CLICK HERE TO VIEW THE 2009 ORIENTATION PRESENTATION. YOU WILL NEED YOUR ID AND PASSWORD.
NEW REGISTRANTS ONLY
Thank you for completing the Registration Form. It is very important to establishing good records regarding your student's educational development and maintaining adherance to state statutes.
We are looking forward to meeting you and thank you for registering at Interactive Education Academy.
Important! This online Registration Form must be completed by a parent or guardian. A separate form needs to be completed for each student.
PLEASE DO NOT FORGET TO CLICK ON THE "SUBMIT FORM" BOTTON AT THE END OF THE ENROLLMENT FORM TO RECORD AND SEND US YOUR ANSWERS.
Parent/Guardian Information: This individual will be the primary contact person.
General Information
Student First Name
Student last Name
Student ID (Included within the Registration email)
Student Social Security Number
Parent/Father Social Security Number
Parent/Mother Social Security Number
Mailing Address
City
State
Zip
Home Phone Number Cell
Work Phone Number
Student Development History
Please click on any of the following evaluations that your student received:
VISION Date of last exam
Who administered the exam
YesNo Glasses were prescribed
HEARING Date of last exam
YesNo Corrective action was prescibed
OT Date of last exam
SPEECH Date of last exam
School History
YesNo Your Student has/has not been retained?
If so, What Grade?
LEARNING DISABILITIES Date of Psychological
General conclusions
YesNo Your student has/does not have an Individualized Education Plan (IEP)?
If "Yes", click on those services that were/are provided:
Specific Learning Disabilities Severly Emotionally Disturbed
Educable Mentally Handicapped Emotionally Handicapped
Speech and Language Other Health Impaired
Please check any of the areas in which your student struggles:
Math Language Arts Reading Social Studies Science
Medical History
YesNo History of Allergies?
If so, what is your student allergic to?
What presription medications does your student take?
YesNo Is your student physical activity limited?
If so, why?
Emergency Contact (Should the Parent not be reached)
Relationship to Parent
Emergency Contact Address
Emergency Contact Home Phone
Emergency Contact Cell Phone
Emergency Contact Work Phone
Preferred Hospital
Insurance Carrier
Group/Policy Number
Permission Slip Approvals
Emergencies: I authorize treatment or hospital procedures as may prescibed or performed by the attending Physician and/or paramedics for my child/student and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/Guardian can be reached in case of an emergency.
I agree
I disagree
Field Trips: I grant permission for my child/student to go on field trips. I release miCommunity, Interactive Education Academy (IEA), Interactive Education Network (IEN), and SunSet Bay Chapel from liability in case of an accident as long as normal safety procedures have been taken.
School Directory (Please note that the School Directory is for the intended use of members only): I grant permission to use my name in the School Directory as indicated my my "Yes" answer to each category listed below. A "No" answer indicates that I do not want my name used in that speciafic category.
YesNo I want only my name listed in the Directory
YesNo I want only my name and address listed in the Directory
YesNo I want only my name, address, and phone number listed in the Directory
YesNo You can include my email address
YesNo I am willing to give my name to prospective parents for a testimonial
Over-the-counter medications: My chilld/student has my permission to take the following over-the-counter medications. I understand that I must bring the sealed bottle with my child/student's name on it to the miCenter or IDA.
List over-the-counter medications and dosages
Any special instructions?
I Agree
I Disagree
Prescription Medications: My child/student has my permission to take the following prescribed medications. I understand that I must provide miCenter or IDA with these medications in its original container.
List prescription medications and dosages
Transportation: Iagree to release and forever waive any claims which may arise against miCommunity, Interactive Education Academy (IEA), Interactive Education Network (IEN), and SunSet Bay Chapel, its employees and volunteers. This waiver of rights shall be effective immediately and shall continue to be enforced during any situation in which trasportation of my child/student required or provided.
Release of Claims: I agree to the release and forever waive any claims which may arise against miCommunity, Interactive Education Academy (IEA), Interactive Education Network (IEN), and SunSet Bay Chapel, its employees and volunteers. This specifically includes all claims and demands of whatever nature, actions and cause of actions, damages, costs. loss of services, expenses, and compensation on account of or in any way growing out of personal injuries, illnesses and/or property damage having already resulted or to result at any time in the future, whether or not contemplated at the present time or whether or not they arise following the execution of this release. This release expresses a full and complete release of any liabilities, past and future, which may be claimed against miCommunity, Interactive Education Academy (IEA), Interactive Education Network (IEN), and SunSet Bay Chapel, its officers, employees and volunteers.
Family Handbook: The "Family Handbook" contains statements and rules-of-thumb guidance designed to faciitate the running of all miCommunity entities; while attending an IDA facility or miCenter and while working from home. Some of the sections of the handbook pertain more to IDA than to MiCenter and visa versa. We will review "Family Handbook" during the Orientation Session, answer your questions and welcome your feedback. Click here to review the "Student Policy and Procedure Manual".
Parent Goals
What are the "3" primary Objectives that you want your student to achieve?
Goal # 1
Goal # 2
Goal # 3
Thank You!
Thank you for taking the time to establish a record file for your student. Remeber that we will have a copy of your form at the Orientation Session and will review it with you at that time. Below you can indicate any comments and topics that you will want to review with us more thoroughly at the Orientation Session.
Comments and Topics
DO NOT FORGET TO SUBMIT THE FORM BEFORE YOU CLOSE THIS DOCUMENT!
We will be in touch within the next 24 hours.
