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Parent/Guardian Consents

Please complete the form below. Required fields marked with an asterisk *

Student Name*

Answer Required

Student High School*

Answer Required

Parent/Guardian Name(s)*

Answer Required

Parental Consent for Application under the Dual Enrollment Program

By your signature on this application, you give permission for your son/daughter to enroll in the Healthcare Excellence Academy Lab School under the dual enrollment program at the community college serving the region of their high school.

Please select an option from below:*

Answer Required

I authorize my student to participate in obtaining TUITON-FREE college credit as part of the HEALS program.

I decline tuition-free college credit for my child.

Parental Consent and Authorization to Photograph during School Activities

By your signature on this application, you authorize HEALS to use personally identifiable photographs and/or videos of your son/daughter for award recognition or promotional purposes.

Please select an option from below:*

Answer Required

I authorize the HEALS program to use photographs/videos of my child, along with their name, in future promotions or news releases.

I DO NOT authorize the use of photographs/videos of my child, along with their name, in future promotions or news releases.

Parental Acknowledgement for Dual Enrollment

Parents/Guardians “I Will…”

As a parent or guardian of a HEALS student, I will:*

Answer Required

Monitor student's attendance and grades.

Accept financial responsibility for payment of tuition, fees and books if the student does not meet the obligations for proper and timely notification of drop/add dates.

Accept financial responsibility for all debt incurred, if the student does not successfully complete all course(s) with a grade of "C" or above.

By signing below, I acknowledge and agree to abide by the stipulations indicated in this agreement.

Parent/Guardian Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required