Student Information Name(Required)
First
Last
Program Enrollment My student will be:(Required)
BOARDING STUDENTS Requests or Concerns around Boarding:
Guardian Information & Emergency Contact Guardian 1(Required)
First
Last
Guardian 2
First
Last
Primary Address (Student's Home Address)(Required)
Emergency Contact(Required)
First
Last
In the event we can't get ahold of a primary guardian, who do you want us to call?
Student Medical Information & Records Dietary Restrictions(Required) Known Medical Conditions(Required) Consent: Self-Administration of Prescribed Medication(Required) Students that take medications can be allowed to self-administer their own medications. By saying yes, you agree that your student is competent and able to administer their own medication. You agree that your student can carry their medication on them, when appropriate. You agree that all medications will be in their originally labeled bottle. You agree that you will provide a note from the prescribing physician that your student can self administer, and that you will do so with this submission or submit it before the school year begins.
What over the counter medications can your student have at school (be administered by trained staff)? Consent: Administration of OTC medications by a trained staff member:(Required) At times, it may be necessary to administer OTC medications to your student. If your student asks for an approved OTC medication, do you consent to the student getting medication from a trained professional on staff?
Consent: Self-Administration of OTC medications by the Student(Required) Is your student able to give themselves OTC medications?
Has your child begun menstruation?(Required) Tampons(Required) Does your child use/have permission to use tampons?
Does your child require an epi-pen?(Required) Children that require an epi-pen must provide an extra set to the ICON front office.
Primary Care Provider
First
Last
Specialty Care Provider
First
Last
Dentist
First
Last
Transcripts: List School, Address, Contact Name, and Contact number or email
Optional: Extended Student Information
Consents, Releases & Acknowledgements Incidentals(Required) I agree
Parent agrees to pay the School for incidental fees, such as interest, Extended Day charges, field trips, etc. charged to Parent’s account within thirty days of receipt of each statement.
School Rules(Required) I agree
Student’s enrollment at the School is subject to the general statements, rules, regulations, conditions, and financial terms contained in the School’s Student and Family Handbook and other published documents, which may be amended from time to time. Parent acknowledges that Parent and Student must abide by such School rules and guidelines.
Support(Required) I agree
Student’s enrollment at the School is subject to Parent support of the standards of the School in its philosophy, methods, objectives, and policies, including moral, academic, behavioral, dress, conduct, and disciplinary standards; to assume the responsibility for parental monitoring of Student’s education, being an encouraging influence, and keeping in regular contact with Student’s teachers, keeping informed on the student’s well-being and success.
Termination of Student's Attendance(Required) I agree
The School has the right to suspend or terminate the attendance of any student for reasons set forth in the Student and Family Handbook, for reasons that the School Administration considers detrimental to the School community, student, or to other students of the School, or for the Parent’s failure to pay all or any part of the Parent’s financial obligations for Student’s attendance (including any amounts charged on Student’s account with the School).
Damages(Required) I agree
The Parent assumes responsibility for any damage to the School property caused by the Student or chargeable to him/her under the rules and regulations of the School. The Parent acknowledges and agrees that the School shall have no responsibility whatsoever for any damage or loss sustained by the Student to his/her personal property while it is located on the School premises or is accompanying the Student on any School-related or other trip.detrimental to the School community, student, or to other students of the School, or for the Parent’s failure to pay all or any part of the Parent’s financial obligations for Student’s attendance (including any amounts charged on Student’s account with the School).
Legally Binding Contract(Required) I agree
This Contract is between the Iowa Conservatory (hereinafter the “School”) and the parent(s) or legal guardian(s) (referred to as “Parent,” which term includes the singular or plural, as applicable) of “Student”. All persons signing this Contract are jointly and severally liable for the tuition and fees set forth herein. Parent’s signature and/or initials on this Contract evidence Parent’s understanding and agreement to the terms of this Contract.
Registration & Student Life Fee(Required) I agree
Parent understands that the $350 Annual Registration Fee is an expense that is worked into the ICON tuition invoice. The Annual Registration Fee is non-refundable.
