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Imago Dei Learning Community: 21/22 Enrollment Application Form
This is not a guarantee of admission to Imago Dei Learning Community. You will be contacted for next steps regarding registration for homeschooling and admissions based on space per grade level.
Please submit one form per child.
Imago Dei Learning Community does not discriminate on the basis of race, color, national or ethnic origin.
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* Indicates required question
Child's First Name
*
Your answer
Child's Middle Initial
Your answer
Child's last name
*
Your answer
Child's Gender
*
Female
Male
Required
Child's 2021/2022 Grade Level
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Twelfth Grade
Other:
Required
Child's Address (street, city, state, zip)
*
Your answer
Child's Previous School Attended (n/a if not applicable)
*
Your answer
Does your child require additional support for emotional, behavioral, and/or academic reasons? If so, please explain.
*
Your answer
Are there additional health and/or medical issues Imago Dei Learning Community should be informed of for your child? If so, please explain.
*
Your answer
Parent / Guardian #1: First and Last Name
*
Your answer
Parent / Guardian #1: Address
*
Same address as child(ren)
Different as child(ren)
Required
List Address of Parent / Guardian #1 if different from child(ren): street, city, state, zip
Your answer
Parent / Guardian #1: Email
*
Your answer
Parent / Guardian #1: Cell Phone
*
Your answer
Parent/Guardian #1 Employer
*
Your answer
Parent / Guardian #1: Work Phone
*
Your answer
Parent / Guardian #2: Name, First and Last
Your answer
List Address of Parent / Guardian #2 if different from child(ren): street, city, state, zip
Your answer
Parent / Guardian #2: Email
Your answer
Parent / Guardian #2: Cell Phone
Your answer
Parent / Guardian #2: Employer
Your answer
Parent / Guardian #2: Work Phone
Your answer
How did you hear about Imago Dei Learning Community?
*
Your answer
Why are you choosing to send your child(ren) to Imago Dei Learning Community?
*
Your answer
What do you believe will be the greatest struggle and greatest reward your child(ren) will experience in a Christ-centered, innovative, grow at your own pace, collaborative environment?
*
Your answer
Does your child have an IEP, 504 or any educational documentation that supports their learning?
*
Yes
No
I acknowledge that my learner will be immersed in an education rooted in Christ at Imago Dei Learning Community.
*
By checking this box, I am agreeing to this statement.
Required
The fee to attend Imago Dei Learning Community is $4,000 for the 5-day, FULL TIME option, and $3,500 for each additional sibling. The fee to attend the 5-day, PART-TIME option is $3,500, per child. Please check which box applies to your learner.
*
$4000 full-time option
$3500 additional sibling
$3500 part-time option
Required
Do you have another child to enroll? If so, please submit another survey for each additional child.
*
Yes
No
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