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Pre-Registration Form
7/20/2018

WilcoxAcademy

 2018-2019 Pre-Registration

 

Name of Parents/Guardians___________________________________________________________________

Mailing Address                                                                                   Home Phone                                                   

                                                                                                         Cell/Linc #                                                       

Work Phone (hers)                                                                 Work Phone (his)                                                           

Email                                                                           

Name of contact if you cannot be reached in case of sickness or emergency

Name                                                                                                   Number                                                           

Please accept this application for the enrollment of the following student(s) inWilcoxAcademyfor the

2018-2019 school year.

                                                                                                                                                                                  

                                                                                             Social              Grade               School LastFull Name                                 Age         Birthdate                       Security              Entering            Attended                                                                               Number                                                                           

 1.                                                                                                                                                                                

2.                                                                                                                                                                                

3.                                                                                                                                                                                

4.                                                                                                                                                                                

5.                                                                                                                                                                               

If applicant is requesting readmission of a former student, there is a $100.00 re-entry fee that must accompany the application.

 The payment of tuition may be made by 1 payment, 2 payments, 3 payments or 9 payments as outlined in the pre-registration information.

 

Students are accepted only by approval of the Board of Directors, Wilcox Educational Foundation.

 

                                                                                                                                                                        

FOR BOARD USE ONLY                                                      Signature of Parents or Guardians

Date Received                                                                                                    

Grade Levels                                                                           

Quota                                                                                      

Enrollment                                                                   

Date Approved                                                           

Late Fee                                                                      

Membership Fee (New)                                  

Re-entry Fee (Former)___________

 

**Back Page to be completed at registration

 

________________                                                                ________________________________________

Grade level                                                                               Name  

                                         

Program of Studies    (Grades 5-12)

 

                        Period                                                 Subject                                                            Teacher

                        First                                                                                                                                                    

                        Second                                                                                                                                                

                        Third                                                                                                                                                   

                        Fourth                                                                                                                                                 

                        Fifth                                                                                                                                                    

                       Sixth                                                                                                                                                    

                        Seventh                                                                                                                                               

 

Wilcox Academy – Activity Permission

 Our child, a student atWilcoxAcademy, desires to participate in the sport or activity shown below, for the upcoming school year. We realize that occasionally injuries occur in this sport or activity and thatWilcoxAcademydoes not provide insurance coverage or assume any risk or liability for said injuries.

 We agree fully to the following statements:

 1.      Our child may participate in this sport or activity.

2.   We will be fully responsible for any and all doctor, hospital, or any other medical

     expenses resulting from or relating to injuries or damages sustained while traveling or  

     participating in the said sport or activity.

3.   We will not holdWilcoxAcademyor any of its personnel liable for any accidents,  

       injuries, or claims that might occur.

 

_______________________________________

Sport or Activity

 

Wilcox Academy – Transportation Permission Form

 We hereby give permission for our child to go on any school sponsored field trip, athletic event, or any trip of a special nature for the upcoming school year. The driver of the motor vehicle in which our child rides will not be held accountable for any accident or injury, which might occur, nor will the administration, faculty, or school be held responsible or accountable.

 ___________________________________                          _______________________________________

Signature of Parents or Guardians                                             Student’s Signature