Enrollment Form | Brooke House Academy

Enrollment for the 2024-25 school year is now open!

Please complete this online enrollment form to reserve your student's place for the upcoming school year. The enrollment form should take about 5-10 minutes per student. Upon submission, you will be prompted to pay the annual enrollment fee of $500.

Please contact info@brookehouseacademy.com if you have any questions.

Location

Maitland

Jacksonville

Student's Full Legal Name

Preferred Nickname (if different)

Date of Birth

Previous School

Has the student receved a Step Up scholarship?

Yes

No

Residential Street Address

City

State

Zip Code

Parent / Guardian - First Name

Parent / Guardian - Last Name

Phone

Email

2nd Parent / Guardian - First Name

2nd Parent / Guardian - Last Name

Phone

Email

Emergency Contact #1

Phone

Relationship to Student

Emergency Contact #2

Phone

Relationship to Student

Doctor or Office Name

Office Phone

Health Insurance

Policy #

Please list any health or medical conditions here, including any physical limitations.

Please list any allergies here.

Please list any prescription medications here.

Please list any diet limitations here.

Student Citizenship(s)

Student City, State, Country of Birth

sex

Female

Male

Select one - for reporting purposes only

Hispanic or Latino

Non-Hispanic

Emergency Authorization

In case of accident or illness, I hereby request to be contact at the phone numbers provided or through my emergency contacts until I can be reached. In the event of a serious accident or illness, I request that the school make whatever arrangements are necessary to provide emergency care and treatment for my child. I understand it is my responsibility to keep my profile and emergency contacts up to date.

Medical Information

I hereby warrant that all of the health and medical information provided above is true and correct and that I assume all responsibility for the health of my child and keeping my student's medical and health information up to date. I hereby consent for my child to take any prescription or non-prescription medication listed above or later requested in writing to the school. I understand that Brooke House Academy requires a current physical exam (FL DOH form 3040) and a current immunization form (FL DOH form 680) for every student.

Image / Media Release

I agree that Brooke House Academy may use my student's image and likeness for promotional purposes. For valuable consideration received, I expressly assign to Brooke House Academy all rights, interest, and use of my and my student's image or likeness including but not limited to photographs, video recordings, livestreams, or audio recordings taken on Brooke House Academy property or during Brooke House Academy events. I hereby waive any claim against and release Brooke House Academy, its employees, volunteers, and agents from any and all actions, liabilities, costs, and damages whatsoever in connection with the interest in or use of such image or likeness.

Financial Requirements

I agree to accept the obligations of the Brooke House Academy tuition and fee schedule for the current school year as set forth on the Brooke House Academy website.

Student and Parent/Guardian Handbook

I have read and agree to the Brooke House Academy Student / Parent Handbook located here on the Brooke House Academy website.

Enrollment Agreement

I hereby agree to each and every term of this Enrollment Agreement and affirm that all of the information contained in this enrollment application is accurate, complete, and honestly presented. I understand that withholding or misrepresenting information in this application is cause for denial of the application. I understand that submittal of this enrollment is not a guarantee of admission into Brooke House Academy.

Select a date

Parent / Guardian Signature