MICHAELS  HOMESCHOOL  ASSOCIATION

                      OF  CHATTANOOGA

  Michaels Homeschool Association
               of Chattanooga                    

Put God First

Registration Form

                                                                                        REGISTRATION FORM

                                                                             (ONE REGISTRATION FORM PER CHILD PLEASE)  


GENERAL INFORMATION


Child's Name ___________________________________________  Phone______________________


Address _________________________________________________________________________


City ________________________  State _______________________  Zip Code __________________


Age: ______  D.O.B.: __________  Grade Level: ______  Gender: _______   


Email:__________________________________ Umbrella School: _____________________________


Any allergies: _____________________________________________________________________


What is the name of your home church? _____________________________________________________


In case of emergency - please contact:


Father's Name _________________________________  Phone  _______________________________


Mother's Name: ________________________________  Phone ________________________________

 

Other Contact: _________________________________  Phone ________________________________


COURSE  AND PAYMENT INFORMATION

 

My child will attend the following course(s):  (Please check ALL that apply) 

    [To make things more simple for everyone, fees have been included below.]

    

    *Physical Education / K5 thru 4th grade ______                           *Physical Education / 5th thru 8th grade ______ 

          as a 1st child  ($25/month) ______                                                       as a 1st child ($30/month) ______      

          or additional child ($20/month) ______                                           or additional child ($25/month) ______

          Plus registration fee ($20/year)  ______                                           Plus registration fee ($25/year) ______


                                                        *Physical Education / 9th thru 12th grade ($55/month) ______

                                                                  Plus registration fee ($35/year) ______ 


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    *Spanish Classes/ Elementary Level ($40/month) ______         *Spanish Classes/Middle School Level ($45/month) ______

            Plus registration fee ($30/year) _____                                                   Plus registration fee ($35/year) ______   


    *Spanish 1 Classes/ High School ($60/month) ______                *Spanish 2 Classes/ High School ($60/month) ______ 

             Plus registration fee ($40/year) ______                                              Plus registration fee ($40/year) ______     


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    *Mathematics / Elementary Level ($40/month) ______             *Mathematics / Middle School Level ($55/month) ______ 

            Plus registration fee ($25/year) ______                                               Plus registration fee ($30/year) ______  


    *Mathematics / Pre-Algebra ($55/month) ______                        *Mathematics / Algebra 1 - HS ($60/month) ______  

            Plus registration fee ($30/year) ______                                               Plus registration fee ($35/year) ______


    *Mathematics / Geometry - HS ($60/month) ______                  *Mathematics / Algebra 2 - HS ($60/month) ______ 

             Plus registration fee ($35/year) ______                                              Plus registration fee ($35/year) ______       


                                                                   *Mathematics / Advanced Math ($60/month)  _____                                                                                                                                                                               Plus registration fee ($35/year) _____                                          


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    *Science / Elementary ($45/month) _____                                      *Science / Middle School ($55/month) _____

           Plus registration fee ($35/year) _____                                               Plus registration fee ($50/year) _____ 


    *Science / Biology ($65/month) ______                                          *Science / Physical Science ($65/month) _____                                                    Plus registration fee ($55/year) ______                                           Plus registration fee ($55/year) _____

                          

                                                                     *Science / Chemistry ($65/month) ______

                                                                            Plus registration fee ($55/year) ______


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*Music / Elementary Class ($35/month) ______                             *Music / Beginner Recorder Class ($35/month) ______

          Plus registration fee ($25/year) ______                                               Plus registration fee ($25/year) ______

           

*Music / 2nd Year Recorder Class ($35/month) _____                 *Music / Middle School Appreciation Class ($40/month) _____        

          Plus registration fee ($25/year) _____                                                   Plus registration fee ($30/year) _____


*Music / Middle School Recorder Class ($40/month) ______   *Music / High School Class ($45/month) ______

          Plus registration fee ($30/year) ______                                                Plus registration fee ($35/year) ______ 


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    *Art / Elementary Class ($40/month) ______                              *Art / Middle School Class ($45/month) ______

           Plus registration fee ($30/year) ______                                           Plus registration fee ($35/year) ______


                                                                         *Art / High School Class ($55/month) ______

                                                                                Plus registration fee ($45/year) ______       


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Your Yearly Total: _____________ (Please include ALL monthly fees (x 10 months) + registration fee(s))  (OFFICE USE ONLY)


