LifeWise Student Enrollment Permission Slip
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<p><strong>The form below is for the 2024-25 school year (next year), but we would love for your child to start right away. Enrollment is always open.</strong></p><p> </p><p><strong>Click </strong><a href="https://form.jotform.com/231427736742156" target="_blank"><strong>HERE</strong></a><strong> to register for the current school year, too.</strong></p><p> </p><p>In addition to their regular classes, parents have the option of enrolling their children in LifeWise Academy.</p><ul><li>LifeWise Academy is a non-denominational, Bible-based released time religious instruction program emphasizing character education.</li><li><strong>New Albany Primary & Intermediate School students (Grades 1-6) will meet once per week every week during their lunch and recess time. </strong>Day of the week will be determined based on registrations. </li><li>Students will be transported to and from their LifeWise classes by background- and reference-checked program staff and volunteers.</li><li>For more details, visit our website at <a href="https://lifewise.org/district/3904699-oh-franklin-county-new-albany-plain-local/" target="_blank">lifewise.org/newalbanyoh</a>.</li></ul>
Ask for gender?
Please select...
Yes
No
Enrolling for 2023-2024?
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Yes
No
Ask for Classroom Teacher?
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Yes
No
Ask if student is homeschooled?
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Yes
No
Allow option to add additional parent information?
Ask T-Shirt Question?
Ask for Additional Email Address?
Ask Student Needs Question?
Ask custom consent questions?
Student Information
First Name
Last Name
Birth Date
Gender
Please select...
Male
Female
School Year
Please select...
2024-2025
School Year
Please select...
2023-2024
2024-2025
School
Grade
Classroom Teacher
Is your student homeschooled?
Please select...
Yes
No
Shirt Size
Please select...
Youth Extra Small
Youth Small
Youth Medium
Youth Large
Adult Extra Small
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Parent/Guardian Information
First Name
Last Name
Relationship to Student
Email
Phone Number
Street Address
City
State
Zip Code
Add another Parent/Guardian
Additional Parent/Guardian Information
First Name
Last Name
Relationship to Student
Email
Phone
Do you have the same address as the Parent/Guardian above?
Please select...
Yes
No
Street Address
City
State
Zip Code
Additional Information
Additional Email Address for Classroom Communications
Does your student have any learning, behavioral or emotional needs of which we should be aware?
Please select...
Yes
No
Please explain your student's needs:
Does your student have any health concerns or food allergies of which we should be aware of?
Please select...
Yes
No
Please list your student's health concerns/food allergies:
Does your student take any prescribed medications?
Please select...
Yes
No
Prescribed medications
Does your student have any medication allergies?
Please select...
Yes
No
Medication allergies
Signs & symptoms
Action plan
Preferred Physician Name
Preferred Physician Phone
Preferred Hospital Name
Preferred Hospital Address
Do you consent to the photography or video of your student while in LifeWise, for promotional purposes?
Please select...
Yes
No
Do you consent to the disclosure of personally identifiable information (as defined in FERPA) including medical information to LifeWise personnel in the event of a medical emergency or for reasons determined by the school district as appropriate.
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Yes
No
Do you agree with the above statement?
Please select...
Yes
No
Yes, I choose to allow my child to attend LifeWise Academy classes. I have read and fully understand the terms of the
Release and Waiver
and I am voluntarily giving up substantial legal rights, including the right to sue LifeWise Academy.
I understand that this form will not be processed until I verify my email address in the next step.
Signature
Your Full Name
Signature
Do you accept this signature as your own?
Yes
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<p><em>This program is not sponsored by New Albany - Plain Local Schools. Student participation is voluntary upon written permission of the parent.</em></p>
School Year ID
Director Email
School Year One Option
School Year Two Options
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