Enrollment

    FAMILY INFORMATION

    Primary Phone Number:

    Secondary Phone Number:

    Phone:

    How did you hear about Midwest Christian Academy?

    STUDENT INFORMATION

    Birthday:

    Does this student have any learning difficulties? If yes, please describe:

    Phone:

    Fax:

    We would like to begin school on this date:

    ENROLLMENT AGREEMENT
    I am responsible for the payment of all fees for this account. I understand the registration fee is non-refundable and is to be paid each school year, beginning on July 1. My student will be supervised during study time by a parent or responsible adult who will not allow the student to copy answers from the score keys. I agree to follow the procedures taught in the Parent-Supervisor Training Packet. I will keep all tests and test keys in a secure place, inaccessible to the student. I will grade the tests and return them promptly at the end of each quarter.

    I agree to these conditions:

    Date:

    Fees due with Enrollment Application:
    $50 Registration Fee and $30 Diagnostic Testing Fee. After completion of Diagnostic Tests, you may pay annually or quarterly. For a complete current price list, see Registration and Fees page.

    Payment Options - Please call (309) 663-4477 with credit card information.

    Please be sure to submit this form, then call the office to make your payment.