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.