Student Applications What courses (and programs) do you plan to take during your first year at BLASS Online Secondary School? * Please specify the courses and program(s) below. For a complete list of all the course offerings please go to https://www.blendedlearningcenter.com/courseofferings BLASS Secondary School applicants, please upload the following documents or send them to blass@blendedlearningcenter.com Required documents: Copy of International passport (or proof of identification), Birth certificate, Current or Previous School transcripts/Report Card, Copy of health records and health insurance, Proof address, and an essay on why you want to attend BLASS ONLINE SECONDARY SCHOOL Name * First Name Last Name Gender * Male Female Other Date of Birth * MM DD YYYY Phone Number (include country code) * Email * What is your current grade level? What School do you currently attend? School Name, Address, Country and contact information FERPA NOTICE https://studentprivacy.ed.gov/?src=fpco Signatures Electronic Signature Statement * I, parent or guardian of the above-named child, give my approval for my child to participate in any and all activities of Blended Learning and Study Center. I further hereby release, indemnify, and hold harmless the organizers, instructors, and staff of Blended Learning and Study Center. I likewise waive, to the extent not covered by liability insurance, any claim against any person overseeing my child’s activities and transporting my child to and from activities. If I choose the study abroad package for myself or the above named child, I agree to pay the full amount before beginning with the study abroad process or thereby canceling any further activities with Blended Learning and Study Center until the full amount is paid. I also agree to make all payments required by the chosen plan and activities associated with my registration or the registration of the above-named child. Visit the electronic statement link in the footer of website for more information Guardians' Signature: First name & Last name What is your parent/guardian's email? What is their relationship to you? Mother, Father, Guardian, Sister, Spouse etc What is your parent/guardian's phone number? Today's Date * MM DD YYYY Photos Photo Release * I give Blended Learning and Study Center the right to take photographs of me, my family, or my child in connection with learning experiences at the facility and on outings to field trips and other activities. I authorize Blended Learning and Study Center, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Blended Learning and Study Center may use such photographs of me without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. Guardian's Signature: First name and Last name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Additional Information How did you hear about us? Linkedin Twitter Instagram Facebook Tutor Referral Other Thank you for submitting your application. We are currently processing multiple applications, and we plan to get back to you within 1-2 business days. All communication is done through email, so make sure you used an email that you often check. Please be on the lookout for an email from us. Have a great day. THANK YOU FOR COMPLETING THE APPLICATION FOR BLASS COLLEGE ONLINE SCHOOL
