Remote Learning Academy

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Remote Learning Academy Registration

Please take some time to read the following documents:

I understand it is my responsibility to complete a daily health screening form (online).

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I understand the program operates in accordance with the school policies found in the Parent/ Student Handbook.

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I understand my child is required to bring their assigned chrome book daily and it will need to be fully charged.

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Additional students may be registered with separate options on the next page. Please enter the details for the first student.

Student Information

Student First Name

Student Last Name

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Grade Level

Select a Grade Level

Programs

Deposit Remote Learning Academy - $100.00
Remote Learning Academy - $100.00

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Medical and/or Allergy Information

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Photo Permission

I give permission for my child to be photographed and/or videotaped during the current (2020/2021) school year at Lawrence Family Development Charter School. Invalid Input

I understand photographs may be used in publications, which report on school news and performance; and videotaping for study, research and teacher training purposes only. Please note that student pictures or videos can be used to highlight school activities on the school website. Parents are not allowed to take pictures or videos of students without permission from School Administration.

Finished?

Yes, I am finished
No, I have additional students to register Invalid Input

An additional student may be registered with separate options on the next page. Please enter the details for the second student.

Student Information

Student First Name

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Student Last Name

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Student Level

Select a Grade Level

Programs

Deposit Remote Learning Academy - $100.00
Remote Learning Academy - $100.00

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Medical and/or Allergy Information

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Photo Permission

I give permission for my child to be photographed and/or videotaped during the current (2020/2021) school year at Lawrence Family Development Charter School. Invalid Input

Finished?

Yes, I am finished
No, I have additional students to register Invalid Input

Please enter the details for the third student.

Student Information

Student First Name

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Student Last Name

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Student Level

Select a Grade Level

Programs

Deposit Remote Learning Academy - $100.00
Remote Learning Academy - $100.00

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Medical and/or Allergy Information

Invalid Input

Photo Permission

I give permission for my child to be photographed and/or videotaped during the current (2020/2021) school year at Lawrence Family Development Charter School. Invalid Input

An additional parent may be registered with separate options on the next page. Please enter the details for the first parent.

Parent Details

First Name

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Last Name

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Please let us know your email address.

Cell Phone Number

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Finished?

Yes, I am finished
No, I have additional adults to register Invalid Input

Please enter the details for the second parent.

Parent Details

First Name

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Last Name

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Email Address

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Cell Phone Number

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Additional emergency contacts may be registered with separate options on the next page. Please enter the details for the first emergency contact.

Emergency Contact

Name

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Address

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Phone

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Relation

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Finished?

Yes, I am finished
No, I have additional adults to register Invalid Input

An additional emergency contact be registered with separate options on the next page. Please enter the details for the second emergency contact.

Emergency Contact

Name

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Address

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Phone

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Relation

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Finished?

Yes, I am finished
No, I have additional adults to register Invalid Input

Please enter the details for the third emergency contact.

Emergency Contact

Name

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Address

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Phone

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Relation

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Payment Details

Please enter your payment information.

Your Total Charge

0.00 USD

Credit Card

Visa
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MasterCard
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Name On Card

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Credit Card Number

Please enter a valid Credit Card number

Expiration Month (MM)

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Expiration Year (YYYY)

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Card CVV Code

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Billing Details

These details should match with the billing details of your credit card.

Billing First Name

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Billing Last Name

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Billing Address

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Billing City

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Billing State

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Billing Country

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Billing Zip

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Billing Phone

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AuthorizeNet

Human Verification

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