Wonder Learning Center Student Application

Student Personal Information

Any cells required*- If not applicable please fill in with N/A.

First Name

Last Name

Student's Birthday

Month

Day

Year

What grade will your student be attending in the 25/26 school year?

Student's Gender

Female

Male

Other

Does your student have any allergies/Intolerances (food, environment, drug)?

Yes

If Yes, what allergies and what is the reaction and Severity?

If Yes, is an EpiPen required?

Yes

Does the student require medications (OTC/Prescribed)?

Yes

If Yes, what medications/dose and time (if during the school day)?

Educational Background

Any cells required*- If not applicable please fill in with N/A.

Previous school/s attended (if applicable) (Provide, name, city/state, dates of attendance and grade levels, as well as reason for your student's departure):

If Homeschooling, please provide a brief summary of your current Homeschool approach, curriculum, and description of what grade level(s) your student is working in different subject areas:

Is your student “gifted” or “high IQ”, and if so, how/when and by whom was that determination made.

Does your student have learning differences, and if so, please explain and include how/when and by whom that determination was made? If undiagnosed, but suspected, please provide details here as well.

Please describe your student's learning style and any learning challenges or strengths.

In what type of learning environment would your child be most likely to find success?

Personal Student Background

Any cells required*- If not applicable please fill in with N/A.

Please describe your child in five words:

When your child is not learning/at school, what types of activities do they enjoy, and how do they spend the bulk of their time?

Does your child have chores or household responsibilities at home? Please describe briefly.

Wonder Classes & Offerings

Any cells required*- If not applicable please fill in with N/A.

If other, give a brief description:

If your student is taking ELA, Math, History and/or Science, are they interested in:

High School Credit

Honors Credit

Both Honors & High School Credit

If other, give a brief description:

Parent/Guardian Contact Information

Any cells required*- If not applicable please fill in with N/A.

Primary Parent/Guardian

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Secondary Parent/Guardian

First Name

Last Name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

YOUTH WAIVER & RELEASE OF LIABILITY

In consideration of being allowed to participate in any way in related events and activities, the undersigned, (full legal name):

Agree that the parent(s) and/or legal guardian(s) of the participant should inspect the facilities and equipment to be used, and if the parent or guardian believes anything is unsafe, he or she should immediately advise a supervisor (advisor, manager, etc.) of such condition(s) and refuse to participate.

Acknowledge and fully understand that each member/participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and sever social and economic losses which might result not only from their own actions, inactions, or negligence but the action, inaction, and negligence of others, or the condition of the premises or of any equipment used. Further, there may be other risks not known to us or not reasonably foreseeable at this time.

Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability, or death.

Release, waive, discharge and covenant not to sue Wonder Learning Center, its affiliated clubs, their respective administrators, directors, agents, and other employees of the organization, other members/participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors or premises used to conduct the event, all of which are hereinafter referred to as “releases,” from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death and damage to property, caused or alleged to be caused in whole or in part by negligence of the releases or otherwise.

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY

Name of Parent/Guardian

Name of Student

Parent/Guardian Relationship

Signature of Parent/Guardian

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Parent/Guardian phone number

Parent/Guardian address

PHOTOGRAPHY & VIDEO WAIVER

I understand there may be photos taken by Wonder Learning Center Administrators, Instructors, or other parties and sent to Wonder Learning Center Center. These photos may be used at Wonder Learning Center’s discretion for display on the internet, posters, advertisements, or any other publication. I understand that my presence at any function, event, field trip, etc., hosted by Wonder Learning Center is my unconditional consent to allow the use of your voice and likeness without compensation.

BY SIGNING THE BELOW, YOU CERTIFY THAT YOU HAVE READ THE WAIVER AND UNDERSTAND THE CONTENTS

Name of Student

Student Signature

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Name of Parent/Guardian

Parent/Guardian Signature

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APPLICATION FEE DISCLAIMER

Please note that a non-refundable application fee of $65 is required to submit your application to Wonder Learning Center. Payment of this fee does not guarantee admission or advancement to the next stage of the selection process. All applications will be carefully reviewed, and candidates will be contacted if selected to move forward.

I understand that this application will not be considered without the required application fee and that submission does not guarantee acceptance or selection for the next steps in the admissions process.

Name of Parent/Guardian

Parent Signature

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Application Packages:

Single Student Application$65

Full Family Application (3 or more students)$150

Wonder Learning Center Student Application

Student Personal Information

Educational Background

Personal Student Background

Wonder Classes & Offerings

Parent/Guardian Contact Information

YOUTH WAIVER & RELEASE OF LIABILITY

PHOTOGRAPHY & VIDEO WAIVER

APPLICATION FEE DISCLAIMER

Notice of Non-discriminatory Policy