Application for Admission:

Transcription

1 Application for Admission: (Returning Student New Student ) Applicant s Legal Name: Grade: Last First Middle Primary Home Address: Street City/State Zip Goes by: Date of Birth Age: Home Phone: Gender: Race: Place of Birth: Social Security Number: Applicant s Current School: Number of Years Attended: School Address: Street City/State Zip Phone Number Father s Information: Father s Full Name: Address (if different from above): Preferred Name: Cell Phone: Job Title: Address: Company Name: Business Phone: ext. Spouse s Name: Mother s Information: Mother s Full Name: Address (if different from above): Preferred Name: Cell Phone: Job Title: Address: Company Name: Business Phone: ext. Spouse s Name: Office Use Only: Date Application Received: Received by: Logged: Transcript: Application Fee Paid Date: Check Number: $ Tested:

2 Applicant lives with (check all that apply): Father Mother Stepmother Stepfather Other Other Name: Relationship: Name: Relationship: Name and address of individual with financial responsibility for applicant: Does the applicant take any medication on a daily basis? If yes, please identify and explain: Does the applicant have any physical, emotional, or psychological weakness or learning disability? If yes, please explain: Has the applicant been dismissed from any school for any reason or received severe disciplinary censure? If yes, give full details on a separate sheet of paper, including name of school and principal. Provide any additional information you feel we should know: List applicant s siblings and ages: List any Thomas Hart alumni in your family: Name: Relationship to applicant: Year of graduation or years attended THA: How did you become interested in THA? If a specific family referred you to the school, please name the family. I authorize this application for my child for admission as a student to Thomas Hart Academy for the school year. I understand that admission is subject to the general statements, rules, regulations, conditions, and traditions of the school and the financial terms contained in the Enrollment Contract. Signature of Parent/Legal Guardian Date Thomas Hart Academy welcomes students regardless of race, gender, ethnicity, nationality or religion.

3 Thomas Hart Academy Academic Year Enrollment Contract Page 1/2 Office Use Only: Date Received: Application Fee $ Check # Thomas Hart Academy agrees to enroll the student(s) listed below for the school year and to provide the educational program and other services as prescribed for that grade. In consideration of the acceptance of the Enrollment Contract by Thomas Hart Academy the undersigned agrees to pay the required fees as specified below. For returning students, a tuition deposit in the amount of $200 is due in two installments: $100 at the time of reenrollment and $100 on June 1. For new students, an application fee of $100 is due with the application. A tuition deposit of $200 is due at the time of acceptance. Student(s) Name: Grade: Date of Birth: I understand that my obligation to pay the fees for the full academic year is unconditional and that after August 1 no portion of fees paid or outstanding will be refunded or canceled in the event of absence, withdrawal, or dismissal from the school of the student(s) listed above. In view of this obligation, I understand that the Tuition Repayment Plan (TRP) is being made available to me at this time to protect my yearly financial obligation under the terms of the Enrollment Contract. This program insures fees (prepaid and due) in the event of separation according to the terms of the policy. Tuition Repayment Plan Note: Participation in the TRP is required unless the full annual charges are paid by July 1. (Please choose one AND initial.) A. I wish to participate in the TRP. The premium rate is 2.7% of the annual fees. I authorize the school to process and collect any claim payment to which I am entitled under the TRP and credit it to my account, paying any excess to me. I have received and read the enclosed brochure detailing the terms and conditions of coverage concerning this Plan. B. I do NOT wish to participate in the TRP. I understand that no refund or cancellation of the yearly fees will be made by the School for absence, withdrawal, or dismissal before the end of the school year and herein agree to assume full responsibility for the full annual fees. I have received and read the enclosed brochure detailing the terms and conditions of coverage concerning this Plan. Financial Obligation Options (Please choose one.) Annual Payment: One payment in the amount of $ is due on July 1. Semi-Annual Payments: Two payments in the amount of $ each are due on July 1 and January Monthly Payments: Twelve payments in the amount of $ each are due on the first day of each month July through June.

4 Page 2/2 I understand that in signing this Enrollment Contract for the coming academic year, I am agreeing to accept the rules and regulations of the School as stated in the current handbook and the rule concerning payment of fees as referred to the above. Furthermore, I agree to the policy of the School that no student will be permitted to take examinations, nor will grades/ transcripts be released unless an account has been paid in full. A late fee of $20 will be assessed to any account unpaid by the 10 th of any month. If the parent or guardian allows the account to lapse on the twentieth of the month, the student will not be allowed to attend school until the account is satisfied. Thomas Hart Academy shall have the right to legal action for the collection of school fees and that parents will be responsible for all costs of collection, including but not limited to court expenses and reasonable attorney s fees. The undersigned agrees to release and hold harmless the School, its agents, and employees from all claims, damages, or other liabilities for injuries to my child which are not the result of gross negligence by this School, its agents, or employees. The undersigned also agrees to indemnify the School for damages by my child. I authorize my child to participate in school trips under the supervision of the School faculty and staff. I agree to release and hold harmless Thomas Hart Academy, Inc., its agents, and/or employees from any and all liability whatsoever associated with the said School trips. Should a medical emergency arise, I give my permission for the teachers to authorize treatment for my child should it be necessary, and I agree to assume all costs associated with this treatment and hold harmless the School for all outcomes and injuries resulting from such care. Enrollment, as specified within this Enrollment Contract, may be canceled by the parents or guardians in writing, without penalty (except forfeiture of the Tuition Deposit) prior to August 1. If enrollment is canceled after August 1, parents or guardians financially responsible for the student are obligated to pay full annual charges. In order to reserve a place for your child, this Enrollment Contract and your Tuition Deposit must be received by the School no later than the time of reenrollment for returning students or at time of acceptance for new students. My signature below affirms that I have read, understand, and accept the terms and conditions of this contract. Signature of parents or guardians financially responsible for the student(s) listed above: Name Address Date Name Address Date Family Referral Primary address for billing Accepted by Thomas Hart Academy Name Date *Enrollment Contract Revised 1/6/17

