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Homeschool Enrichment Enrollment Form
Registration for HS Enrichment Classes
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* Indicates required question
Parent e-mail address
*
Your answer
Student's Name
*
Your answer
Gender
*
Female
Male
Date of Birth
*
MM
/
DD
/
YYYY
Approximate Grade Level
*
Your answer
Class(es) in which your child is enrolling
*
America the Beautiful Art $25
Art Fundamentals $45
Beginner Conversational Spanish $20
Beginner Oil Painting $70
Boxing $25 new/$10 returning
Color Theory $20
Geology $20
P.E. $15
Required
Parent's Full Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Emergency Contact (Someone other than parents)
*
Your answer
Emergency Contact Phone Number
*
Your answer
Is the student being treated for any long-term medical conditions? (If yes, please explain.)
*
Your answer
Does the Student have any limitations in physical activity? (If yes, please explain.)
*
Your answer
Is the student on any medications? (If yes, please list.)
*
Your answer
Is the student allergic to any foods or medications? (If yes, please list.)
*
Your answer
Physicians Name
*
Your answer
Insurance Carrier
*
Your answer
Student's spot will not be held until payment has been made. Listed prices cover the entire semester. Waivers will need to be signed in person on the first day of class.
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