RTA of MTHEA RETURNING STUDENT REGISTRATION
Checklist for 2012-2013
FAMILY NAME________________________________
Please return the following to us by March 1st to ensure your reserved space:
Class Request Form:__________
$45.00/student, non-refundable registration fee__________
(without this fee, your class space will not be reserved)
The following must be turned in by April 2nd to claim the $25 discount at Registration Day:
Registration Checklist:__________
Application
Update:__________
Only one each of the following per family:
The following 5 forms must be signed by both parents and the student(s)
Signed Parental Involvement Form:__________
Signed Student Honor Code Sheet:__________
Signed Insurance/Liability Release Form__________
Signed Family Contract:__________
Signed Academic Conduct Form:___________
FYI: Complete administrative fees are $250, due on Registration Day. If files are completed by April 2nd there is a $25 discount. This includes all paperwork signed and completed and turned in. Tuition payments and fees will be due on Registration Day. After registration the fees will be $275.
RTA of MTHEA 2012-2013
Name________________________________________________________
Last First Middle
Address______________________________________________________
Street City State Zip
Date of Birth:____________________Grade ’12-'13____________________
Telephone:_______________________Cell Phone:____________________
Father:__________________Occupation:_________________Work #______
Mother:__________________Occupation:_________________Work #______
Siblings: (Names and Ages):________________________________________
______________________________________________________________
E-mail Address (student) __________________________________________
E-mail Address (parent)___________________________________________
(PLEASE inform us if this e-mail address changes mid-year. If you do not have an email address, please contact someone who can keep you informed of our correspondence.)
THIS REFERENCE SHEET WILL BE USED IN CASE OF AN EMERGENCY.
Contact person in the event of an emergency if parents can not be reached. This person should be available during school hours.
Name:______________________________ Phone:______________________
Family Physician: _____________________ Phone:_______________________
If your parents allow us to give Tylenol or Advil, if you request it for headaches or minor pain, they should sign below.
Parent’s Signature: _________________________________________________
Please list serious allergies, prescription medication that affects class work, or any health problems that need to be brought to our attention:
________________________________________________________________