Student Registration Submission

Complete Payment Before Registering

Before submitting your student registration, please make sure the enrollment fee has been paid. If it hasn’t, click here to complete payment.

Once enrollment has been paid, check your email for your Enrollment Order Number and use that to begin completing this submission form with.

For families registering more than one child they will need to fill out this form for each child they enrolled with Family Academy.

Note: Immunization information or a Certificate of Exemption are only required for new students, returning students do not need to fill out these forms unless their immunization status has changed

Immunization and Exemption Directions

Download and print-out whichever form applies to you:

Immunization Status Form

Certificate of Exemption (if applicable).

• Complete the required Immunization or Exemption forms, then return to this page and submit the appropriate form after filling in all the required fields.
• Note: Your Immunization Status Form or Certificate of Exemption need to be in either pdf, png or jpeg formats only.
• If you’re registering more than one child you will need to complete the registration process for each child.

Enrollment Order Number(Required)

The order number can be found at the top of the email received after paying the enrollment fees.

Was the student previously enrolled with Family Academy?(Required)

No

Yes

Has anything changed for student from last year's enrollment?(Required)

No

Yes

Change of address, living arrangements, immunization status, emergency contact name etc?

Learning Center or Teacher Consultant(Required)

— Please Select —Arlington Learning CenterGreen Acres AcademyHighline Tutoring & Testing Center of BurienHomestead ElementaryJoy First LearningNurtured Nuggets AcademyPacific Learning SolutionsPuget Sound Academic CenterSalmon Creek Learning CenterStanwood Camano Learning CenterStride Christian AcademySupplemental Needs Alternative to Education CenterThe Education ExpressUniversity of the Nations Kona High School Learning CenterUnlocking Learning PotentialWest Seattle Learning CenterOther

Other Teacher Consultant or Learning Center Name(Required)

Student First Name(Required)

Student Last Name(Required)

Birth Date(Required)

MM slash DD slash YYYY

Birth Sex(Required)

Male

Female

Graduation Date(Required)

MM slash DD slash YYYY

Grade this year(Required)

Please enter a number from 0 to 12.

For Kindergarten use 0 (zero)

Mailing Adrdress(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Email(Required)

Phone(Required)

Student Resides with Which Parent or Guardian?(Required)

Both Parents

Male Parent

Female Parent

Student did not reside with any parent or guardian

Male Parent/Guardian First Name(Required)

Male Parent/Guardian Last Name(Required)

Male Parent/Guardian Relationship to Student(Required)

Male Parent/Guardian Email(Required)

Male Parent/Guardian Cell Phone Number(Required)

Female Parent/Guardian First Name(Required)

Female Parent/Guardian Last Name(Required)

Female Parent/Guardian Relationship to Student(Required)

Female Parent/Guardian Email(Required)

Female Parent/Guardian Cell Phone(Required)

Previous School Attended(Required)

Previous School Address(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Did student have dual enrolment?(Required)

No

Yes

Dual Enrollment School Name(Required)

Dual Enrollment School Address(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

How many classes?(Required)

Please enter a number from 1 to 10.

Ethnic Background(Required)

Asian or Pacific Islander

Black (not of Hispanic origin)

Hispanic

Native American

White (not of Hispanic origin)

Decline to provide

Emergency Contact First Name:(Required)

non-relative

Emergency Contact Last Name(Required)

Relationship to Student(Required)

Emergency Contact Email(Required)

Emergency Contact Phone(Required)

Additional Information(Required)

Is your student planning on a future in Sports?

Do you need NCAA information?

Parenting plan in place?

Is your student planning to attend college?

Choose all that apply

Supporting Documents

Drop files here or Select files

Accepted file types: jpg, png, pdf, Max. file size: 8 GB, Max. files: 3.

Attach Immunization status form, certificate of exemption (if applicable) and parenting plan (if applicable)

Additional information you feel necessary to provide us with?

Social Media Consent

I agree

Permission for Photos & Student Work

Family Academy and your student's Teacher Consultant/Learning Center request permission to share photos-including those that may include your child-on our website, social media, and Family Academy newsletter.

As the parent or legal guardian, I give Family Academy permission to use my child’s photos or work, provided that no names are included on the images or projects.

Does your child's education require the use of video conferencing?(Required)

No

Yes

Zoom Conferencing Consent(Required)

I agree

Permission to Meet Requirements via Zoom & In-Person Meetings

Family Academy and your student's Teacher Consultant/Learning Center need permission to meet with your student to fulfill Washington State’s required one (1) hour per week or nine (9) hours per quarter of conferencing. These meetings may take place via Zoom, in-person, or other electronic communication.

As the parent or legal guardian of the student listed on this registration form, I give Family Academy permission to use Zoom, in-person meetings, or other electronic communication as needed to meet these requirements.

Consent(Required)

I agree to the Terms and Conditions

Conditions of Enrollment:

• Provide immunization and/or immunization exemption records for each student at the time of registration.
• Adhere to the parent/teacher consultant financial agreement.
• Late payments are subject to a $15.00 fee.
• NSF fees are $45.00.
• All payments are due on the 1st of each month with billing beginning August 1st of the current school year.
• Authorize Family Academy to obtain necessary student records from any previous school(s) the student attended.
• Some Teacher Consultants have an additional non-refundable deposit fees that will be included in the Parent/TC Financial Statement you will receive through DocuSign.
• Family Academy is fully accredited by the Western Accreditation of Schools and Colleges for Prek-12th grade.
• Attending 5 scheduled conferences with the Teacher Consultant for the purpose of reviewing student progress and setting future goals.
• Late Cancellation or failure to show is $25.00.
• Immediately inform the Teacher Consultant if my student tests positive for COVID and will not send the student to school as per Health Dept. guidelines.
• Understand that a withdrawal requires a fourteen (14)-day written notification to Teacher Consultant.
• Withdrawal requires a final conference with the Teacher Consultant within 7 days. Direct Family Academy as to the disposition of student records once fees are paid in full. Family Academy retains a permanent record of high school transcripts only.
• Payment through the first quarter after enrollment of tuition fees and any Family Academy fees must be paid in full prior to records being released should the student leave before the end of the first quarter.
• Understand that a student may be withdrawn by the Teacher Consultant for any of the following reasons, though not limited to:
• Non-attendance for more than two (2) consecutive weeks without prior arrangement with the Teacher Consultant, excessive absences, inadequate record-keeping by parent or student, or insufficient progress in the student’s learning plan.
• Disruptive behavior (i.e., hurtful comments, inappropriate dress, bullying, sexual harassment, pressuring other students to engage in inappropriate behavior) which remains unresolved after verbal and/or written warning from the Teacher Consultant.
• Student involvement in any illegal activity, illegal substance use, or bringing any weapon to any Family Academy event or Learning Center activity.
• Plagiarism.


My signature below gives evidence that I have read, and I agree to adhere to the terms and conditions of this Agreement. All information provided to the school is truthful and complete and all relevant information has been disclosed to the Teacher Consultant and to Family Academy.

If you are enrolling in one of our Learning Centers, you will also follow the terms and conditions of the Learning Center in lieu of Family Academy's.

Complete the phrase:(Required)

Signature(Required)

Sign inside box with mouse or stylus.

Name of parental signator(Required)

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