Test Page for PayStand Button Enrollment Agreement for Courses for Credit - Summer Date* Date Format: MM slash DD slash YYYY Title of course*Course Selection 1*Please enter the time or class period of the course(s) you wish to enroll your child. (ex. 8:00-11:00)Alternate time/class periodPrivate coursesPlease call for availability of one-on-one courses.Student Name (as appears on transcripts)* First Last Parent or Guardian Name* First Last Address* Street Address City ZIP Code Parent Cell*Student Cell*Student's grade in Fall*9th10th11th12thYear of Graduation*201520162017201820192020202120222023Student's school to receive transcript*Parent Email to receive progress reports* Student email*Student's Date of Birth* Date Format: MM slash DD slash YYYY How did you hear about us?*My child has already attended HBAMy child's sibling has attended HBAWe were referred by friends.We were referred by school staffWe found High Bluff on the internet.We saw an ad in the newspaper.We received a flyer in the mail.OtherEmergency Contact Name* First Last Emergency Contact Phone*Credits*Both semesters 10 credits (equal to full year)Semester 1 only 5 creditsSemester 2 only 5 creditsAuthorization*Please click here to read the full text of our Enrollment Agreement. Please acknowledge that you are aware of the following policies by checking all boxes below: A parent must call in absences by 8:00 am Excessive or unexecused absences may incur an extra charge. No grade is guaranteed. Parents may log in to Engrade.com to check student progress and to communicate with the teacher. Please contact us if you do not receive log-in instructions the first week of class. Disruptive or disrespectful behavior will not be tolerated. A full refund will be given if a student is asked to withdraw from the program. Completion of homework is mandatory. Students are knowledgable 4th of July is the only school day off Once payment is made all deposits and tuition payments are nonrefundable. Students who withdraw after payment deadline must show documentation of emergency such as hospital bill, emergency room bill, etc. for any credit or refund. Photo Release*From time to time we take pictures of class activities to post on our website or Facebook page. We would appreciate it if you would allow use to your child's image (no names) without prior consent. I agree to allow my child to be photographed for promotional purposes on our website, Facebook page, or printed materials No, please contact me for permission before using my child's image Special Needs*Please contact an administrator or the teacher prior to the first day of class to discuss any modifications, medications, or special instructions that may help us in working with your child.NoneLearning DisabilityHealth concernADD/ADHDPaymentPlease select your preferred method of payment and continue to step 2 to complete your payment. Electronic CheckCheckCredit CardPayment Options*DepositGroup course 1 semesterGroup course both semestersPrivate Course for CreditPrivate Course 1 semesterTotal $0.00 CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.