Admission Application Student Application and Enrollment Form Student InformationStudent 1 Name* First Last Student 1 Birth Date* Student 1 Grade in school*Please enter a value between 0 and 12.Please put "0" for kindergarten Do you have another student?*YesNoStudent 2 Name* First Last Student 2 Birth Date* Student 2 Grade in school*Please enter a value between 0 and 12.Please put "0" for kindergarten Do you have another student?*YesNoStudent 3 Name* First Last Student 3 Birth Date* Student 3 Grade in school*Please enter a value between 0 and 12.Please put "0" for kindergarten Do you have another student?*YesNoStudent 4 Name* First Last Student 4 Birth Date* Student 4 Grade in school*Please enter a value between 0 and 12.Please put "0" for kindergarten Do you have another student?*YesNoStudent 5 Name* First Last Student 5 Birth Date* Student 5 Grade in school*Please enter a value between 0 and 12.Please put "0" for kindergarten Parent InformationParent Name* First Last Parent Email* Enter Email Confirm Email Parent Phone*County*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country The BasicsHow did you hear about us?*Records Request/Enrollment ConfirmationWhen you withdraw your child from their previous school, they may require an enrollment confirmation/records request from Real Life ALC. Please include the name of the previous school and their address or email here.What attracts you most to the Agile Learning Center?Trial WeekWe require a paid trial week for new students to ensure mutual compatibility. Please enter a week that works for you and your child. Agreement to pay trial week tuition-Tuition for a trial week will be charged according to your calculated suggested tuition rate (see "Tuition" page for slider). I agree and will pay a week's tuition for my child at the beginning of the trial week.Desired Enrollment Date* We have rolling admissions, and our semesters generally follow the Hillsborough County public school calendar (with some exceptions). Ideally, when would you like to have your child start school at ALC?Schedule*Please tell us which days of the week your child will attend. Monday Tuesday Wednesday Thursday Friday Student AgreementThese questions are to be answered by the student. (It's fine for the parent to type or enter the information for younger students, but the answers should come from them.)Please read and agree to the statement below.*I understand and agree to these responsibilities.I don't understand or don't agree to these responsibilities.An ALC is an environment where students of every age are free to direct their own learning and activities, yet this freedom comes with responsibilities. I understand that I am expected to: 1) Treat others with respect (whether student, volunteer, staff or parent), 2) Behave appropriately for a shared space such that I don't interfere or disrupt others' learning activities, 3) Participate in making, honoring and enforcing rules and structures of the community, and 4) Help solve conflicts when they arise.Parent QuestionnaireALC Philosophy Agreement*I understand, support and agree to this philosophy and extent of freedomI do not agree with this approach to learningI understand that the ALC provides a real-world learning environment for students to develop self-direction, self-motivation and self-knowledge and as such never requires students to attend specific classes or produce specific work. The school will support students' requests for learning, but does not direct learning activities according to any curriculum. The School Meeting may make certain activities mandatory for the smooth operation of the school. Currently these are: morning meetings, end of day meetings, clean-up, fire drills, and appearing when a complaint has been filed. Beyond these, the choices are up to each child.Tell us about your child. Personality? Challenges? Interests?Why do you think ALC will be a good fit for your child's learning needs?Describe your child's prior schooling. Please include names/dates/schools attended/reason for leaving.Emergency Contact and Medical InformationPlease enter contact information for person to alert in case of an emergency.Name* First Last Phone*Relationship*Please list any food allergies, medication allergies, and/or medical conditions that we should be aware of. If none, please enter N/A.*ReleasesMedical Release*As the legal guardian, I give consent to Real Life ALC to provide all emergency medical and dental care prescribed by a licensed physician (M.D.), Osteopath (D.O.), or Dentist (D.D.S.) required to treat any conditions that are necessary to preserve life, limb and wellbeing of dependent.I agreeI disagreePhoto Release*Please be advised that your child's photograph or video may be taken at various school functions events, and for our yearbook. Do we have your permission to post these pictures on our website, social media sites, and/or printed promotional materials?YesNoTrampoline Waiver*I give my child permission to play on the trampoline at Real Life ALC. I acknowledge that use of a trampoline can be dangerous and may result in serious injury. I assume full liability for any accidents involving my child on the trampoline.I agreeI do not give my child permission to use trampoline, my child