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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Child's First Name *
Child's Middle Initial
Child's last name *
Child's Gender *
Required
Child's 2021/2022 Grade Level *
Required
Child's Address (street, city, state, zip) *
Child's Previous School Attended (n/a if not applicable) *
Does your child require additional support for emotional, behavioral, and/or academic reasons? If so, please explain. *
Are there additional health and/or medical issues Imago Dei Learning Community should be informed of for your child? If so, please explain. *
Parent / Guardian #1: First and Last Name *
Parent / Guardian #1: Address *
Required
List Address of Parent / Guardian #1 if different from child(ren): street, city, state, zip
Parent / Guardian #1: Email *
Parent / Guardian #1: Cell Phone *
Parent/Guardian #1 Employer *
Parent / Guardian #1: Work Phone *
Parent / Guardian #2: Name, First and Last
List Address of Parent / Guardian #2 if different from child(ren): street, city, state, zip
Parent / Guardian #2: Email
Parent / Guardian #2: Cell Phone
Parent / Guardian #2: Employer
Parent / Guardian #2: Work Phone
How did you hear about Imago Dei Learning Community? *
Why are you choosing to send your child(ren) to Imago Dei Learning Community? *
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? *
Does your child have an IEP, 504 or any educational documentation that supports their learning? *
I acknowledge that my learner will be immersed in an education rooted in Christ at Imago Dei Learning Community. *
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. *
Required
Do you have another child to enroll? If so, please submit another survey for each additional child. *
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