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The Von Der Becke Academy Corp

The VA School

We don't lower the bar. We raise the student.

503 Lake Ave, Storm Lake, Iowa 50588 · (712) 560-1128 · teamvcorp@thevacorp.com

Document 9 of 9

Family Enrollment Agreement

Complete one agreement per enrolled student. Return the signed original to the Head of School. This agreement may also be completed online.

9.1 Student Information

Student legal name:
Date of birth:Grade level / cohort:
Enrollment start date:

9.2 Family / Guardian Information

Parent/guardian name(s):
Address:
Primary phone:Email:
Emergency contact (if different):
Emergency phone:

9.3 Iowa ESA / School Choice

  • ☐ Our family intends to apply for Iowa Education Savings Account (ESA) funding for this student
  • ☐ Our family will pay the monthly family contribution without ESA funding
  • ☐ Our family is applying for financial hardship consideration

ESA applications are made directly through the Iowa Department of Education. The VA School will provide any required documentation to support your application.

9.4 Program Acknowledgments

By signing below, the parent/guardian confirms they have read The VA School Student & Family Handbook and agree to the following:

  • ☐ We understand and accept the school's mastery-based progression model — our student advances upon demonstrated mastery, not by calendar year.
  • ☐ We understand that Taekwondo is a core and required component of enrollment, not elective.
  • ☐ We understand that graduation from The VA School is earned through demonstrated academic and character mastery, and is not conferred by age.
  • ☐ We agree to maintain consistent attendance and to communicate promptly regarding absences.
  • ☐ We understand and accept the school's behavioral framework, including the Three Pillars of Pivotal Behavior.
  • ☐ We acknowledge the monthly family contribution of $200 per student and agree to timely payment.
  • ☐ We consent to our student's participation in all regular school activities, including Taekwondo training.
  • ☐ We understand that student records are maintained confidentially and may be accessed by the family upon request.

9.5 Medical & Health

Known medical conditions or allergies:
Current medications (if any):
Doctor/clinic name and phone:
  • ☐ Immunization records on file
  • ☐ Immunization exemption on file

Iowa law requires documentation of either immunization compliance or a valid exemption for enrolled students.

9.6 Photo & Media Release

  • ☐ I consent to photographs or video of my student being used for school promotional materials
  • ☐ I do NOT consent to photographs or video of my student for any school promotional use

9.7 Signatures

Parent / Guardian

Name (print):
Signature:
Date:

Head of School

Robert Von Der Becke — The Von Der Becke Academy Corp

Signature:
Date: