Offer Forms - Independence Academy

Welcome to Independence Academy

Please review all linked documents and complete all sections.

Child Medical Information

Child's Name(Required)

First

Last

Any Known Allergies:(Required)

Treatment:

Health Limitations:

Emergency Medications:

Daily Medications:

Any Other Health Information You Think We Should Know:

*If health information changes, please inform the director and the child’s teacher as soon as possible. Additional forms for medication, including emergency medication, are required.

Acknowledgements and Permissions

I have read the IA Photography Waiver Information below.

IA Photography Waiver

Please select one:(Required)

I do allow my child to be photographed

I do not allow my child to be photographed

For children to participate in nature walks, visit the outdoor classroom, and participate in specials events such as trunk or treat, permission must be given to play outside the fenced area. Enrollment in all Inde Nature School programs requires permission to play outside the fence.

Please select one:(Required)

I do give permission for my child to play outside the fenced area

I do not give permission for my child to play outside the fenced area

I have read the Assumption of Risk, Release, and Indemnity Information below.

Assumption of Risk, Release, and Indemnity

Payment will be made monthly via Quickbooks invoices. Please indicate below whether you will be paying via ACH Bank Transfer or Check.(Required)

ACH Bank Transfer (1% Processing Fee) made online

Check (no Processing Fee) placed into DropBox outside of Office Door

Credit/Debit Card (3% Processing Fee) made in person at The Inde Nature School Office

Name(Required)

First

Last

Date(Required)