Enrollment Documents 2017-2018

Name of Adult completing this form
Name of Adult completing this form
R School Location *
Student Information
Enrollment / Program *
Private School Enrollment *
R School is a registered private school in the state of Florida and offers private school enrollment, even if not attending full-time. Attendance and "school days" are flexible under this enrollment, and students can choose to be registerd as private school students with R School or as homeschool students under their county regulations. If you want to be included as a private school student, please indicate this below.
Child #1 Name *
Child #1 Name
Child #1 DOB *
Child #1 DOB
Please list all food, medical, or other allergies:
Please describe any other relevant medical concerns here:
Child #2 Name
Child #2 Name
Child #2 DOB
Child #2 DOB
Please list all food, medical, or other allergies:
Please describe any other relevant medical concerns here:
Child #3 Name
Child #3 Name
Child #3 DOB
Child #3 DOB
Please list all food, medical, or other allergies:
Please describe any other relevant medical concerns here:
Family Information
This information can be completed one time for each family. If there is a need to complete separate information for each child, please complete an additional form or contact us.
Parent/Guardian 1 Name *
Parent/Guardian 1 Name
Parent/Guardian 1 Phone # *
Parent/Guardian 1 Phone #
Parent/Guardian 2 Name
Parent/Guardian 2 Name
Parent/Guardian 2 Phone #
Parent/Guardian 2 Phone #
Emergency Contact #1 *
Emergency Contact #1
In case of emergency, after calling Parent/Guardian 1 or 2. These contacts may also pick up child from school.
Emergency Contact #1 Phone *
Emergency Contact #1 Phone
Emergency Contact #2
Emergency Contact #2
In case of emergency, after calling Parent/Guardian 1 or 2. These contacts may also pick up child from school.
Emergency Contact #2 Phone
Emergency Contact #2 Phone
Child's Primary Care Doctor Name
Child's Primary Care Doctor Name
Child's Primary Care Doctor Phone *
Child's Primary Care Doctor Phone
Usually name of parent or guardian
Health Insurance Policy Phone #
Health Insurance Policy Phone #
Child's Primary Dentist Name
Child's Primary Dentist Name
Child Primary Dentist Phone #
Child Primary Dentist Phone #
Specialist Doctor / Therapist
Specialist Doctor / Therapist
Specialist Doctor / Therapist Phone #
Specialist Doctor / Therapist Phone #
Consents & Policies
Acknowledgement of the following consents, waivers and policies can be completed one time for each family. If there is a need to complete separate information for each child, please complete an additional form or contact us.
Medical Consent *
I recognize that as a result of participation in student activities, medical treatment on an emergency basis may be necessary and further recognize that R School personnel may be unable to contact me for my consent for emergency medical care. I do hereby consent in advance to such emergency care, including hospital care, as may be deemed necessary under the then existing circumstance. I understand that this Authorization for Medical Treatment is ONLY to be used in the case of an extreme emergency when I, the parent / legal guardian of my child am not available or cannot be reached by phone. In the event that I cannot be reached to make arrangements for emergency medical attention, I hereby authorize the staff or volunteers of R School Inc. to render first aid and/or take my child to the nearest medical facility for any and all necessary treatment. I agree to pay for any and all expenses related to the medical services for my child.
Waiver of Liability
Waiver of Liability Agreement *
In order to provide protection for all parties involved, R School has created a Waiver of Liability. The hope of R School is that families, volunteers, teachers, and staff can collaborate together to bring exceptional educational opportunities to the children in an atmosphere where all parties are respectful and responsible for themselves and/or their families. I release, indemnify and hold harmless R School, Inc., and [the above R School LOCATION/FACILITY, their officers, directors, associates, employees, independent contractor instructors, and volunteers] from and against any claims for damages an/or injury of any nature (except intentional misconduct or negligence) arising from, during, or pertaining to participation of myself and my family in any activity sponsored or sanctioned by R School, Inc. This indemnification and hold harmless includes any claim(s) by any visitors whom I request be allowed to participate in and/or observe any activity sponsored or sanctioned by R School, Inc. If this Waiver of Liability involves the release of any claim(s) for injury suffered or sustained by a minor, which claim(s) by the minor (or minor’s guardian, heirs successors or assigns) subsequently assert(s) against R School, Inc., its officers, directors, associates, employees, independent contractor instructors and/or volunteers, then and in that event, I PERSONALLY agree to defend (pay all attorney fees and costs reasonably associated with the defense) of such claim(s) and I PERSONALLY agree to indemnify and hold harmless R School, Inc., its officers, directors, associates, employees, independent contractor instructors, and volunteers from and against any such claim(s) by said minor for damages. If I, my family, my child(ren), or guests cause damage to R School, Inc. or any of the R School LOCATIONS buildings or property during the use of, or as a result of such use, I agree to accept responsibility for any damage occurring and will bear the full cost of repair, including replacement, if necessary. I have read, understand, and agree with all statements included in this document. I agree to be responsible for the behavior and safety of the children in my charge while volunteering. I understand that R School reserves the right to deny participation to any student or family for behavior concerns.