Tuition Obligation(Required) I agree
Parent understands that Student is being enrolled for the entire School Year or period covered by this Contract. Parent further understands that the overhead expenses of the School do not diminish with the departure of some students during the course of the school year and agrees that it is impossible for the School to determine at the time of Parent’s execution of this Enrollment Contract the damage and loss to the School that would occur due to the later cancellation/withdrawal of some of the students who have enrolled. Therefore, once this Contract has been submitted to the School, Parent becomes liable for the entire year’s tuition and fees as liquidated damages (and not a penalty) even if the Student is withdrawn, absent, or is involuntarily separated from School UNLESS the Parent terminates this Contract in strict accordance with the termination procedures set forth below (or the School rejects, in its sole discretion, Student’s enrollment and unilaterally terminates this Contract). If Student is withdrawn, absent, or involuntarily separated, for any reason, including without limitation, change of residence, health, withdrawal, or expulsion, after the termination dates set forth, there will be no refund or reduction of fees or tuition, and any unpaid balance may, at the School’s election, become immediately due and payable.
Termination Procedure(Required) I agree
The Parent may terminate this Contract by submitting a WRITTEN Termination Notice to the Registrar by the dates indicated below. The Termination Notice must (a) be dated, (b) state the Student’s name, (c) provide a reason for the termination of the Contract; and (d) be RECEIVED by the Registrar on or before the Termination Date. If such Termination Notice is timely received, the Parent will be relieved of all tuition paid and other payments and fees that would have come due after the Termination Date. Even if this Contract is terminated pursuant to the terms of this Paragraph, Parent understands that the School will not refund any portion of the Student’s Tuition Deposit set forth. The Termination Dates are as follows: A. If the Student was enrolled by March 1st (prior to the start of the academic year applicable to this Contract), the Termination Notice in form stated above must be RECEIVED by April 15th (prior to the start of the academic year applicable to this Contract). B. If the Student was enrolled after March 1st, but before June 1st (prior to the start of the academic year applicable to this Contract), the Termination Notice in form stated above must be received by the EARLIER of ten (10) days after payment of the Tuition Deposit set forth OR May 31st (prior to the start of the academic year applicable to this Contract), whichever occurs first. C. If the Student is first enrolled on or after June 1st (prior to the start of the academic year applicable to this Contract), no termination option is available.
Tuition Refund Plan(Required) I agree
Parent has received and read the Tuition Schedule detailing the terms and conditions, which are set forth in a separate document made available to Parent. Parent understands that in the event of Student’s separation from School, the Tuition Refund Plan will provide a percentage of the yearly tuition (as determined in accordance with the Plan’s terms and conditions). The amount paid by the Plan will be credited to the Student's account. Any overpayment on Student’s account will be reimbursed to Parent and any underpayment will be billed to Parent. Any such balance is payable on demand. Parent authorizes the School to process and collect any claim payment to which Parent is entitled under the Tuition Refund Plan and credit it to Student’s account, paying any excess to Parent. The School will not make any other refunds or adjustment to the Student's account other than through the Tuition Refund Plan.
Reimbursement for Domestic Legal Issues(Required) I agree
The Parent understands and agrees that the School’s primary purpose is to provide educational opportunities to the students within its institution. The Parent also understands that it is disruptive to the School for a Parent to involve the School (or any of its employees) in domestic legal disputes between the Parents and that the School often must pay for legal fees and costs associated with such issues. Therefore, the Parent agrees to promptly reimburse the School for all expenditures incurred by the School as a result of Parent’s domestic legal disputes, including, but not limited to: Parental disagreements about Student’s education or placement; divorce proceedings; custody proceedings; and/or modifications of custody proceedings. Cost incurred may involve reasonable attorneys’ fees/costs to prepare for and/or attend depositions, trials, or hearings; communication with Parent or Parent’s counsel, guardians ad litem or attorneys ad litem; respond to subpoenas; draft letters or motions; and perform research. Costs include the cost of copying documents, providing records, engaging substitute teachers or temporary employees, computerized research, and travel expenses. Parent agrees to reimburse the School for such fees/costs within thirty (30) days of School billing Parent for such expenses. Any dispute between the Parents regarding which Parent may owe which portion of the bill should be resolved between the Parents so that the bills for reimbursement to the School can be paid on a timely basis. Parent’s failure to pay such fees/costs promptly will result in dismissal of the family from the School.
Off Campus Consent(Required) I agree
As the parent/guardian of the student, I am aware of the “Off-Campus” privileges available to my student per Iowa Conservatory’s policy. By initialing, I consent to my student leaving campus for all school-related activities as well as non-school-related activities that will not be supervised by ICON’s Faculty and Staff, which may include, but are not limited to obtaining a meal throughout the academic day; personal shopping in the Iowa City downtown area during free time activities; other activities my student will have opportunities to participate in during free time at the School. Throughout the year, students at Iowa Conservatory will have opportunities to participate in off-campus activities. Students are expected to adhere to ICON’s policies when off-campus, as they are representatives of Iowa Conservatory and should reflect this in their behavior. During ICON-sponsored functions, students must utilize school transportation or be chaperoned by ICON’s faculty and staff unless specific permission for other arrangements is given by an administrator. ICON is released from all liability pertaining to off campus activities. Examples include: Specific activities may be organized in the Iowa City area, including attending movies, bowling, swimming, and eating out at local restaurants. Any special performances at local theaters including The James Theatre, Hancher Auditorium, The Englert Theatre, or Riverside Theatre. Attending outings such as grocery shopping, any necessary medical appointments, and off-campus performing arts coursework. Transportation is provided for students who wish to travel within Iowa City and the surrounding area to attend religious services.
