Student Name
*
First Name
Last Name
Student Email
Student Phone
(###)
###
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Student Birth Date
*
MM
DD
YYYY
Gender
*
Male
Female
Previous School
Previous Grade
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Grade for 2024-2025
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Parent Name
*
First Name
Last Name
Parent Email
*
Parent Phone
*
(###)
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Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact
*
First Name
Last Name
Emergency Contact's Phone
*
(###)
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Does your Child have any Allergies?
*
Yes
No
If yes, to what and how severe?
Describe any social, emotional, physical or educational needs that your child may have.
Is your child on any medication?
*
Yes
No
For what purpose?
What is your cover school?
What church do you attend?
Elementary Classes
Check all that apply
Art from the Heart, Grades 4K-8, Tuesday 9:15 - 10:15
Elementary FUN!, Modern History & Science, Grades 2-5, Tuesday 10:15 - 1:00
Middle School Classes
Check all that apply
Introduction to Literary Analysis, Grades 8-10, Tuesday 8:45-10:15
Art from the Heart, Grades 6-12, Tuesday 10:30 - 11:30
Essay Writing for Middle School, Grades 7-8, Tuesday 10:30-12:00
Eastern Hemisphere History for Middle School, Grades 6-8, Wednesday 8:45 - 10:15
Intro to Physical Science for Middle School, Grades 6-8, Wednesday 10:30 - 12:00
High School Classes
Check all that apply
Biology, Grades 9-12, Tuesday 8:30 - 10:15
Physics, Grades 10-12, Tuesday & Wednesday 8:45 - 10:15
Introduction to Literary Analysis, Grades 8-10, Tuesday 8:45-10:15
Programming: Physical Computing with Arduino, Grades 9-12, Tuesday 10:30 - 12:00
Art from the Heart, Grades 6-12, Tuesday, 10:30 - 11:30
Forensic Science, Grades 9-12, Tuesday 12:15-1:45
Business Math, Grades 10-12, Tuesday, 2:00-3:30
Advanced Writing with American Literature, Grades 10-12, Wednesday 8:15-10:25
Writing with American Literature, Grades 9-12, Wednesday 10:30-12:00
ACT Prep, Grades 10-12, Wednesday 8:45 - 10:15
ACT Prep, Grades 10-12, Wednesday 10:30 - 12:00
Ancient Civilizations, Grades 9-12, Wednesday 12:15 - 1:45
Algebra 2, Grades 10-12, Thursday 9:00 - 10:45
Homework Help & Tutoring Classes
Check all that apply
(Mrs. Moore) Homework Help: Writing, Grades 7-12, Tuesday 12:15-1:45
(Mr. Summers) Math & Science Tutoring, Grades 7-12, Tuesday 12:15 - 1:45
(Mr. Summers) Math & Science Tutoring, Grades 7-12, Wednesday 10:30-12:00
(Mr. Summers) Math & Science Tutoring, Grades 7-12, Wednesday 12:15 - 1:45
By submitting this form to the registrar:
*
Please check each of the following boxes to indicate your agreement.
I understand registration is not complete until the $25 registration fee per class is submitted to each instructor. This fee is nonrefundable.
I understand registration is not complete until the $50 administrative fee per student is submitted to Grace on Main, PCA. This fee is refundable through June 30, 2024.
I understand that submission of this form after June 30, 2024, will result in a late fee of $50. Registration is not complete until the $50 late fee per student is submitted to Grace on Main, PCA
I understand enrollment in each class (with the exception of ACT Prep) is a year-long commitment.
I assume financial responsibility for all fees and tuition for the entire year.