Heart Academy 2011-2012

Student:  _______________________________________                 Date of Birth:  ____/____/____

Address:  ________________________________________________________________________

City:  _______________________________                    State:  ______      Zip:  ____________

Parents’ (or Guardians’) names:  ________________________________________________________

Home phone: (____)____________                    Email address:  _______________________________

Dad’s cell/daytime #: (___ )__________           Mom’s cell/daytime #:  (___ )__________     

    Heart Academy’s Discipline Plan is as follows:

      1st Offense:  Teacher(s) will contact the parent.

      2nd Offense:  Parent will come to Heart Academy for a conference & will sit with the child in

                class(es) the next Wednesday that the child attends Heart Academy.

     3rd Offense:  Child is dismissed from Heart Academy.

     I have read & understand Heart Academy’s discipline policy:

     Parent’s signature: __________________          Student’s signature: ___________________