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**Note that required fields are in bold**
First Name
Middle Initial
Last Name
Gender
Date of Birth
Calendar
Grade Level
Academic Interests
Parent/Guardian Name(s)

You may list both parents' name if applicable.

Email Address
Confirm Email

Must have 8 characters, at least one Upper Case letter, and at least one number.

Address Line 1
Address Line 2
City
State
Zip Code
Phone Number
Emergency Contact (Name)

in case of an EMERGENCY if Parents cannot be reached.

Emergency Contact (Relationship)

Relationship to student

Emergency Contact (Phone Number)
Emergency Contact (Email)
Does the student currently have any illnesses?
If yes, please describe. (If no, please type N/A)

If select "No" above, please type N/A in this field.

Is there medicines that the student use on a continuous, long-term basis? (If no, please type N/A)

If YES, please describe. If NO, please type NO.

Category
Will you be using Charter Instructional Funds?

We accept Charter Funds from Excel Academy and Valiant Prep for Summer Camps that start after July 2018. If you'd like to pay via Charter Funds, please have your class(es) selected and pay only the application fee portion at checkout. We will email you the charter fund payment instruction when we receive your application. To learn more, please call our office at (949)371-5785.

If yes, what is your Charter School?
If yes, who is your Charter Rep?
My Charter Rep's email
My Charter Rep's phone number
How did you hear about American Academy?
Please Accept Terms and Conditions: By proceeding with the enrollment and class registration to American Academy of Strategic Education, you [hereafter, "User"] agree to the following conditions. PLEASE READ: *Financially responsible: User agrees to be personally financially responsible at all times for any unpaid balance(s) associated with any and all costs, tuition, and/or fees incurred. User assumes all financial responsibility whether or not User's charter school ultimately agrees to pay such balance(s). Moreover, upon registration, User agrees to commit to and be personally financially responsible for the timely payment of all tuition owed for the length of the entire semester for which the Student is being registered and enrolled. Upon registration, User will have the option to pay the entire tuition balance due for the Semester at the time of the Student's enrollment and registration, or to pay the tuition due for the Semester using instructional funds to be paid by the charter school on a monthly basis. American Academy does not accept partial tuition payments, nor does it provide pro-rated refunds, regardless of the Student's actual attendance during the course of the Semester for which the Student has been registered or enrolled. *Self-provided curriculum: Unless otherwise instructed or noted, User agrees to personally provide curriculum or study materials for each of User's registered Student(s) at American Academy. *Able to learn and study independently: User states that, to the best of User's knowledge, each Student registered by User is able to study independently in a quiet environment with minimum supervision and assistance. American Academy staff reserve the right to determine a student's ability to study independently in a quiet environment with minimum supervision and assistance.
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