Purpose Prep Academy Enrollment Form

Purpose Prep Academy K-8 Enrollment Form

This enrollment contract is between Purpose Prep Academy(hereinafter the “Program”) and the parent(s) or legal guardian(s) (hereinafter referred to as “Parent”) of the student listed in this form (hereinafter “Student”).
Purpose Prep Academy is a STEAM-focused academy that provides a personalized academic experience that helps each child discover their unique talents and passions. We empower learners with the confidence and skills to become 21st-century leaders who drive positive change and shape the future.

Interested in enrolling learner into our program? Please begin the application process by pressing the next button below.

STUDENT INFORMATION

Please fill out this information for your learner. If you are enrolling more than one learner, you will repeat this process for each learner.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Most recent grade/learning year completed*
(e.g. K, 1, 2, etc.)
Current School or Homeschool Program *
Please type the school or homeschool program your learner completed
Learner's Interests*
Please describe interests and/or extracurriculars
Learner's Strengths and Challenges *
Please describe any noted academic strengths and/or challenges
Please Select Your Learner's T-Shirt Size*
Formal IEP or 504 Plan*
Please type "none" if this section is not applicable.
Allergies, Medical Conditions, or Special Diets*
Please type "none" if this section is not applicable.
Health Insurance Information*
In case of emergency, please provide your child's insurance provider/policy number
By checking this box, I authorize the staff of Program who are trained in the basics of first aid/CPR to give my child first aid/CPR when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached and a delay would be dangerous to the health of my child, I hereby authorize the program to transport my child to a medical care facility and to secure necessary medical treatment for my child, including, but not limited to, an epinephrine auto-injection for suspected exposure to a life threatening allergen. **

I have read the above and I agree.

Program Enrollment Selection
Please Select Your Preferred Enrollment Plan *
Please Select Your Preferred Program Type*
Please note: High School Programs are only self-guided with included coaching and/or mentorship. No LIVE classes.
Please Select Your Preferred Payment Plan *
Please Select Your Desired Method of Payment *

Parent/Guardian Information
How many parents/guardians would you like to add to your child's enrollment profile? *
PARENT GUARDIAN 1
Name*

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
PARENT GUARDIAN 2
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
If you would like to authorize your child to be released from Program premises without authorized adult supervision, please select the approved methods of transportation below. Please note that this authorization grants permission for this child to leave Program without adult supervision. If permission is granted, Program is not responsible for your child once they leave the premises.*

My child is authorized to leave the premises without adult supervision.My child is NOT authorized to leave the premises without adult supervision.
Additional Authorized Pickups
If you would like to authorize additional individuals to pick up your child, please list theire name, email, and phone number below. They must show an ID that matches the name on this form. *

