CTA Student Application

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(The following demographic information is required for accreditation and is kept CONFIDENTIAL)



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Does the student currently receive the following benifits? (If yes to either of the below, the student is required by these agencies to attend a minimum of twenty in­person hours per week)


Canterbury Technical Academy reserves the right to refuse admission to individuals based on, but not limited to the following conditions, the students: involvment with illegal substances, commitment of acts of violence, and/or convicted of a felony. Any person who contracts a contagious disease while attending Canterbury Technical Academy will not be allowed to attend classes until medical proof is provided that the student is no longer contagious.
Canterbury Technical Academy may require participation of the student in various research programs, which can include academic, psychological, and other forms of testing. No name will be released with these test scores, but scores will be available to the parent and faculty of Canterbury Technical Academy to aid in the development of personalized program to enhance the educational benefits provided. There will be no additional charge for these services.
I agree for my child to participate in all aspects of Canterbury Technical Academy, which may include:
• Individual counseling provided by the school counselor, and/or (under supervision) a graduate student intern from one of the area universities
• Testing and assessment for the purpose of providing insight and understanding of my child’s educational needs
• My participation with my child in counseling or educational planning as requested by the staff of Canterbury Technical Academy.
• Canterbury Technical Academy school uniform is maroon polos and khaki pants, knee length shorts or skirts.
• Participation in photo or video productions from time to time that may be marketed to the general public.

The signing of this application gives my permission and consent for the staff of Canterbury Technical Academy to have access to any of my student’s school records that may enable them to meet the needs of my child.
I understand that all school records, counseling records and psychological testing will be held confidential. I understand that the counselors must make these records available only when a threat of serious harm to another person is present or when my child’s health or life is in immediate danger.
I understand that it may become necessary for the school to consult with other agencies/institutions (i.e. Dept of Youth Services, DHR, Montgomery Public Schools, etc.). I give my permission for them to discuss my child’s treatment needs. By giving permission for my child to participate in all aspects in all aspects of Canterbury Technical Academy, I release Canterbury Academy, LLC. and any officer, agency, and/or institution it may consult with on behalf of my child from any and all liability that may be incurred in assisting my child in successfully completing his/her educational program.

I understand that the fee for enrollment is $200.00, and that the enrollment fees are billed yearly and under no circumstances will this fee be refunded. I also understand that this fee is separate from any tuition obligations or late fees incurred.

By signing below, I acknowledge that I have received, read, and understand the school’s orientation booklet, tuition policies, and the school’s guidelines for behavior. I agree that I will support Canterbury Technical Academy and its efforts to enforce the regulations and policies contained in these documents. I have also been informed of Canterbury’s commitment to the Quality School guidelines and I agree to support all aspects of the educational program. I have also been informed of the emphasis that Canterbury Technical Academy places upon parent/legal guardian participation in the student’s education and agree to attend meetings with the staff to discuss the student’s progress and or diagnostic test results.

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