Mosaic Fall 2021 Class Registration
Please carefully review the daily schedule prior to registering. Submit one form per student. Upper Elementary classes are for ages 10-11, Middle School classes for ages 12-13 and High School classes for 14+. You will receive a confirmation email within 48 hours of completing the registration form.
Don't forget to click "Submit" at the bottom of the form!
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Email *
Parent First Name *
Parent Last Name *
Parent Email Address *
Parent Home Phone Number
Parent Cell Phone Number *
Home Address (Street, Town, Zip) *
Student Name *
Student Age *
Indicate age of student as of Sept 2021
Period 1: 9:00am - 10:30am
Choose one class offering for Period 1
Clear selection
Period 2: 10:35am - 12:00pm (UE and MS) or 10:35am - 12:30pm (HS)
Choose one class offering for Period 2
Clear selection
Period 3: 12:50pm - 2:15pm (UE and MS) or 1:05pm - 2:25pm (HS)
Choose one class offering for Period 3
Clear selection
Period 4: 2:20pm - 3:45pm (UE and MS) or 2:30pm - 3:45pm (HS)
Choose one class offering for Period 4
Clear selection
Code of Conduct *
Our Code of Conduct states that all students are expected to be respectful of their facilitators and fellow students at all times. Repeated disruptions or refusal to follow instructions may be cause for dismissal. In addition, students should be actively engaged in classes, complete assignments, and not miss more than two classes per semester unless prior arrangements are made with the class facilitator. By enrolling in any Mosaic Freeschool class you agree to be bound by our Code of Conduct. Please confirm below that you have read and understand the Mosaic Freeschool Student Code of Conduct.
Allergies *
If Yes, please indicate student name(s) and allergy
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