Annual Field Trip Consent(Required) I agree
As the parent/guardian of the student, I am aware that students will partake in field trips throughout the school year. School trips are outside the boundaries of our campus. By agreeing to this stipulation, you consent that your student can go on these field trips. All parents WILL receive a notification and reminder that a school trip is happening, however, the school will no longer send individual permission slips out for each student run field trip.
Truthfulness in Enrollment & Admissions Process(Required) I agree
The School is relying on the completeness and truthfulness of the information provided by the Parent in the admissions and enrollment process. If the School finds out after the Student has been admitted and enrolled that the Parent was not truthful in the admissions and enrollment process on any issue that the School, in its sole discretion, finds to be important, the School has the absolute right to terminate this Contract. There will be no refund of tuition where such termination occurs and any unpaid balance is payable in full according to the terms of this Contract.
Payment and Late Fees(Required) I agree
In the event of default (default being 30 days past due), Parent also agrees to pay all costs of collection, including collection agency fees, attorneys’ fees, court costs, and interest of 1.5% per month. Further, as to any account more than 90 days in arrears, the School reserves the right to accelerate the total unpaid balance of tuition and fees due under this Enrollment Contract. When accounts are in arrears, the account may be referred to the School’s collection agent and/or counsel for satisfaction.
Default of Payment(Required) I agree
All accounts must be current before records and transcripts can be released or transferred to other schools. The Student will not be allowed to continue to attend classes or participate in other School activities unless tuition and fees are paid by stated deadlines (or until Parent makes other written arrangements acceptable to the School).
School and Family Cooperation(Required) I agree
A positive and constructive relationship between the School and Family Member (defined as Parent, Student, or other person associated with Student) is essential to the School’s educational purpose and responsibilities to its students. If any Family Member engages in behavior, communications, or interactions on or off campus, that is disruptive, intimidating, overly aggressive, or reflects a loss of confidence in or disagreement with the School’s policies, methods of instruction or discipline, or otherwise interferes with the School’s safety procedures, responsibilities, or accomplishment of its educational purpose or program, the School reserves the right to dismiss the Family or Family Member from the community. The School may also place restrictions on a Family Member’s involvement or activity at School for other reasons that the School deems appropriate. Any determination under this Paragraph shall be in the School’s sole discretion. There will be no refund of tuition where such dismissal occurs and any unpaid balance is payable in full according to the terms of this Contract. The School also reserves the right to withdraw an offer of enrollment or re-enrollment at any time and to void an executed Enrollment Contract
Marketing: Photos, Socials, Media(Required) I agree
The Parent agrees to allow the Student’s name, photograph, voice, image, and information to be used by the School for use in the School’s publications, promotion materials, social networks, and website, without compensation and without prior notice. The Parent also allows the Student to be interviewed by the media on campus or at school-related events. Parent releases and holds the School harmless from any liability stemming from the use of the Student’s name, photograph, voice, image, or information.
School Directory(Required) I agree
Parent authorizes the School to place family information, including name(s), home address(es), email address(es), and telephone numbers of Parent, Student, and other children in attendance at the School, in a directory of students to be available to School families. Parent acknowledges that this directory and the information therein is not to be used for commercial use and is not to be distributed to any person other than another School family.
Boarding Students: Medical Authorization(Required) I agree
If, in the opinion of a properly licensed and practicing physician, Student needs medical or surgical services which require Parent’s pre-authorization or consent, Parent hereby authorizes, appoints, and empowers the School to act as Parent and furnish such consent on Parent’s behalf. Parent confirms that it is Parent’s desire that the Student be furnished with such medical or surgical services as soon as reasonably possible after the need arises. Parent hereby releases and holds the School harmless from any liability which might arise from the giving of such consent. Parent agrees to reimburse the School for any medical expenditures made on Student’s behalf.
Consent to onsite Medical and Counseling Care(Required) I agree
The Parent hereby authorizes the School to supply medical care as needed for Student (including administration of allergy medications, Epi-Pens, etc. according to the Student’s prescription from a licensed practitioner) or other minor medical care or emergency as determined to be appropriate by the School Staff.
