Upload Student Application 2023-24
School begins on September 5, 2023. A $50 non-refundable application fee per family is due before school starts. (Cash or check to Upload Student is accepted. Venmo @UploadStudent. Credit card and Venmo requires an additional 3% fee.) Please fill out a separate application for each student.
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Email *
Student's first and last name *
Student's age *
Required
Student's birthdate *
Program registration *
Required
Student's approximate grade level *
Required
Home Address *
Primary Guardian's First and Last Name *
Primary Guardian's Phone number *
Primary Guardian's Email *
Secondary Guardian's Name
Secondary Guardian's Phone number
Secondary Guardian's Email
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship to Student *
Last school attended or academic experience *
If you have specific curriculum that you want to use for your child's education, please describe below.
How do you plan to pay for Upload Student tuition? *
Are you applying for public school support through Tech Trep Academy or Overture Learning for additional free resources and up to $1700 reimbursement per year? Please understand that there are additional student and parent responsibilities for these families. *
Can you provide a physical copy of student's birth certificate by school start date?  *
Have you read and agree to the Upload Student Handbook? *
Do you want Upload Student to provide nutritious, homecooked student lunches? Cost is $4 per meal. *
Does your child have any allergies? Please describe.
My child may be given the following when necessary: (Check boxes to indicate "Yes") *
Required
Does your child require medication during school hours? If yes, please list type and dosage.
Physician's Name and Phone Number
What are your student's strengths? *
In which areas does your child need the most support? Check all that apply. *
Required
Does your child have any learning or behavioral disorders? If so, please explain.
Has your child ever been suspended or expelled from any other school? If so, please explain.
Are you interested in volunteering at Upload Student? Background checks required. *
Did a friend or family member refer you to Upload Student? If so, please give me their name, so we can thank them!
Do you agree to support and celebrate your child's academic progress, such as encouraging independent study as well as supporting your child's entrepreneurial efforts at the Youth Business Fair at the end of the school year? *
Photo Permission: I hereby authorize Upload Student to photograph or video my child for the following purposes: 1. Advertisement of school and school programs. 2. Media coverage featuring students that are considered "human interest" or "good news" stories, not controversial in nature or containing sensitive subject matter. *
Release of Liability: By signing this form electronically, I acknowledge that I am the legal guardian of the child(ren) named above, and I consent to my child(ren) taking part in school activities. I understand that there is always the risk of injury, loss, death, and possible medical expenses. I assume all risk and expenses. I release Upload Student and any representative from all liability and waive any claims or causes of action against it or its agents related to any and all activities and/or transportation provided by it. I consent to the application of first-aid or other emergency medical services to be applied to my child(ren) if needed, in connection with a health problem or emergency, including calling 911 for an ambulance. I agree to hold Upload Student harmless as a result of any such injury or damage I may suffer due to the application of treatment, medical services, or emergency medical care provided or offered to my child(ren). I affirm that the information provided is true, correct and complete, to the best of my knowledge and belief. This electronic signature below and its related fields are treated by Upload Student like a handwritten signature on a paper form. *
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