Registration Request Form2025 - 2026Once the registration request form is submitted, you will receive a confirmation email on the following Tuesday. Student Name * First Name Last Name Student Email Student Phone (###) ### #### Student Birth Date * MM DD YYYY Gender * Male Female Previous School Previous Grade * Kindergarten First Grade Second Grade Third Grade Fourth Grade Fifth Grade Sixth Grade Seventh Grade Eighth Grade Ninth Grade Tenth Grade Eleventh Grade Twelfth Grade Grade for 2025-2026 * Kindergarten First Grade Second Grade Third Grade Fourth Grade Fifth Grade Sixth Grade Seventh Grade Eighth Grade Ninth Grade Tenth Grade Eleventh Grade Twelfth Grade Parent Name * First Name Last Name Parent Email * Parent Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact * First Name Last Name Emergency Contact's Phone * (###) ### #### Does your Child have any Allergies? * Yes No If yes, to what and how severe? Describe any social, emotional, physical or educational needs that your child may have. Is your child on any medication? * Yes No For what purpose? What is your cover school? What church do you attend? Elementary Classes Check all that apply Art from the Heart, Grades 4K-8, Tuesday 9:15 - 10:15 Elementary FUN!, Modern History & Space/Energy Science, Grades 2-5, Tuesday 10:15 - 1:00 Elementary PE!, Grades 2-6, Tuesday, 1:00 - 2:00 Elementary FUN!, World Geography & Mammals/Botany Science, Grades 2-5, Wednesday 9:00 - 12:00 Elementary PE!, Grades 2-6, Wednesday, 12:00 - 1:15 Middle School Classes Check all that apply Art from the Heart, Grades 4K-8, Tuesday 9:15 - 10:15 Art from the Heart, Grades 6-12, Tuesday 10:30 - 11:30 World Cultures & Geography for Middle School, Grades 6-8, Wednesday 8:45 - 10:15 Life Science for Middle School, Grades 6-8, Wednesday 10:30 - 12:00 Essay Writing, Grades 7-9, Wednesday 12:15 - 1:45 Composition & Literary Analysis, Grades 8-11, Wednesday 2:00 - 3:30 Intro to Middle School, Grade 6, Tuesday (10:15-3:15) & Wednesday (9:00-2:00) High School Classes Check all that apply Biology, Grades 9-12, Tuesday 8:30 - 10:15 Programming: Physical Computing with Arduino, Grades 9-12, Tuesday 10:30 - 12:00 Art from the Heart, Grades 6-12, Tuesday, 10:30 - 11:30 U.S. History - part 1, Grades 9-12, Tuesday 12:15 - 1:45 Physical Science, Grades 9-12, Wednesday 8:30 - 10:15 ACT Prep, Grades 10-12, Wednesday 8:45 - 10:15 American Sign Language 1, Grades 9-12, Wednesday, 10:30 - 12:00 Human Anatomy, Grades 9-12, Wednesday 12:15-1:45 Composition & Literature Analysis, Grades 9-12, Wednesday 2:00 - 3:30 Writing with Literary Classics, Grades 9-12, Wednesday 2:00 - 3:30 Algebra 2 - part B, Grades 10-12, Thursday 9:15 - 11:00 (held offsite) Tutoring Classes Check all that apply; $195 per section per semester. Section A - Tutoring: Math & Science, Grades 7-12, Tuesday 8:45 - 10:15 Section B - Tutoring: Math & Science, Grades 7-12, Tuesday 12:15 - 1:45 Section C - Tutoring: Math & Science, Grades 7-12, Wednesday 10:30 - 12:00 Section D - Tutoring: Math & Science, Grades 7-12, Wednesday 12:15 - 1:45 Study Hall Check all that apply; $50 per section per semester; Study Hall classes do NOT have a facility fee. Section A - Tuesday, 8:45 - 10:15 Section B - Tuesday, 10:30 - 12:00 Section C - Tuesday, 12:15 - 1:45 Section D - Tuesday, 2:00 - 3:30 Section E - Wednesday, 10:30 - 12:00 Section F - Wednesday, 12:15 - 1:45 Section G - Wednesday, 2:00 - 3:30 By submitting this form to the registrar: * Please check each of the following boxes to indicate your agreement. I understand registration is not complete until the $25 registration fee per class is submitted to each instructor. This fee is nonrefundable. I understand registration is not complete until the $50 administrative fee per student is submitted to Grace on Main, PCA. This fee is refundable through June 30, 2025. I understand that submission of this form after June 30, 2025, will result in a late fee of $50. Registration is not complete until the $50 late fee per student is submitted to Grace on Main, PCA I understand enrollment in each class (with the exception of ACT Prep) is a year-long commitment. I assume financial responsibility for all fees and tuition for the entire year. Thank you! You have submitted your registration form! You will receive a confirmation email on the following Tuesday confirming receipt of your registration request. You will receive another email in mid-March detailing fees which much be paid to secure your student’s enrollment.