2023-2024 Program
Registration

Please complete the information below to enroll in our hybrid homeschool program.

Primary Contact First Name

Primary Contact Last Name

Phone

Street Address

City

Postal / Zip code

Additional Contact Parent/Guardian First Name

Additional Contact Parent/Guardian Last Name

Phone

Please describe your family's religious beliefs and affiliation.

Do you regularly attend a local church?

Yes

Church name

For each child being enrolled, please list the following: NAME, DATE of BIRTH, AGE, GENDER, and GRADE LEVEL

Please list the program option for each child.

Please describe your child's interests and dislikes.

How do you hope for your child to grow through their time at Grace Family Learning Center.

Briefly describe your approach to parenting and discipline.

Describe any medical, behavioral, or other special coditions related to your child.

List any known allergies.

List any medications that your child takes.

Emergency Contact First Name

Emergency Contact Last Name

Phone

Are there any custodial or other legal agreements involving the enrolling students?

Yes

Are you requesting financial assistance? (Only the 5-day option is eligible)

Yes

I agree to the terms & conditionsView Policies and Waivers

Your Signature

Thanks for applying to volunteer with us! We'll get back to you soon.