agrees and will not go on trampoline.Pool and Sunscreen Waiver*I give my child permission to swim in the pool at Real Life ALC, with the understanding that they will alert an adult to be present while he/she is doing so. I acknowledge that swimming can be dangerous and may result in serious injury. My child is aware that failure to follow policies will result in the loss of pool use privileges, with reinstatement of privileges at the sole discretion of Real Life ALC. I grant my child my permission to participate in pool use. I understand the Pool Rules [alert an adult to be present and no running] and have explained them to my child. During outside activities, there is potential for sunburns. Please bring in a bottle of sunscreen with your child's name on it, swimming suit, and towel to be kept in their cubby. Hats and water are also recommended, however we do have filtered ice water.I AgreeI do not give my child permission to use the pool, my child agrees and will not go in the pool.Off-Campus Release*I understand that my child may have opportunities to walk to close-by places, such as the park or to stores. BY CLICKING "I AGREE" ON THIS FORM I AM AUTHORIZING A MINOR STUDENT TO EXIT THE SCHOOL WITHOUT REAL LIFE ALC STAFF SUPERVISION. Real Life ALC will require participants to follow Off-Campus sign‐out and sign‐in procedures, but will not monitor a participant’s whereabouts after they leave the property. The decision to agree to this Off-Campus Release is solely a parental decision. Students who do NOT have parental permission to leave the campus will not be allowed to do so unless supervised by a Real Life ALC staff member, or unless signed out by an authorized adult (see Authorized Adults Release). Real Life ALC planned activities/outings will be chaperoned by Real Life ALC staff and will not require an Off-Campus Release (see field trip release). I allow our (my) child to leave the campus and accept responsibility for and hereby waive, release, and discharge Real Life ALC and its officers, directors, members, agents, representatives and employees from any claim, demand, or cause of action arising out of or in connection with any incident that may occur while he/she is away from the supervision of Real Life ALC staff. We (I) understand that Real Life ALC cannot monitor where students go when given this privilege. We (I) also agree to indemnify and save harmless Real Life ALC and its officers, directors, members, agents, representatives and employees from all claims for loss, damage, or injury sustained by us (me) or by our (my) child whether the same be caused by the negligence of Real Life ALC and its officers, directors, members, agents, representatives, or employees, or otherwise. I grant Campus exit privileges. I AgreeI do not give my child permission to go off campus without supervision, and my child agrees and will not go off campus without supervision.We Recommend: Teaching Children to Walk Safely as They Grow and Develop: A guide for parents and caregiversEnrollment and TuitionTuition Agreement*Tuition is due on the 1st of each month. There is a 5% deduction If you pay for a full semester, and a 10% deduction if you pay for a full year. If you choose to pay month to month, you will be required to pay your first and last month's tuition installments upon admission. Please see "Tuition" on the "Admissions Information" tab.I will pay at the beginning of each month, and I will remit my first and last month's tuition.I will pay at the beginning of each semester, with a discount of 5%.I will pay at the beginning of each year, with a discount of 10%.Financial Assistance*ALC is funded by tuition. The current full time tuition is described on the "Tuition" page under the "Admissions Information" tab. Financial assistance and scholarships may be available in the form of tuition adjustments and through McKay Scholarship Program, Florida Tax Credit Scholarship, Gardiner Program, and others. I am paying the full tuition and NOT applying for financial aid.I would like to apply for financial aid.I am an unschooler/homeschooler and interested in exploring my options.If you intend to enroll your student full-time you agree to submit all required documents (see below).*(1) This Information Sheet (Done when clicking submit online). (2) Birth Certificate -- a copy. (3) Health Exam (Form DH 3040) -- must be current information (no more than 1 yr old). Please Note: If your religious convictions conflict with requirement (3a) you may submit a letter taking an exemption from this requirement. (4) Immunization Record (Form DH 680) -- must be current information (no more than one year old). Please Note: If your religious convictions conflict with requirement (4a) you may submit Form DH 681 (Religious Exemption from Immunizations Form). You may obtain this form from your local health department. Rule 64D-3.046 Florida Administrative Code: https://www.flrules.org/gateway/ruleno.asp?id=64D-3.046 KEEP COPIES FOR YOUR RECORDSI AgreeI am not enrolling my student full-timeTuition*What did your tuition worksheet determine your family would pay annually? Has the Financial Committee finalized your tuition?*YesNot yetCAPTCHACommentsThis field is for validation purposes and should be left unchanged.