FOB/Keys(Required) I agree
Parent and student understand that the student will be given one FOB (keycard) to get in and out of the building. In the event the FOB is lost, stolen, or damaged, the student will report it to the main office and be entitled to one free replacement. All additional replacements will result in a $50.00 charge.
Student's Satisfactory Completion of Current School Year(Required) I agree
This Contract is further conditioned upon the Student successfully completing the school year preceding enrollment in the School in good standing, both academically and behaviorally. If, after completion of the preceding school year, the School determines in its sole discretion that Student has not met this requirement, the School has the right to unilaterally cancel this Contract. Any applicable refund will be issued according to the Tuition Refund Plan.
Release of Student Records(Required) I agree
Parent consents and holds the School harmless for the release of Student’s records and information upon request by an educational institution or law enforcement agency. Parent also releases and holds the School harmless from any liability stemming from the use, disclosure, or release of Student’s records or information.
Promotional Materials & Statements(Required) I agree
The School continually strives to ensure the accuracy of all written materials, including, but not limited to, promotional information, catalogs, brochures, handbooks, and advertising. In an effort to do so, however, information included in the materials (including class sizes, student-to-teacher ratios, School accreditation, teacher qualification, specialization, and length of service, etc.) may change as programs grow and as staff changes. Prior to relying on any written materials in making your decision to enroll Student in the School, please verify the accuracy of information with the Admissions Office. Please also understand that even if the information was accurate at the time that you enrolled the Student, the information may change prior to commencement of classes or during attendance at the School. Please also note that only the Head of the School (or his/her designee) has the authority to make commitments regarding the nature of the program, specific arrangements for the Student, or other changes from the School’s regular curriculum.
Governing Law/Waiver of Jury Trial(Required) I agree
This Contract and the rights and obligations of the parties shall be governed by and construed in accordance with the laws of the State of Iowa without regard to principles of conflicts of law. The parties agree to waive the right to jury trial over any claims pertaining to Student’s enrollment, attendance, or separation from the School including, but not limited to, claims of breach of contract, under statute, ordinance, or common law. The exclusive venue for any claim shall be the Johnson County District of Iowa located in Iowa City, Johnson County, Iowa.
Force Majeure(Required) I agree
The School’s duties and obligations under this Contract shall be suspended immediately without notice during all periods that the School is closed because of force majeure events including, but not limited to, any fire, act of God, hurricane, war, governmental action, act of terrorism, epidemic, pandemic, or any other event beyond the School’s control. If such an event occurs, the School’s duties and obligations in this Contract will be postponed until such time as the School, in its sole discretion, may safely reopen. In the event that the School cannot reopen due to an event under this clause, the School is under no obligation to refund any portion of the tuition paid.
Non-ICON Staff and Faculty Transportation(Required) I agree
I understand that the student may want to utilize transportation provided by friends or other trusted adults in order to attend ICON or non-ICON related events. ICON is released from all liability pertaining to transportation.
Approved Transport for my student: (check all that apply)(Required) Assumption of Risk and Liability: I understand that ICON does not conduct driving history reviews on student drivers or unaffiliated individuals. You assume all risk with the transportation of your student. You release ICON from liability.
Authority(Required) I agree
Each party represents and warrants to the other (1) that it has full power to enter into and perform its obligations under this Contract; and (2) that this Contract constitutes its legal, valid, and binding obligation, enforceable in accordance with its terms. Parents in two-parent households agree that each is acting as an agent for the other. Modification of this agency relationship shall be in writing and delivered to the School. No oral modifications will be recognized or accepted.
Entire Agreement(Required) I agree
This Agreement sets forth the entire understanding of the parties hereto with respect to the subject matter hereof and merges and supersedes all prior and contemporaneous oral understandings between the parties. There have been no representations or warranties made by any party other than the representations and warranties contained herein.
Understanding of Terms(Required) I agree
Please read this Contract carefully. By signing below, Parent acknowledges that Parent understands the terms of this Contract, Parent’s obligation to pay the full year’s tuition even if the Student is withdrawn or dismissed, the Parent’s option to terminate, and all other obligations set forth herein. If Parent has questions about the terms, Parent is encouraged to seek advice of counsel or to seek clarification from the Registrar.
Final Agreement & Signature I certify that this form was filled out by a guardian and is done to the best of my ability. I certify that everything I have said or provided is true. I understand this contract in its entirety, and when I was uncertain, I reached out to ICON to get clarification before signing below.(Required) 