Name of Parents/Guardians___________________________________________________________________
Mailing Address Home Phone
Work Phone (hers) Work Phone (his)
Name of contact if you cannot be reached in case of sickness or emergency
Please accept this application for the enrollment of the following student(s) inWilcoxAcademyfor the
2019-2020 school year.
Social Grade School LastFull Name Age Birthdate Security Entering Attended Number
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 10 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
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
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