Father’s Name: _Mother’s Name_______

Father’s Social Security No. ____________________Mother’s Social Security No. __________________________

Mailing Address: ________________________________________________________________________________

Physical Address: ________________________________________________________________________________

City: ____________________________State: __________Zip______________Home Phone #: _________________

Father’s Place of Employment: ______________________________ Work Phone #: ________________________

Mother’s Place of Employment: ________ Work Phone #: _

Father’s Cell Phone #: ___________________________ Mother’s Cell Phone #: _____________________________

Emergency Contact: _______________________________________ Phone #: _______________________________

Student’s Full Name: ______________________________________________________________________________

Date of Birth: ________________________ Grade for 2009/10: __________Age: ___________ Sex: ______________

Student’s Social Security Number: ___________________________________________________________________

School Last Attended: ______________________________________________________________________________

Address: ____________________________________City______________________St________Zip_______________

Additional Information: ____________________________________________________________________________

_________________________________________________________________________________________________

Allergies / Health Problems: _________________________________________________________________________

__________________________________________________________________________________________________

Family Physician: ____________________________________Telephone: ____________________________________

REVERSE SIDE OF FORM MUST BE SIGNED AND DATED

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CONTRACT

In making this application, I (we) understand that this application, when accepted by Sylva-Bay Academy, Inc., constitutes an agreement between Sylva-Bay Academy, Inc. and myself, subject to acceptable performance by the student and the student abiding by the rules of the school. Sylva-Bay Academy, Inc., reserves the rights to expel, suspend, or discharge any student who becomes unruly, disobedient or disruptive. The Headmaster has the authority to discipline all students, which may include corporal punishment. I (we) agree to abide by all policies of Sylva-Bay Academy, Inc., presently existing or to be instituted during the school year.

I (we) understand that the school hours are from 8:00 a.m. to 3:00 p.m., and that the children should be dropped off no earlier than 7:30 a.m. and picked up no later than 3:15 p.m.

I (we) agree and promise to pay the tuition on or before the 1^st day of each month for which it is due. I (we) understand that a late fee of $20.00 will be charged if not paid by the 10^th of each month and interest at a rate of 20% per annum will be assessed after thirty days if tuition has not been paid. I (we) also understand that after fifteen days, if no satisfactory arrangements have been made, the student will not be allowed to return to school. Permanent removal of a student does not remove the liability from a parent/guardian for the past due account. Collection of these funds will be obtained by legal action or use of a collection agency if necessary.

I understand that I have two (2) options for the 2009/10 school year in regards to payment of tuition: 1) The total tuition amount can be spread over a ten (10) month period, OR 2) The total tuition amount can be spread over a twelve (12) month period in the following manner: Beginning June 2009 with the first payment followed by a payment each month through May 2010. HOWEVER, IF THE JUNE AND JULY PAYMENTS ARE NOT MADE IN A TIMELY MANNER, THE TUITION WILL ROLL BACK TO A TEN (10) MONTH PAYMENT PERIOD. I (we) understand that tuition is assessed for the entire month if the student(s) attend any portion of that said month. Tuition is non-refundable and due by the 1^st day of each month (August 1 – May 1). Tuition is only refunded on a pro-rated basis if the student and/or family move to a locale outside Jasper County or in the case of debilitating sickness.

I (we) agree to pay all book fees, capital improvement fees, activity fees, mandatory raffle, and any and all other charges associated with attendance at Sylva-Bay Academy, Inc., whether presently existing or to be instituted during the school year. All applicable interest will be assessed on any fees not paid by the due date. Failure to pay any fees within thirty days of the due date may result in the student not being allowed to return to school.

I (we) understand that all fees (tuition, raffle, library, etc.) on accounts are required to be paid in full a week prior to Semester and Final exams. Students will not be allowed to take 1^st or 2^nd semester exams unless their accounts are paid up to date.

I (we) further understand that a fee in the amount of $20.00 will be charged for any returned check.

I (we) agree and understand that I (we) shall be responsible for any and all tuition, fees, assessments and other charges that are stated herein that accrue and remain unpaid, and that in the event of default, I (we) agree to pay reasonable attorney’s fees and other costs of court that Sylva-Bay Academy, Inc. may incur, in collecting any of the sums that I (we) have agreed to pay herein.

I (we) the undersigned acknowledge that I (we) have read, considered, understand and agree to the foregoing requirements.

Father’s Signature: _____________________________________ Date: ______________________________________

Mother’s Signature: ____________________________________ Date: ______________________________________

GUARANTOR

Signature of Person Responsible for Account: __________________________________________________________

Printed Name: _______________________________________ Date: ________________________________________

ACTION BY BOARD

Admission Approved: Date: ________

President, Board of Directors

Sylva-Bay Academy, Inc., admits students of any race, color, nationality and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, nationality and ethnic origin in administration of its educational, employment, or admissions policies, its athletic or other school administered programs

Father’s Name: _______________________________Mother’s Name_____________________________________

Mother’s Place of Employment: ______________________________ Work Phone #: _______________________