Student Name *

First Name

Last Name

Parent Name *

First Name

Last Name

Parent's Primary Phone *

(###)

###

####

Student's Primary Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's Birthdate *

MM

DD

YYYY

Session Registration *

Select all that apply. Registration fees apply per quarter and are credited toward total tuition fees for that quarter.

Quarter 1: September 6 through November 1, 2017.

Quarter 2: November 6 2017 through January 31, 2018. No class Nov. 10, Nov. 23-24, Dec. 18- Jan. 2, Jan 15.

Quarter 3: February 5 - April 4, 2018. No class Feb. 19.

Quarter 4: April 16 - June 20 2018. No class May 28.

Tuition Payment *

Quarterly fee, $1250/quarter, due by the end of the first week of each quarter.

Monthly invoice, variable by the month, due by the 5th of each month. (Quarter 1: $625 Sept, $625 October; Quarter 2: $417 November, $417 December, $417 January; Quarter 3: $625 Feb, $625 March; Quarter 4: $417 April, $417 May, $417 June)

Deposit *

$100 deposit by check written to Kristin Hendrickson: Leonardo, c/o Riggs 15335 81st Ave NE, Kenmore WA 98028

$100 deposit online payment

I grant Leonardo rights to use my child’s image, quotes or work taken or created while at Leonardo through any medium for the purposes of documentation, marketing, education or other purposes as deemed appropriate by Leonardo leadership. *

Yes

No

In case of emergency, I hereby give consent for Leonardo staff to obtain emergency medical care for my child as prescribed by a licensed physician or emergency personnel. This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of the child. Parent(s) and/or emergency contact(s) will be contacted and notified as soon as possible in the event of emergency. *

Agree

I understand that my child will be cooking with knives, peelers, stoves, ovens, and all other common household kitchen equipment, playing outside in all weather, and working under supervision with tools and substances that can cause harm or injury. The class will be cooking a daily community lunch, and while my child will be encouraged to try the meal, they will not be forced to eat it. If my child is not generally willing to try a variety of foods, I understand that I can send them with a lunch. Efforts will be made to comply with all allergy and religious restrictions, and all children will be made to feel welcome at meal time, but food preferences may not always be met. *

Agree

Leonardo will follow the Northshore school district’s weather closure guidelines and will notify families as soon as we are able in the event of a closure or delay. *

Agree

I understand that Leonardo reserves the right to refuse an application or dismiss a child when that child’s behavior interferes with the safety, rights or learning of others, if they are unable to follow the flow of the class, unable to receive instruction and feedback from teachers and/or unable to work and play cooperatively with other students. No refunds will be issued if students are removed for behavioral issues. Refunds may be given in the event of a medically necessary cancellation with a note from a doctor. There are no credits or reimbursements for absences. *

Agree

I understand that Leonardo is a quarterly obligation. If I withdraw my student before the quarter is complete, I will complete any outstanding payments for the quarter. Tuition can be paid either quarterly ($1250/quarter) or monthly. If you select monthly payments, tuition will be due by the 5th of each month. Payments will be as follows: Quarter 1: $625 Sept, $625 October; Quarter 2: $417 November, $417 December, $417 January; Quarter 3: $625 Feb, $625 March; Quarter 4: $417 April, $417 May, $417 June. Since registration is quarterly and enrollment is limited, we cannot refund deposits. *

Agree