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Mommy & Me Registration Form

  • Date Format: MM slash DD slash YYYY
  • I/We, the undersigned parent(s) or guardian(s), seek to enroll the above named child in the “Mommy and Me” program at Canyon Heights Academy for the following:

  • This contract is contingent upon acceptance by Canyon Heights Academy at which time a countersigned copy of the contract will be returned to the parent(s) or guardian(s).

    I/We agree to pay the required tuition, in accordance with the terms and conditions specified below and understand that payment in full must be made prior to the start of each session.

    Tuition Obligation
    I/We understand and agree that my/our obligation to pay the tuition due for the full quarter (or year) is unconditional regardless of circumstances. I/We further understand that this Enrollment Contract does not affect Canyon Heights Academy’s right to dismiss the above student. The basis for any such dismissal of a student shall be determined at the sole discretion of Canyon Heights Academy. Eligibility for refunds of cost will be determined as of the date the student is officially dismissed.

    School’s Reserved Rights
    Canyon Heights Academy reserves the unconditional right to take disciplinary action, suspend, or dismiss any student whose progress or conduct or whose parent’s / guardian’s conduct, (whether or not on Canyon Heights Academy property and under any circumstances) is considered by Canyon Heights Academy in its sole and absolute discretion to be unsatisfactory and/or in violation of the mission of Canyon Heights Academy. Canyon Heights Academy reserves the unconditional right to modify and amend its policies at any time as required to comply with federal, state, and local laws.

    I/We hereby consent to the use of school photographs and/or videos, which may include myself /ourselves and my /our child in school publications, newsletters, and web pages on the Internet, calendars, occasional news releases, or other promotional uses of Canyon Heights Academy. I/We understand and agree that Canyon Heights Academy does not need to notify me/us or solicit my/our approval or compensate me/us in any way prior to using any such photographs or videos.

    If the student or parent should require medical attention of any sort while in attendance at or during travel to, from, or in connection with, Canyon Heights Academy the school's staff is hereby authorized to: administer first aid, have the student transported to a doctor or hospital, have the student examined and treated by a doctor, and take whatever additional action the school may deem necessary to protect the student’s health and welfare. I/We the undersigned parents agree to pay for any such medical procedures or treatment, and agree to release, hold harmless and indemnify Canyon Heights Academy from any and all claims and damages, in accordance with the terms of the release set forth below.

    I/We release and waive, and further agree to indemnify, hold harmless or reimburse Canyon Heights Academy, the individual members, directors, officers, agents, employees and representatives thereof, from and against any claims (including defense attorney's fees to enforce this indemnity provision) which I/we, any other parent or guardian, any sibling, the student, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries to the student or to myself, or to any person or property, during the time of the student’s attendance or my physical presence at Canyon Heights Academy, during travel to or from Canyon Heights Academy, and during any activity which may occur off of the Canyon Heights Academy property, whether or not such losses, damages or injuries were sustained in connection with the school or its activities and arising out of or in connection with the rendering of emergency medical procedures or treatment by Canyon Heights Academy staff for my/our child as authorized in this enrollment contract.

    Non-Discriminatory Policy
    Canyon Heights Academy does not discriminate against applicants and students on the basis of race, sex, color, and national or ethnic origin. Canyon Heights Academy adopts this racially nondiscriminatory policy as to students, makes this policy known to the general public, and operates in a bona fide manner in accordance therewith in administration of its educational policies, admissions policies, tuition assistance, scholarship and loan programs (if any), and other school administered programs.

    This enrollment contract is a contract of adhesion and any modifications to it or failure of both parents / legal guardians (if applicable) to sign it in its entirety without amendment or alteration shall make the contract void and preclude your child from attending Canyon Heights Academy. This contract should be interpreted in accordance with the laws of the State of California and enforceable in court.

    In consideration of the acceptance of this contract by Canyon Heights Academy, I/we, the parent(s)/guardian(s) of the above named student, have read, understand, and agree to the terms and conditions of this contract. Two signatures are required (if applicable).

  • Please select your relationship with the child you are enrolling
  • Date Format: MM slash DD slash YYYY
  • Acceptance by Canyon Heights Academy

    School Representative _________________________________________________________ Date: ___________________________

    Signature: _______________________________________________

  • IMPORTANT: Upon submission of this form you will be redirected to our payment processing site. Your application is not complete without a valid payment.