2022-23 Taubah Academy Registration Form

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PARENT'S INFORMATION

Parent's First Name *

Parent's Last Name *

E-mail *

Home Address *

City *

County *

State *

Zip Code *

Primary Phone *

Secondary Phone

1ST STUDENT'S INFORMATION

1st Student's First Name *

1 st Student's Last Name *

Date of Birth *

Grade Level *

Current / Most Recent School Name *

2ND STUDENT'S INFORMATION

2nd Student's First Name

2nd Student's Last Name

Date of Birth

Grade Level

Current / Most Recent School Name

3rd STUDENT'S INFORMATION

3rd Student's First Name

3rd Student's Last Name

Date of Birth

Grade Level

Current / Most Recent School Name

EMERGENCY CONTACT (E.C.)

Name and Phone 1 *

Name and Phone 2

MEDICAL INFORMATION

Any known allergies?

Yes

Please, all know allergies, if any!

Family Phisician's Name

Phisician's Phone

TERMS OF APPLICATION *

By submitting this application, I agree and understand that I will have to pay a withdrawal penalty of up to 2 months of tuition per student withdrawn, if I decide to withdraw any student from Taubah Academy after the first 30 days of Taubah's 2020-2021 Academic year (August 2020 - May 2021). Failure to pay the withdrawal penalty fee will result in withholding of student records and Taubah Academy reserves the right to initiate any legal action including reporting to credit reporting agencies. Do not submit this application If you do not agree to these terms

Required

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