Allendale Academy
7208 Amhurst Way
Clearwater, Fl 33764
(727) 531-2481 Office hours Mon-Thu 10am-2pm Est.
e-mail: adacademy@aol.com
STUDENT NAME_____________________________________DATE______________
S.S.#__________________________________PHONE#(_____)___________________
MAILING ADDRESS_____________________________________________________
_______________________________________________________________________
BIRTH DATE_______________ BIRTH PLACE__________________AGE_________
SEX__GRADE ENROLLING IN___E-MAIL ADDRESS (Parent's)________________
NAME AND COMPLETE MAILING ADDRESS OF LAST SCHOOL ATTENDED
________________________________________________________________________
________________________________________________________________________
OUR SCHOOL YEAR BEGINS (m/y)_____________ AND ENDS (m/y)_____________
| We,___________________________________and______________________________ as
parent educators agree to uphold the requirements of Allendale Academy, namely: either
teach 180 days per year, or complete the curriculum for the grade level listed above; to
keep a report card showing subjects taught, and grades earned in each subject, and an
attendance record; to submit a copy of the report card to the Director at the end of each
semester and the attendance record at the end of our school year; to keep in our home a
portfolio consisting of a list of materials used and samples of student's work; and to
provide for testing or an evaluation of our student and submit a copy of the results to
the Director at the end of our school year.
We understand that Allendale Academy is a private school whose purpose is
to provide parents with the opportunity to instruct their children at home. We understand
that any advice given by the school and its officers and director is not guaranteed by the
school. We release Allendale Academy from any liability. We assume all responsibility for
compliance with all requirements with regard to education in our state. We understand
Allendale Academy is not liable for any neglect on the parent's part. We understand, if we
withdraw from Allendale Academy, our financial obligations must be met before our
student's records will be released.
Signed:___________________________
Signed:__________________________
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