signing this page Parent/Guardian agrees to the terms and conditions contained hereon and represents that all information is accurate and correct to the best of their knowledge.

__________________________________
Signature of Father

__________________________________
Signature of Mother