5 Thomas Hart Academy Schedule of Tuition and Fees Grade Tuition Annual Semi-Annual 12 Monthly Payment Payments* Payments* TRP K3/K4/K5 $5,057 $4,857 $2,655 $464 $137 K3 (half-day) $3,690 $3,490 $1,937 $338 $100 1 st $5,795 $5,595 $3,042 $531 $156 2 nd -3 rd $6,396 $6,196 $3,358 $586 $173 4 th -8 th $6,478 $6,278 $3,401 $594 $175 Returning Students: Tuition Deposit: A $200 tuition deposit is required to reserve a space in a class. This amount is payable in two installments: $100 is due at time of reenrollment and $100 is due June 1. The deposit is deducted from the annual tuition charge. The payment options shown above are the balances after the deposit has been deducted. New Students: Application: Tuition Deposit: $100 (due with application, non-refundable) $200 (due at time of acceptance) All Students: Tuition Refund Plan 2.7% of tuition and fees required of semi-annual and monthly payment plans, optional for full payment plan K3/K4/K5 = $137, 1 st = $156, 2 nd /3 rd = $173, 4 th -8 th = $175 (one -time fee paid in July) Penalty Charges Returned Check Fee: $25 Late Fee: $20 (assessed to any account unpaid as of the 10 th of the month) *Finance charges of 5% and 10% are added to semi-annual and monthly payment plans respectively. The cost of lunch, class trips, yearbook, and the After School Program are not included in the tuition and will be assessed separately. Miscellaneous Matters Enrollment may be cancelled in writing without penalty (except forfeiture of the tuition deposit) prior to August 1. Credit cards are not accepted for the payment of tuition and fees.

6 THA Academic Calendar for the School Year Revised 01/06/17 August 2, 3, 8, 9, 10 Faculty In-Service 10 (Thursday) Orientation/Registration 17 (Thursday) First Day of School September 4 (Monday) Labor Day (School Closed/ASP Closed) 5-8 (Tues-Fri) Washington DC Trip (grade 8) 6-8 (Wed-Fri) Barrier Island Field Trip (grade 7) 6-8 (Wed-Fri) Camp Greenville Field Trip (grade 6) October 6 (Friday) Parent/Teacher Conferences (School Closed / ASP Open)** 27 (Friday) School 12:00 Noon (ASP Open) Halloween Carnival November 3 (Friday) Professional Development Day (School Closed/ASP Closed) 17 (Friday) Grandparents Day School 12:00 Noon (ASP Closed) (Mon-Fri) Thanksgiving Vacation 27 (Monday) Classes resume December (Mon-Wed) Semester Examinations (grades 7-8) 15 (Friday) School Dismissed at 12:00 Noon (ASP Closed) 18- Jan. 2 Winter Vacation January 2 (Tuesday) Teacher Workday (School Closed/ASP Open)** 3 (Wednesday) Classes Resume February 9 (Friday) School Dismissed at 12:00 Noon/Faculty Workday (School Closed/ASP Closed) March 5-9 Stanford Testing 16 (Friday) Inclement Weather Make Up Day * (ASP Open) 30 (Friday) Inclement Weather Make Up Day * (ASP Open) April 2-6 Spring Vacation (School Closed/ASP Closed) 9 (Monday) Classes Resume May 18, 21, 22 Semester Examinations (grades 6-8) 23 (Wednesday) Last day for Kindergarten Students 24 (Thursday) Awards Assembly, School Dismissed at 10:00 (ASP Closed) 25 (Friday) Graduation 24-25, Faculty Workdays *Inclement Weather Make-Up Day These days are likely to become school days so we encourage everyone to NOT to plan trips or special events on these days ** 8 students required in order for ASP to be available. Notification will be sent home.

7 Transcript Request Applicant s Name Applicant s School Applicant s School Phone # Fax # The above named student has applied for admission to Thomas Hart Academy. Please forward the following information to the school at the address or fax number below: Transcript Standardized Test Scores Attendance Records Discipline Record Immunization Record Copy of birth certificate Send to: Thomas Hart Academy 852 Flinns Road Hartsville SC Fax: Phone: