Michaels Homeschool Association
               of Chattanooga                    

Put God First

Summer Camp Registration Form

GENERAL INFORMATION (one registration form per child please)

Child's Name ___________________________________________  Phone______________________

Address _________________________________________________________________________

City ________________________  State _______________________  Zip Code __________________

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

Email:______________________________ Umbrella School (if applicable): ________________________

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 ________________________________

Whom were you recommended by? _________________________________________________________



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

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


   * Writing Camps (3rd - 12th grade) - Tuesdays @ 8:30 a.m. - 10:00 a.m.

             June Summer Camp - Research Writing  ______

             July Summer Camp - Creative Writing  ______

                                                  Fees: $125 / student / month (includes: registration, a snack, and a drink) 

  Instructor: Mrs. Lindsey Howell


   * Math Camp (Algebra 1) - Tuesdays @ 10:10 a.m. - 11:40 a.m.

             June and July Camp  _____

                                                    Fees: $125 / student / month (includes: registration, a snack, and a drink)

   Instructor: Mrs. Madaline McFarland        

   *Note: This math camp is a total of 8 weeks and will cover Polynomials and Factoring,  Rational Equations and Functions, and Radicals and Connections to Geometry. If your child needs help in other areas of Algebra 1, we will be happy to help. We are also open to suggestions and further help in other areas of math. Please contact us with your needs!


   * Science Camp (All ages) - Tuesdays @ 11:50 a.m. - 1:20 p.m.

              June Camp - Trekking Through the Americas _____

              July Camp - African Safari _____

                                                           Fees: $125 / student/ month (includes: registration , a snack and a drink)

 Instructor: Mrs. Connie Clark

We will explore a different country each week learning about the climate, habitat, natural resources, vegetation, and animals who live there! As an added bonus, there will be a dissection at the end of each camp. Lots of learning!  



   * Art Camp (3rd - 12th grade) - Tuesdays @ 1:30 p.m. - 3:00 p.m.

             June Summer Camp - Fairy House  ______ 

             July Summer Camp - Waterfall Garden  ______

                                                          Fees: $100 / student / month (includes registration fee, a snack, and a drink)

 Instructor: Mrs. Shannon Swann 

 *Note: Art materials will need to be individually purchased. A list of items will be sent to every student upon registration.*


Your Monthly Total: _____________ (OFFICE USE ONLY)

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

               ______                   ______                                ____________                                                        ____                           ______

               ______                   ______                                ____________                                                        ____                           ______ 

               ______                   ______                                ____________                                                        ____                           ______  


                                                                                                 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 beginning in the month of June AND/OR beginning in the month of July, whichever month(s) I have indicated above. Upon payment, an email will be sent out to me that will serve as my receipt. 

_____ 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 5th 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 5th 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 containing child(ren)'s name and amount of payment inside. 

_____ 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 $30 charge per student per class if I withdraw at any time during the registered month. This INCLUDES dropping at the end of the month before the last class.

_____ 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 my child does not get into a class because it is full, MHA will refund all my fees.

_____ I understand that if my account becomes overdue by 1 month, 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/tuition payments will be forfeited if my child is dismissed at any time during the summer. 

Parent/Guardian Signature: ________________________________________ Date: ________________


                                                                                  CONSENT AND RELEASE FORM 

I hereby give permission for _________________________ to participate in the Michaels Homeschool Academy (MHA) Summer Camp program during the year ____________. Further, I authorize the administrative personnel to provide any 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 program or sport and/or being a part of any recreation 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 MHA, any outside facilities affiliated with MHA, 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. In addition, I understand that 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 contract. 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 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/tuition fees are non-refundable. THANK YOU AND WELCOME!*