Terms and Conditions

TERMS AND CONDITIONSThis Contract is between Purpose Prep Academy(hereinafter the “Program”) and the parent(s) or legal guardian(s) (hereinafter referred to as “Parent,” which term includes the singular or plural, as applicable) of the student listed above (hereinafter “Student”). All persons signing this Contract are jointly and severally liable for the tuition and fees set forth herein. Parent’s signature and/or initials on this Contract evidence Parent’s understanding and agreement to the terms of this Contract, as follows.
HOURS OF OPERATION AND CALENDAR Program is open from 9:30 AM to 3:15 PM, Monday through Thursday, and from 9:30 AM to 2:15 PM on Fridays, consistent with the calendar listed on the Program website. Student is not permitted to remain at Program after closing time. The Program is not responsible for the care or supervision of students beyond program closing time.*
COMMITMENT AT PURPOSE PREP ACADEMY, a semester commitment is required for all enrolled families (each semester). If a student needs to be withdrawn after any semester, for any reason, a written notice must be submitted 30 days prior to the desired withdrawal date. Failure to provide this 30-day written notice will result in parents/guardians being responsible for all remaining tuition installments for that semester. *
REFUNDS Due to the nature of our personalized program, all tuition fees (including registration, curriculum, and monthly payments) are non-refundable. This applies to student absences, withdrawals (initiated by any party), and school closures. Parents/Guardians are responsible for the full month's tuition if their child attends any days in a given month. Families who utilize the one-semester promise option will receive a waiver of the semester commitment, but no refunds of any payments made will be issued.*
LATE PAYMENTS & NONPAYMENT PENALTIES Timely payments are essential for program participation. To ensure smooth operation, a late fee of $50 will be applied to outstanding balances not paid by the 3rd of the month. An additional late fee of $50 will be assessed to any remaining balance after the 10th of the month. If tuition payments are not received by the 10th, your child's enrollment may be suspended until the balance is paid in full. Interest of 10% will accrue monthly on any unpaid balance. During suspension, students cannot attend classes and will not have access to Purpose Prep Academy's learning coaches or curriculum. No refunds or credits will be issued for suspension due to non-payment. After one month of suspension, Purpose Prep Academy reserves the right to terminate enrollment. We may require a credit card to remain on file in the case of consistent late or non-payments. This authorization allows us to process outstanding balances and avoid further disruptions to your child's enrollment. NOTE: Families utilizing scholarship funds must reserve funds by the 25th of the previous month to make sure they are payable by the first month.*
LATE PICK-UP FEES To ensure the smooth operation of our program, we have established policies for late payments, specifically regarding student pick-up. Late pick-up fees should be paid at the end of the week during which the child was picked up late. A late fee of $35 will be applied to any family balance that has not been paid at the end of that week. A $50 fee will be charged for all returned checks due to insufficient funds. For student pick-up, a late fee of $1.00 per minute will be charged for any pick-up occurring after 3:30 PM (Mon, Wed, Thur), 3:00 PM (Fri). If a student remains in our care by 3:45 PM (Mon, Wed, Thur), 3:30 PM (Fri), our staff will call authorized contacts listed on the enrollment form. In the unfortunate event that a child is not picked up by 4:00 PM (Mon, Wed, Fri), 3:45 PM (Fri), and staff cannot reach authorized contacts, the Department of Child Safety will be notified. Consistent late pick-up may result in dismissal from Purpose Prep Academy.*
SUSPENSION AND TERMINATION Purpose Prep Academy reserves the right to suspend or dismiss a student from the program at its sole discretion. This may occur due to student misconduct, inappropriate behavior by a student or family member, violations of Purpose Prep Academy policies, or non-payment of tuition. In the event of involuntary discharge or expulsion, all tuition payments are forfeited. After one month of suspension Purpose Prep Academy has the right to proceed with collection.*
CONSENT FOR OBSERVATION OF STUDENTS Parent understands that from time to time, third parties who are neither Program staff nor parents of other students may visit Program while the Student is there and observe my child, without interacting with Student and without Student being identified to such third parties. Parent understands that there are benefits to allowing such observations. For example, this allows members of the community, such as prospective students and their families, to learn about the program and tour the facility. It also allows the Program to interact with prospective community partners which may provide services to the Program. By signing below, Parent gives general informed consent to allow this type of non-interactive, de-identified observation of the Student.*
