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Application Form

Windjammer Plaza, 461 Walkers Road, George Town, Grand Cayman

Email: info@ascendtechacademy.com
Phone: +1 (345) 326-2882
Website: https://ascendtechacademy.com

Firstname:

Lastname:

Date of Birth:

Gender:

Male Female Other

Address:

District:

PO Box and PostCode

Nationality:

Primary Language Spoken at Home:

Schools Attended:

Years attended:

Schools Attended:

Years attended:

Schools Attended:

Years attended:

Primary Guardian:

Firstname:

Lastname:

Relationship to Student:

Please provide more information if other:

Phone Number:

E-mail address:

Secondary Guardian (if applicable):

Firstname:

Lastname:

Relationship to Student:

Please provide more information if other:

Phone Number:

E-mail address:

Does the student have any allergies?

Yes No

If yes, please specify:

Does the student have any medical conditions?

Yes No

If yes, please specify:

Primary Doctor’s Name:

Doctors Contact Number:

Does the student have any medical conditions?

Yes No

If yes, please specify:

Heath Insurance Provider (if applicable):

Policy Number:

EMERGENCY CONTACT INFORMATION (if different from parent/guardian information)

Emergency Contact Name:

Relationship to Student:

Phone Number:

I, the undersigned parent/guardian of the above-named student, hereby give permission for Ascend Tech Academy Ltd. to seek medical attention for my child in the event of an emergency. I understand that reasonable efforts will be made to contact me before initiating medical care. However, if I cannot be reached, I consent to my child receiving emergency medical treatment as deemed necessary by qualified medical personnel.

Parent / Guardian Signature:

Date

I understand and agree to the policies of Ascend Tech Academy Ltd.

I confirm that the information provided in this form is accurate and up-to-date.

I consent to my child's participation in academy activities.

I understand the risks associated with unsupervised one-on-one situations with children and adults.

I understand that photographs and videos of my child may be taken during activities and used for promotional purposes.

Yes No

Parent/Guardian Signature:

Date

Ascend Tech Academy

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info@ascendtechacademy.com
+1 (345) 326-2882

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Application Form

Ascend Tech Academy

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