Send registration and payment with this form! We will begin sending our new quarters on July 1st. If you are planning to be away during a certain period of time, and do not want your curriculum to arrive while you are away please call 309-663-4477 and let us know!

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We wish to re-enroll our student(s) in Midwest Christian Academy.

We would like to have our curriculum by (month)

and (day)

We would like to start our school year by (month)

and (day)

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Parent's name

Mailing address

Mailing city

Mailing state

Mailing zip

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Home phone

Work phone

Email

Daytime phone

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Student 1 full name

Student 1 grade
Registration $50.00
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Student 2 full name

Student 2 grade
Registration $50.00
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Student 3 full name

Student 3 grade
Registration $50.00
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Student 4 full name

Student 4 grade
Registration $50.00
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Re-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 July 1st. 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 agreed to follow the procedures time in the Parent/Supervisor Training Booklet. I will keep all tests and test keys in a secure place inaccessible to the student. I will grade the tests and return properly at the end of each quarter.

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Signature of Parent/Guardian

Date

If you are paying annually, specify the number of quarters you want to have sent at the beginning of the year.

4 quarters

2 quarters

1 quarter

Include Registration & Tuition Fee for each student. For current prices see the Registration and Fees page.