For a printable registration form, please click the green button below. However, if you prefer to stop by our facility and fill out your registration form(s), we will have printed registration forms on site.
GENERAL INFORMATION (one registration form per child please)
Child's Full Name ___________________________________________ Phone____________________
Address _________________________________________________________________________
City ________________________ State _______________________ Zip Code __________________
Age: ______ D.O.B.: __________ Grade Level (in the fall): ______ Gender: _______
Child's 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 ________________________________
Father's Email: ___________________________ Mother's Email: ________________________________
Other Contact: _________________________________ Phone ________________________________
Whom were you recommended by? _________________________________________________________
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 / Elementary Level ______ *Physical Education / 6th through 12th grade ______
(K5-2nd grade) _____ OR (3rd-5th grade) _____ (6th-8th grade) _____ OR (9th-12th grade) _____ as 1st child ($35/month) ______ as a 1st child ($35/month) ______
or additional child ($30/month) ______ or additional child ($30/month) ______
Plus registration fee ($25/year) ______ Plus registration fee ($25/year) ______
*Health/CPR/First Aid (9th thru 12th grade) ______
Tuition Fee ($60/month) ______
Plus registration fee ($30/semester) ______
Fall semester ______ OR
Spring semester ______
-------------------------------------------------------------------------------------------------------
*Spanish Classes/ Elementary Level ($50/month) ______ *Spanish Classes/Middle School Level ($60/month) ______
Plus registration fee ($30/year) _____ Plus registration fee ($30/year) ______
*Spanish 1 Classes/ High School ($70/month) ______ *Spanish 2 Classes/ High School ($70/month) ______
Plus registration fee ($40/year) ______ Plus registration fee ($40/year) ______
-------------------------------------------------------------------------------------------------------
*Sign Language / Elementary Level ($50/month) ______ *Sign Language /Middle School Level ($60/month) ______
Plus registration fee ($30/year) ______ Plus registration fee ($30/year) ______
*Sign Language 1 / High School Level ($70/month) ______ *Sign Language 2 /High School Level ($70/month) ______
Plus registration fee ($40/year) ______ Plus registration fee ($40/year) ______
-----------------------------------------------------------------------------------------------------
*Japanese / Elementary Level ($50/month) ______ *Japanese / Middle School Level ($60/month) ______
Plus registration fee ($30/year) ______ Plus registration fee ($30/year) ______
(K5-1st grade) ____ OR (2nd-4th grade) _____
-----------------------------------------------------------------------------------------------------
*Mathematics / Elementary K5 grade ($50/month) ______ *Mathematics / Elementary 1st grade ($50/month) ______
Plus registration fee ($30/year) ______ Plus registration fee ($30/year) ______
*Mathematics / Elementary 2nd grade ($50/month) ______ *Mathematics / Elementary 3rd grade ($50/month) ______ Plus registration fee ($30/year) ______ Plus registration fee ($30/year) ______
*Mathematics / Elementary 4th grade ($50/month) ______ *Mathematics / Elementary 5th grade ($50/month) ______
Plus registration fee ($30/year) ______ Plus registration fee ($30/year) ______
*Mathematics /Middle School 6th grade ($60/month) _____ *Mathematics/Middle School 7th grade ($60/month) _____
Plus registration fee ($30/year) ______ Plus registration fee ($30/year) ______
*Mathematics / Pre-Algebra - ($60/month) ______ *Consumer Mathematics 8th-12th grade ($70/month) _____
Plus registration fee ($30/year) ______ Plus registration fee ($40/year) ______
*Mathematics / Algebra 1 - HS ($70/month) ______ *Mathematics / Geometry -HS ($70/month) ______
Plus registration fee ($40/year) ______ Plus registration fee ($40/year) ______
*Mathematics / Algebra 2 - HS ($70/month) ____ *Mathematics / Pre-Calculus ($70/month) _____ Plus registration fee ($40/year) ______ Plus registration fee ($40/year) _____
--------------------------------------------------------------------------------------------------------
*Personal Finance Class (spring semester) - HS ($65/month) _____
Plus registration fee ($35/year) _____
--------------------------------------------------------------------------------------------------------
*Science / Elementary ($50/month) _____ *Science / Middle School ($60/month) _____
Plus registration fee ($30/year) _____ Plus registration fee ($40/year) _____
(K5-2nd grade) ____ OR (3rd-5th grade) _____
*Science / Biology ($70/month) ______ *Science / Physical Science ($70/month) _____ Plus registration fee ($50/year) ______ Plus registration fee ($50/year) _____
Plus one-time lab fee ($25/year) ______ Plus one-time lab fee ($25/year) _____
*Science / Chemistry ($70/month) ______ *Science / Anatomy & Physiology ($70/month) _____
Plus registration fee ($50/year) ______ Plus registration fee ($50/year) _____
Plus one-time lab fee ($25/year) ______
*Science / Applied Psychology ($70/month _____
Plus registration fee ($50/year) _____
