LEGACY ACADEMY of IDAHO 2023-2024 STUDENT Enrollment Application

Note: Please complete this application along with an interview as part of the admissions process. Please email legacyacademyidaho@gmail.com to schedule an interivew.

Family Information

Family Last Name *

Family Home Address *

City *

State *

Zip Code *

Name of Mother *

Daytime Phone *

Address

Cell Phone *

Occupation

Employer Name/Address

Mother's Email Address *

Name of Father *

Daytime Phone

Address

Cell Phone *

Occupation

Employer Name/Address

Father's Email Address *

Please list names and ages of other children in the family not being registered:

Family Emergency Contact Information

Please list the names of two people who know your child well and who could be contacted in case of an emergency.

1st Emergency Contact Name (other than parents) *

Phone *

Relationship *

2nd Emergency Contact Name (other than parents) *

Phone *

Relationship *

Family Medical Information and Medical Authorization and Release

Family Physician *

Phone *

Insurance Company *

Account Number *

I agree to allow the personnel at Legacy Academy (teachers, part-time instructors, chaperones, administrators, volunteers collectively, "Legacy") to provide or authorize medical assistance for my child/children in case of an emergency and until professional medical attention can be administered. I am responsible for any and all medical expenses that may be incurred. Such medical expenses shall not be paid by Legacy.

I have read and understand and accept the statements above.

Parent Signature *

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Family- Photo Release

I grant Legacy Academy my permission to use the photographs or videos described as classroom photos for any legal use, including but not limited to publicity, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Parent Signature *

clear

Family- Liability Release

I do hereby waive any and all claims against Legacy Academy, Legacy Academy’s Directors, Administrators, Instructors, Board Members, individuals, drivers, or any staff members and hold them harmless for any mental, physical or financial claims of injury, damage, and/or loss, that may be sustained from August 2023- June 2024 while my child/children are in the school building, traveling, on field trips, or while he/she/they are touring for and on behalf of Legacy Academy.

Parent signature *

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Family Memo of Understanding (MOU)

For information only, new this year as part of the enrollment process, all new and returning families will schedule a 1-on-1 meeting with the Principal to review and sign a parent and student MOU covering Honor Code, dress standards, and positive attitude toward learning. This is separate from the admissions interview which takes place for new families. This will happen prior to the school year during the summer--slots will be available beginning in July for these meetings.

LEGACY ACADEMY of IDAHO 2023-2024 STUDENT Enrollment Application

Family Information

Family Emergency Contact Information

Please list the names of two people who know your child well and who could be contacted in case of an emergency.

Family Medical Information and Medical Authorization and Release

Family- Photo Release

Family- Liability Release

Family Memo of Understanding (MOU)

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