Media Consent
Media Consent Agreement *
I hereby give R School Inc. permission to photograph and record my child for use in audio, video, or any other electronic, digital, and printed media. I understand that my child’s name will not be used in any above media without specific consent. I release R School Inc. and their agents, affiliates, or employees from any responsibility or liability arising from the permitted use of interviews, photographs, videotapes, sound recordings or other images either of my child or created by my child or others. I certify that I have read the Media Consent statement. This agreement is in effect for 12 months from the submission date or until agreement is revoked, whichever comes first.
Policies
Acknowledgement of the following policies can be completed one time for each family. If there is a need to complete separate information for each child, please complete an additional form or contact us.
Tuition & Fees Payment *
Payment of all fees and tuition must be made in a timely manner and according to program of enrollment. In the event that payments CANNOT be made in a timely manner, parents must contact the school director before the payment becomes past due (rschooladmin@rschool.us). Late fees of 10% of past due amount may be assessed. Any and all requests for changes in tuition payments, payment intervals, deferments, refunds, or tuition assistance, must be submitted to the school Director prior to the regular payment date. If payments are overdue and no equitable arrangements, approved by the Director, have been made, the student may be denied admittance to the campus and re-enrollment will be suspended until the account is current and paid as agreed.
Refunds *
Refunds are available on a case by case basis but generally adhere to these guidelines: Annual Payment in Full: Withdrawal after payment but before the first day of class: 80% refunded, minus application, enrollment, or curriculum / materials fees. Withdrawal after classes start during first quarter of enrollment: 50% refunded, minus application, enrollment, or curriculum / materials fees Withdrawal during second quarter of enrollment: 25% refunded, minus application, enrollment, or curriculum / materials fees Withdrawal during third quarter of enrollment: 10% refunded, minus application, enrollment, or curriculum / materials fees Withdrawal during fourth quarter of enrollment: 0% refund Refunds for A-La-Carte, Installment, or Quarterly payments are as follows: Withdrawal after payment but before the first day of class: 80% refunded, minus application, enrollment, or curriculum / materials fees. Withdrawal after the class or session starts, regardless of attendance, 0%. All tuition and fees for the quarter/session during which a student withdraws are due in full, regardless whether paying in monthly installments or by the Quarter/Session or 1/2 session.
Dress Code *
R School requests that children on campus be dressed appropriately for the weather and for an academic setting (appropriate coverage). Families are asked to provide a change of clothes in a labeled plastic bag to be kept on campus. Many school activities are not conducive to skirts or dresses without additional under-attire (yoga shorts, etc) or a change of clothes for specific classes.
Discipline *
The R School approach to discipline is founded on developmentally appropriate expectations and is mindful of children’s individual needs. We encourage self-awareness, personal responsibility, and consideration for others through the development of respectful relationships and provision of supportive guidance when conflicts or frustrations arise. R School teachers, staff, and volunteers are required to document any behavior that may result in physical or emotional harm to self or others. The school director will notify Parents/Guardians of consistent behavioral concerns as needed and for assistance in addressing the concerns. R School reserves the right to temporarily suspend, permanently suspend, or expel/dismiss students for behavioral concerns.
Illness Policy *
We know how much students enjoy coming to R School; however, in the event that your child is sick, please let the school know via email and please keep your child home under the following circumstances: Vomiting (two or more times in 24 hours) Rash, lice, or nits (body rash, especially with a fever or itching) Diarrhea (3 or more watery stools in 24 hours) Eye infection (thick mucus or pus draining from the eye) Sore throat (with a fever or swollen glands) Fever (temperature of 100° (F) or more, taken under the arm, within 12 hours) Just not feeling very well (unusually tired, pale, lack of appetite, confused or cranky) We appreciate your assistance in following our illness policy to keep all children and teachers in the best health possible.
Schedule / Teacher Changes *
I understand that schedules and teachers are subject to adequate enrollments and may change with notice by the R School Director.
Lunch/Snack *
Families must provide a cold-packed daily lunch, snack, and refillable water bottle. We will notify students if food allergy policies are necessary to ensure the safety of other children.
Homework/Extension Activities/Practice *
R School does not have a mandatory homework policy. However, teachers may send home extension activities, additional practice opportunities, and from time to time, particularly for the middle school students, short homework assignments related to the class activities from that day. We do not believe in homework for the sake of homework, and we hope you find the extension activities and additional practice opportunities useful, particularly for homeschool families working on other school opportunities outside of R School courses/enrollments. If you have questions about anything that comes home with your child, please let us know.
Progress Monitoring / Reporting *
R School assesses academic progress through multiple measures. Each year, all children enrolled in the Monday/Wednesday/Friday program may take a nationally recognized standardized academic achievement test to assist in planning for their individual academic needs. Students enrolled in our elective options may participate in the assessment process or request a homeschool portfolio evaluation for an additional $60. All students will receive quarterly reports of academic progress with more specific goals and benchmarks, as appropriate, for the students enrolled in the MWF program. Please communicate with the school director or teacher regarding specific needs for assessment and progress monitoring. Each location may have different reporting policies.
Agreement *
I agree to all the policies and information stated in this form, and I confirm that all information provided is accurate. I also agree to provide the following documents, if applicable, via email to rschooladmin@rschool.us:
My initials in the box below indicate the above is all true and accurate