Student Registration Form - 2021
Please complete the registration form
Email address *
Parent/Guardian Full Name
Phone Number
Student First Name *
Student Last Name
Student Email Address
Date of Birth
MM
/
DD
/
YYYY
Address
Gender
Clear selection
Name of Current School
Grade
Class Delivery Method
Clear selection
PROGRAMS FOR 2021
Program Option
HELP US GROW
How did you hear about us? Referred By?
Please complete the following acknowledgement by read and checking off the check boxes to complete the registration form. STUDENTS 18 YEARS OF AGE AND OVER SHOULD READ AND COMPLETE THEIR OWN WAIVERS.
I / We hereby warrant and acknowledge, that the above information for is complete and accurate to the best of my/our knowledge. I/We also agree to provide the Academy, in a timely manner, any changes regarding my/our child’s information.I/We, hereby acknowledge that the Academy is not free of allergens. I/We understand that my child may inadvertently come into contact with a substance he/she may be allergic to and that such contact may cause an allergic reaction. I understand that there are certain risks of allergen contact that are inherent in a Academy setting. *
Required
During the course/program, numerous photographs are taken to document daily classroom activities, events and special activities. Some of these photographs are used for internal purposes, such as bulletin boards displays and newsletters.By enrolling my child in the School and permitting them to participate in school activities and events, I acknowledge that the Academy may use the photographs taken of my child for internal Academy purposes, promotional, advertising and public relations purposes. DataWiz Academy reserves the right to use my child’s name, photograph and or videos containing my child’s image for promotional, advertising and or public relations purposes. Such use of name or photographs may be included in the DataWiz brochures, posters, Web site and newspaper, magazine and television advertisements. DataWiz will incur the full costs of such photography or videotaping.I acknowledge and confirm that all photographs, advertisements, Web site materials and related records and documents used in, arising out of or related to DataWiz promotional, advertising and or public relations activities shall remain the exclusive property of DataWiz who shall own all copyright.I also waive any and all rights to any personality rights of my child to DataWiz for use on the DataWiz Academy Web site or in other promotional, advertising or public relations materials. *
Required
Comments/Requests
Thank you for your interest in DataWiz Academy. One of our counselor will be in touch with you soon.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy