Student Information
This database will only be seen by the Administration and Tutors of Star Academy Class Day.  All information will be kept confidential.

If you have more than one student in Star Academy Class Day, please fill out a form for each student separately.  You will be asked for names, phone, email, health concerns, what classes your student will be taking, and whether your student can leave the campus. Items with a red star are required.

NOTE ~ Your class slot is not confirmed until all tuition and fees are submitted to Star Academy Class Day.

Please scroll all the way down, filling in each item, and click "submit" when you are finished.
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Email *
Student First Name *
Student Middle Name
Student Last Name *
Student Date of Birth *
MM/DD/YYYY
Grade Level for 2020-2021 School Year *
Student Email (ONLY if different from parent)
Student Cell Phone Number (or N/A)
Parent(s) / Guardian(s) Name *
Please list any allergies, current medications, medical conditions, or other concerns about which the Director and tutors of Star Academy Class Day should know.
First Hour Class *
Second Hour Class *
Third Hour Class *
Fourth Hour Class *
Fifth Hour Class *
Sixth Hour Class *
Online Classes *
PHOTO RELEASE *
YOUTH WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in Star Academy Class Day related events & activities, the undersigned:

 1.    Agree that the parent(s) and/or legal guardian(s) of the participant should inspect the facilities and equipment to be used, and if the parent or guardian believes anything is unsafe, he or she should immediately advise supervisor (advisor, manager, etc.) of such condition(s) and refuse to participate.

 2.  Acknowledge and fully understand that each member/participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions, or negligence but the action, inaction, and negligence of others, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

 3.    Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.

 4.    Release, waive, discharge and covenant not to sue Star Academy Class Day, its affiliated clubs, their respective administrators, directors, agents, and other employees of the organization, other members/participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, all of which are hereinafter referred to as “releases,” from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise.

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY.
Name of Student/Participant *
Name of Parent/Guardian *
Parent/Guardian Relationship *
Parent - Please type your name and today's date as an electronic signature. *
To save paper we are using digital signatures. Your name and today's date will be your signature on this form. Thank you.
Address of Member/Participant *
A copy of your responses will be emailed to the address you provided.
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