AUTHORIZATION By signing below, Parent represents and acknowledges that Parent is/are the parent(s) or legal guardian(s) of the student identified above (“Student”) with legal authority to agree to the terms and conditions of this Authorization. Parent consents to the Student’s participation in the program operated by Program, including his/her/their attendance at Program. To ensure that Program is fully equipped to support Student, Parent agrees to share Student's academic data, including but not limited to: academic programs, curriculum, and gradebooks. Parent authorizes Student's school or academic program to share any academic data with Program.Parent forever releases, acquits, discharges, and covenants to hold harmless Program and its agents, employees, officers, directors, successors, and assigns of and from any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses, and compensation on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which Parent may now have or may hereafter have that result from or relate to the Student’s participation in the Program or engagement in related activities unless such injury, loss, or damage is due to the gross negligence of Program. “Related activities” include but are not limited to activities sponsored by, carried out by, or otherwise involving Program or a related third-party, such as after-hour or weekend program events, field trips, excursions, and community service activities. Notwithstanding anything contained in this Authorization to the contrary, no personal liability shall accrue against any individual officer, director, member, partner, fiduciary, employee, agent or representative of Program, or any heir, personal representative, successor or assign of the foregoing with respect to any matters arising under this Authorization.Parent assumes liability for and shall indemnify and hold harmless Program from and against any and all losses, damages, penalties, liabilities, claims, actions, suits, costs, and expenses, including reasonable attorney’s fees, whether in law or in equity, of any kind or nature whatsoever, imposed upon, incurred by, or asserted against Program in any way directly or indirectly relating to or arising out of any negligent or other wrongful act or omission of the Student. The provisions of this paragraph shall survive the termination of Student’s participation in the Program.In signing this Authorization, Parent acknowledges and represents that Parent has read the foregoing Authorization, understands it, and signs it voluntarily. Parent executes this Authorization for full, adequate, and complete consideration. Parent understands that Parent is permanently giving up rights, including, but not limited to, the right to sue. Parent hereby asserts that participation is voluntary and that Parent knowingly assumes all risks. Parent has carefully read this agreement, has carefully considered it, and attests that Parent fully understands and knowingly and voluntarily accepts its terms in their entirety and without reservation, including the release of all known and unknown claims.*
FERPA RECORD RELEASE By signing below, Parent acknowledge that the Family Educational Rights and Privacy Act (FERPA) affords parents and students who are 18 years of age or older ("eligible students") certain rights with respect to the student's education records. These rights are:The right to provide written consent before the school discloses personally identifiable information (PII) from the student's education records, except to the extent that FERPA authorizes disclosure without consent.One exception, which permits disclosure without consent, is disclosure to school officials with legitimate educational interests. A school official is a person employed by the school as an administrator, supervisor, instructor, or support staff member (including health or medical staff and law enforcement unit personnel) or a person serving on the school board. A school official also may include a volunteer or contractor outside of the school who performs an institutional service of function for which the school would otherwise use its own employees and who is under the direct control of the school with respect to the use and maintenance of PII from education records, such as an attorney, service provider, auditor, medical consultant, or therapist; a parent or student volunteering to serve on an official committee, such as a disciplinary or grievance committee; or a parent, student, or other volunteer assisting another school official in performing his or her tasks. A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibility.*
FAMILY HANDBOOK Please click here to view the Family Handbook. Parent acknowledges that Parent has received, reviewed, understands, and agrees to comply with the policies set forth in the Program's Student & Family Handbook, including, but not limited to, Program’s Code of Conduct. Parent acknowledges that Parent has reviewed Program’s conduct expectations with Student who will be participating in the Program, and that Student understands and agrees to abide by those expectations.
AGREEMENT By signing below, Parent acknowledges that this Agreement/Contract is between Program and the undersigned Parent to enroll Student at Program. The parties agree that this agreement may be electronically signed and agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity and admissibility. After submitting this form, someone from our team will contact you within 3 business days to discuss the next steps. If you have any questions in the meantime, please don't hesitate to contact us at hello@purposeprepacademy.org. Parent/Guardian: Please sign your full name below. *
Type Full Name and Sign Below
Signature*

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After submitting this enrollment form, I understand that I will be redirected to a payment page to submit an enrollment deposit.*

I have read the above and understand that my enrollment form is not considered complete without submitting the enrollment deposit on the next page.

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Application Fee$50.00

This fee is per learner and waived if you have completed an Experience Day.

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Purpose Prep Academy K-8 Enrollment Form

STUDENT INFORMATION

Program Enrollment Selection

Parent/Guardian Information

PARENT GUARDIAN 1

PARENT GUARDIAN 2

Additional Authorized Pickups

Terms and Conditions