Registration

Registration Form

Registration Form 2023-2024

Registration Fee $100 per student (due at time of registration)

(ALL TUITION AND FEES ARE NON – REFUNDABLE)

Please fill out one form per student

Date

Student Name

Address

Date of Birth

Age

Sex

Email address

Phone number

Mother’s Name

Place of Employment

Daytime Phone

Father’s Name

Place of Employment

Daytime Phone

Last Grade completed

Enrolling Grade

Homeschool Name

Home School ID

County that you are registered in

Are you a member of NCHE?

HSLDA?

Stanly/Montgomery Homeschool Assoc.?

Emergency Contacts: Please add name, contact number, and relation to child

Field label

PICK UP

Please include name, phone number, relation to child. ONLY NAMES LISTED WILL BE PERMITTED TO PICK UP YOUR CHILD!!!

PHYSICIANS NAME

PHONE NUMBER

INSURANCE NAME

POLICY#

Address: 102 West Stanly St, Stanfield, NC 28163

Operating Hours: M-Th 9 AM - 3 PM

Tutoring: Fri 9 AM - 6 PM

Phones Open 24/7