Paid: $ ______   Owe: $ ______    Received on:  ____________    Payment Method:   Cash ____  or  Check # ______  

               ______                   ______                                ____________                                                        ____                           ______

               ______                   ______                                ____________                                                        ____                           ______ 

               ______                   ______                                ____________                                                        ____                           ______

               ______                   ______                                ____________                                                        ____                           ______   


How would you like to be billed?    ____ by the month       ____ by the semester (5 months)      ____ by the year (10 months)

                                                                       

                                                                                            Checks can be mailed to:

                                                                                            6001 Morning Glory Drive

                                                                                            Harrison,  TN 37341 


(Note: Please make checks payable to either Mrs. Livia Michaels or MHAC


                                                                                   

Payment Guidelines: (Please initial or check ALL lines on left side of page and check preferred method of payment):


_____ I agree to pay by the ____ month, by the ____ semester, or by the ____ year beginning in the month of August and ending in the month of May. Notifications/Invoices are sent out via email around the 10th of each month and are due upon receipt.


_____ I understand that my invoice is DUE UPON RECEIPT and is considered LATE if Michaels Homeschool Association of Chattanooga does not receive my monthly payment by the 15th day of the month. I realize I will be charged a $10/student/class  late monthly fee if my check is not received by the 15th of the month, or if I have not contacted MHAC to make other arrangements.


_____ I understand that all checks must be sent to Mrs. Livia Michaels who is affiliated with Michaels Homeschool Association of Chattanooga. Any cash must be personally handed to Mrs. Michaels in an envelope with a note containing child(ren)'s name, amount of payment inside, and preferred payment distribution, if applicable.


_____ I understand that payment is required for each class, even if my child is absent. 


_____ I agree to pay a $30 charge on any returned check. 


_____ I agree to pay a $50 charge per student per class if I withdraw after the second week of class. This INCLUDES dropping at the end of the semester.


_____ If I withdraw within the first 2 weeks of class, I agree to pay for ½ of August's tuition.


_____ I understand that all registration fees and payments are non-refundable, unless my child is not accepted or a class does not form (which is rare). If your child does not get into a class because it is full, we will refund your registration fees.


_____ I understand that if my account becomes overdue by 2 months, I will be responsible for all late fees and any necessary collection fees if I am delinquent in paying. I also understand that in the case of a legal dispute, I am responsible for any and all court fees, attorney fees, and all cost incurred in pursuit of debt payment. I further understand all registration fees and tuition payments will be forfeited if my child is dismissed at any time during the year. 


Parent/Guardian Signature: ________________________________________ Date: ________________

  


                                                                                  CONSENT AND RELEASE FORM 


I hereby give permission for _________________________ to participate in the Michaels Homeschool Association of Chattanooga (MHAC) program during the year ____________. Further, I authorize the coaching personnel to provide emergency medical treatment of an injury or illness when deemed necessary and agree to accept all responsibility in case of injury to my child.

                       

My child and I are aware that participating in any sport and/or being a part of any recreation and /or church facility is a potentially hazardous activity. I understand that my child(ren) will attend classes at Oakwood Baptist Church at his/her own risk. I further understand and do hereby waive and agree to hold harmless MHAC, any outside facilities affiliated with MHAC, Oakwood Baptist Church, any coaches, clergy,  administrators, teachers or other participants and all their families in the event of any injury or illness to my child, myself or any other member of my household during any and all activities including but not limited to all classes, games, practices, and special events (field trips, etc.) on or away from building site. All risks are known and understood by me. Furthermore, I agree to give permission to Michaels Homeschool Association of Chattanooga to take and use pictures/projects of my child(ren), at their discretion, for the purposes of advertising. Also, I agree to provide payment for all the above services rendered to my child(ren) and as stated on the "Course and Payment Information" section of this form. We/I further understand that failure of the student and/or parent/guardian to comply to all standards, payment guidelines, terms and conditions may result in the student being dismissed from his/her enrollment at MHAC. Thus, we are committed to the guidelines stated in this form.  In addition, I hereby acknowledge my willingness to agree to all the terms and conditions stated on this agreement.



Parent/Guardian Signature: __________________________________________ Date: _______________



*NOTE: In order for your paper work to be completed, please check, initial, and sign the "Payment Guidelines" section and also fill out                 and sign the "Consent and Release Form" portion of this registration form and send in all pages regardless of which class(es)                   your child(ren) will be participating in. Registration fees are non-refundable. THANK YOU AND WELCOME!*