Integral Academy Registration Form
PARENT INFORMATION
First Name
Last Name
Address
Email
Mobile Phone
How did you hear about us?
STUDENT INFORMATION
First Name
Last Name
Grade Level
Select
Grade K
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
College Level
Current School
Start Date
Is your child a recipient of any scholarships? If yes, please specify!
Choose Location
Select
Online Tutoring
At Palm Coast Center
In Your Home
What academic programs or/and summer camps are you registering for? Please be specific!
Publicity Release
I give my consent to the Integral Academy to possibly use photographs of my child to post on the Integral Academy website, and other social media networks for community awareness and educational purposes. No student names will be included.
Waiver Liability
I, parent or guardian of the above named child, give my approval for my child to participate in any and all activities of Integral Academy. I further hereby release, indemnify, and hold harmless the organizers, instructors, and staff of the Integral Academy. I likewise waive, to the extent not covered by the liability insurance, any claims against any person overseeing my child’s activities.
Remove
Add Fields for Additional Student
Submit
