Horizons Academy Enrollment Form

2026-2027

Student Information

First name

Last name

Phone

Birthday

Month

Day

Year

Address

Parent Information

Emergency Contact Information

Parent/Guardian First and Last Name

Short answer

Emergency Phone Number

Short answer

Primary Contact Employment

Short answer

Emergency Relative or Friend Contact Information

Short answer

Medical Information

Student Known Allergies

Long answer

Diagnoses, if applicable. Medical and/or Learning *abilities*

Long answer

Education Information

Grade of Student

Favorite Subjects

Short answer

Areas of Strengths

Long answer

Areas of Weakness/Concerns/Needs Support

Long answer

Program Enrollment

Preferred Program Investment Plan

Multi choice

Paid in Full (5% Tuition Discount)

Semi-Annual Payment Plan (3% Tuition Discount)

12-Month Payment Plan (June–May)

11-Month Payment Plan (July–May)

10-Month Payment Plan (August–May)

Tuition Discount

Multi choice

Military & First Responder Discount

Sibling Discount

Financial Agreement

I understand that tuition is due on the 1st day of each month. Payments received after the 3rd day of the month are subject to a late fee in accordance with the Enrollment Agreement.

Single choice

I Acknowledge and Agree

Financial Agreement

Single choice

I understand that tuition is due on the 1st day of each month. Payments received after the 3rd day of the month are subject to a late fee.

I understand that the Enrollment Fee is non-refundable and reserves my student's placement in the program.

I understand that tuition is due regardless of student attendance, including absences, vacations, illness, holidays, school breaks, or temporary suspension, unless otherwise agreed to in writing by EUTR, LLC.

I understand that failure to remain current on tuition or other financial obligations may result in suspension of attendance and/or withdrawal from Horizons Academy until satisfactory financial arrangements have been made in writing. Tuition obligations remain in effect unless released in writing by EUTR, LLC.

I understand that returned payments are subject to a $50 returned payment fee.

I have read, understand, and agree to the Financial Agreement and Tuition Policies of Horizons Academy | An EUTR Program.

Parent Authorizations & Permissions

Emergency Medical Authorization

Single choice

I authorize Horizons Academy | An EUTR Program, operated by EUTR, LLC, to obtain emergency medical treatment for my child if I cannot be reached. I understand that every reasonable effort will be made to contact me before treatment is obtained. I accept responsibility for all medical expenses incurred.

Medication Authorization

Single choice

I understand that Horizons Academy staff will administer medication only when proper written authorization has been provided by the parent or legal guardian, and all medication is supplied in its original labeled container.

Photo & Media Permission

Single choice

YES – I give permission for Horizons Academy | An EUTR Program to use photographs and/or videos of my child for educational, promotional, social media, website, and marketing purposes.

NO – I do not give permission for my child's photograph or likeness to be used.

Outdoor Activities & Walking Permission

Single choice

I give permission for my child to participate in supervised outdoor learning activities, walks, playground activities, and other educational activities conducted on or immediately adjacent to the Horizons Academy campus.

Transportation

Single choice

My child may be transported by Horizons Academy staff during academy-sponsored activities when separate written permission has been provided.

My child may not be transported by Horizons Academy staff.

Student Conduct & Parent Partnership Agreement

Please read each statement carefully and acknowledge your agreement.

Single choice

I understand that Horizons Academy | An EUTR Program is committed to providing a safe, respectful, and academically focused learning environment.

I understand that my child is expected to demonstrate respect toward faculty, staff, fellow students, visitors, academy property, and themselves.

I understand that parents and Horizons Academy staff work together as partners in supporting each student's academic, behavioral, social, emotional, and personal growth.

I understand that I am responsible for maintaining open communication with Horizons Academy regarding my child's educational, behavioral, medical, and emotional needs that may affect their participation in the program.

I understand that Horizons Academy reserves the right to implement appropriate behavioral interventions, parent conferences, temporary suspension, or dismissal when necessary to maintain a safe, respectful, and productive learning environment.

I understand that enrollment at Horizons Academy is contingent upon maintaining a positive partnership between the academy, the student, and the parent/legal guardian.

I have read, understand, and agree to abide by the Student Conduct & Parent Partnership Agreement

Parent Certification & Electronic Signature

Please read the statements below carefully before submitting this Enrollment Agreement.

Single choice

☐ I certify that I am the parent or legal guardian of the student identified in this Enrollment Agreement and have the legal authority to enter into this Agreement on the student's behalf.

☐ I certify that all information provided in this Enrollment Agreement is true, complete, and accurate to the best of my knowledge.

☐ I understand that this Enrollment Agreement constitutes a legally binding agreement between myself and EUTR, LLC, the legal entity operating Horizons Academy | An EUTR Program, upon acceptance by EUTR, LLC.

☐ I understand that Horizons Academy reserves the right to deny or revoke enrollment if false or misleading information has been provided.

☐ I acknowledge that I have read, understand, and agree to all policies, procedures, financial obligations, authorizations, and acknowledgments contained within this Enrollment Agreement.

Parent/Guardian Printed Name (Required)

Parent/Guardian Signature (Type Full Legal Name) (Required)

Date (Required)