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Parent Information
If you are enrolling more than one student you must submit a separate form and payment for each student.
Students Name
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Name of Mother
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Name of Father
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Student Information
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YYYY
Last Grade Completed
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Address
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Address (Line 2)
City
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State
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ZIP Code
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Gender
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Classes
Literature
American Literature
none
Survey of Literature
Focused Literature
Mathematics Class
Pre Algebra
none
Elementary Math Lab
Algebra I
Writing Class
Precepts for Excellence in Writing II
none
11th and 12th grade Research Paper
Precepts for Excellence in Writing I
Science Class
Safari Science
none
Interactive Science with Labs
History
World History
none
Us History
Fight For Your Right
Civil War
Elementary
Elementary Essentials
none
Humanities
Creation to Resurrection
none
Emergency and Medical Information
Please include both the name and the telephone number for every emergency contact.
Emergency Contact 1
*
Emergency Contact 2
*
Family Physician
*
Family Medical Insurance Company
Policy Holder
Group Number
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