--------------------------------------------------------------------------------------------------------
*English / Elementary Level ($50/month) ____ *English / Middle School Level ($60/month) ______
Plus registration fee ($30/year) ____ Plus registration fee ($30/year) _____
(K5-2nd grade) _____ OR (3rd-5th grade) _____
*Middle School (Critical Thinking/Career Exploration) ($60/month) _____
Plus registration fee ($30/year) ______
* English / High School Intro to IEW ($70/month) ____ *English / High School Literature ($70/month) ______
Plus registration fee ($40/year) _____ Plus registration fee ($40/year) ______
--------------------------------------------------------------------------------------------------------
*Ancient Times History (2nd-5th) - ($50/month) _____ *Bible Geography (6th-8th) - ($60/month) _____
Plus registration fee ($30/year) _____ Plus registration fee ($30/year) _____
*Economics (fall semester) - HS ($70/month) _____ *Government (spring semester) - HS ($70/month) _____
Plus registration fee ($40/semester) _____ Plus registration fee ($40/semester) _____
*American/US History - HS ($70/month) _____ *World History - HS ($70/month) _____
Plus registration fee ($40/year) _____ Plus registration fee ($40/semester) _____
---------------------------------------------------------------------------------------------------------
*Music / Elementary Class ($50/month) ______ *Music / Middle School Class ($55/month) _____
Plus registration fee ($30/year) ______ Plus registration fee ($35/year) ______
*Music / Middle and High School Choir ($65/month) ______
Plus registration fee ($35/year) ______
--------------------------------------------------------------------------------------------------------
*Art / Elementary Class ($50/month) ______ *Art / Middle School Class ($55/month) ______
Plus registration fee ($30/year) ______ Plus registration fee ($35/year) ______
*Art / High School Art Class with Digital Bonus ($65/month) ______
Plus registration fee ($35/year) ______
--------------------------------------------------------------------------------------------------------
*Knitting/Crocheting Elementary Level ($50/month) ______ *Knitting/Crocheting (6th-8th grade) ($55/month) ______ Plus registration fee ($30/year) ______ Plus registration fee ($35/year) ______
-------------------------------------------------------------------------------------------------------
*Drama / Elementary Class ($50/month) ______ *Drama / Middle School Class ($55/month) ______
Plus registration fee ($30/year) ______ Plus registration fee ($35/year) ______
*Drama / High School Class ($65/month) ______
Plus registration fee ($35/year)
-------------------------------------------------------------------------------------------------------
*Basic Typing/Computer (Elementary) ($50/month) ______ *Web Design/Middle School ($60/month) ______ Plus registration fee ($30/year) ______ Plus registration fee ($40/year) ______
*High School Typing/Keyboarding ($65/month) ______ *Computer Course/High School ($65/month) ______
Plus registration fee ($45/year) ______ Plus registration fee ($45/semester) ______
Fall Semester ______
*CAD Course/High School ($65/month) ______
Plus registration fee ($45/semester) ______
Fall Semester ______
--------------------------------------------------------------------------------------------------------
*Robotics / Elementary Class ($65/month) _____ *Robotics / Middle School Class ($65/month) _____
Plus registration fee ($35/year) _____ Plus registration fee ($35/year) _____
*Robotics Course/High School ($65/month) _____
Plus registration fee ($45/year) _____
Spring Semester _____
--------------------------------------------------------------------------------------------------------
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 MHA)
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. Reminders are typically sent out via email around the 10th of each month and payment is due upon receipt. However, if reminders are not sent on any given month, I understand that it is still my full responsibility to pay on time.
_____ I understand that my invoice is DUE UPON RECEIPT and is considered LATE if Michaels Homeschool Academy 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 MHA to make other arrangements.
_____ I understand that all checks must be sent to Mrs. Livia Michaels who is affiliated with Michaels Homeschool Academy. 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 Academy (MHA) program during the year ____________. Further, I authorize any trained caregiving 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 Hickory Valley Baptist Church at his/her own risk. I further understand and do hereby waive and agree to hold harmless MHA, any outside facilities affiliated with MHA, Hickory Valley 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. In addition, I understand this waiver agreement will also include my decision to allow my high school child(ren) to drive himself/herself to and from school premises. All risks are known and understood by me. Furthermore, I agree to give permission to Michaels Homeschool Academy 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, policies, code of conduct, student dress code, payment guidelines, and terms and conditions may result in the student being dismissed from his/her enrollment at MHA. 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!*