FAMILY INFORMATION

Parent Name (required)

Mailing Address (required)

City (required)

State (required)

Zip Code (required)

Country (required)

Parent Daytime Phone Number (required):

Your Email (required)

Today's Date:

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 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:
Parent or Guardian's Name (required)

STUDENT INFORMATION (You may enter information for multiple students)

ID#

Student Name (required)

Birthday (required):

Grade (required):
KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeNinth GradeTenth GradeEleventh GradeTwelfth Grade

ID#

Student Name

Birthday:

Grade:
KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeNinth GradeTenth GradeEleventh GradeTwelfth Grade

ID#

Student Name

Birthday:

Grade:
KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeNinth GradeTenth GradeEleventh GradeTwelfth Grade

Registration Fee: $50

We want to receive our curriculum by (required):

Date we plan to begin school (required):

Please send number of quarter(s) for my student(s) (required):
1234

Parents, August and September are our busiest months of the year. If you re-enroll during those months, you will have a longer wait to receive your curriculum. If you're in a hurry, enroll early! We begin sending out curriculum for the new school year on July 1st.

Note: Registration and Tuition must be paid before curriculum is sent. For amounts, see price list on the Tuitions page.

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

If your family situation doesn't fit this form, please contact MCA.