SRCCHA 2021-2022 Application for Enrollment 1 Parent2 Student3 Additional Family Information4 Prospective Family Questions5 Signatures6 Payment Information Items marked with an asterisk are required.Current Returning or Prospective*Are you a current, returning, or prospective family to SRCCHA? - Current Family is a family currently enrolled in SRCCHA. - Returning Family is a family previously enrolled, not currently enrolled, but would like to enroll for the next school year. - Prospective Family is a family never enrolled at SRCCHA. CurrentReturningProspective Note, enrollment for returning and prospective families does not begin until March 1, 2021. Applications submitted prior to March 1 will not be considered or processed until after March 1. Parent InformationFather's Name* First Last Father's OccupationFather's Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Father's Primary Phone Number*Type*MobileHomeWorkFather's Secondary Phone NumberTypeHomeMobileWorkFather's Email Address Enter Email Confirm Email Mother's Name* First Last Mother's OccupationMother's Home Address Same as father's address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother's Primary Phone NumberyesnoIs the mother's primary phone number the same as the father's?Mother's Primary Phone Number*Type*MobileHomeWorkMother's Secondary Phone NumberTypeHomeMobileWorkMother's Email Address Enter Email Confirm Email Church attending*Enter the name of the church you are attending.Pastor's NameEnter the pastor's name of the church you are attending.Church PhoneEnter the church or pastor's phone number. Both the father's and mother's name is missing. Please add at least one before proceeding. Both the father's and mother's address is missing. Please add at least one before proceeding. Both the father's and mother's email address is missing. Please add at least one before proceeding. Both the father's and mother's primary phone number is missing. Please add at least one before proceeding. Enrollment Options Due to the nature of the COVID-19 pandemic, the SRCCHA Board reserves the right to make changes at any time in an effort to balance educational priorities against the safety of students, tutors, and administrators. K-G6 - Art & Music: K–G6 students will be taught the grammar of art and music and introduced to the great artists and composers. Students will also learn to draw and sing. K and G1 students will have their own individual classes. G2 and G3 students will play the recorder. No homework will be assigned for Art and Music. Math Lab (K-D2): Open to all students. Math Lab will be directed tutoring in all levels of math. This will be an after-school lab from 2:10pm-3pm one day a week on Thursdays. This is an additional $250 in tuition. Dialectic (D1 & D2): students have the choice of Math and/or Advanced Latin. If the student does Math AND Advanced Latin, you will be charged another $450 in tuition for a second elective. *Pre-Algebra, Algebra and Geometry (D1 – D2) students will receive classroom instruction and homework assignments. Students will be assessed by the Math Tutor and placed in an appropriate course level. Advanced Latin students (D1–D2) will receive classroom instruction and homework assignments. Student Count*How many students are you registering?Student 1 InformationStudent 1 Full Name* First Last Nickname Student 1 Gender*MaleFemaleStudent 1 DOB* What is the student's date of birth?Student 1 Grade Entering*KG1G2G3G4G5G6D1D2What grade is the first student entering?Student 1 Enrollment Options Adv. Latin (D1, D2) Pre-Algebra (D1) Algebra (D1, D2) Geometry (D2) Choose enrollment options for student.Student 1 Math Lab*YesNoWould you like to enroll the student in Math Lab?Student 2 InformationStudent 2 Full Name* First Last Nickname Student 2 Gender*MaleFemaleStudent 2 DOB* Student 2 Grade Entering*KG1G2G3G4G5G6D1D2What grade is the second student entering?Student 2 Enrollment Options Adv. Latin (D1, D2) Pre-Algebra (D1) Algebra (D1, D2) Geometry (D2) Choose enrollment options for student.Student 2 Math Lab*YesNoWould you like to enroll the student in Math Lab?Student 3 InformationStudent 3 Full Name* First Last Nickname Student 3 Gender*MaleFemaleStudent 3 DOB* Student 3 Grade Entering*KG1G2G3G4G5G6D1D2What grade is the third student entering?Student 3 Enrollment Options Adv. Latin (D1, D2) Pre-Algebra (D1) Algebra (D1, D2) Geometry (D2) Choose enrollment options for student.Student 3 Math Lab*YesNoWould you like to enroll the student in Math Lab?Student 4 InformationStudent 4 Full Name* First Last Nickname Student 4 Gender*MaleFemaleStudent 4 DOB* What is the student's date of birth?Student 4 Grade Entering*KG1G2G3G4G5G6D1D2What grade is the fourth student entering?Student 4 Enrollment Options Adv. Latin (D1, D2) Pre-Algebra (D1) Algebra (D1, D2) Geometry (D2) Choose enrollment options for student.Student 4 Math Lab*YesNoWould you like to enroll the student in Math Lab?Student 5 InformationStudent 5 Full Name* First Last Nickname Student 5 Gender*MaleFemaleStudent 5 DOB* Student 5 Grade Entering*KG1G2G3G4G5G6D1D2What grade is the fifth student entering?Student 5 Enrollment Options Adv. Latin (D1, D2) Pre-Algebra (D1) Algebra (D1, D2) Geometry (D2) Choose enrollment options for student.Student 5 Math Lab*YesNoWould you like to enroll the student in Math Lab? Additional Family InformationSiblings not attending SRCCHAFull NameAgeGrade EnteringSchool Attending Click the plus to add additional students.Special CareIn the space above, please write anything you think would be necessary or helpful to us to care for your child(ren) while in class (e.g., allergies, glasses, learning disabilities, behavior problems, etc.). Please note that SRCCHA is not equipped to educate students with serious medical conditions or emotional, physical, or learning disabilities.GoalsBriefly describe your goals for the upcoming Academy Year.Committee AssignmentCheck all that apply. See Family Handbook for descriptions. Care Class Coordinator Prayer Setup Social Yearbook IT/Technology Other Prospective Family QuestionsYou said you were a prospective family. Please complete these additional questions for prospective families only.Education HistoryPlease list preschools/schools/tutorials previously attended, starting with the most recent.School Name and Contact Informationfrom Gradeto Grade Phonics/Grammar Experience*Has instruction been received by your child(ren) for Phonics and Grammar?YesNoPhonics/Grammar Curriculum*What curriculum was used for Phonics and Grammar?Latin Experience*Has instruction been received by your child(ren) for Latin?YesNoLatin Curriculum*What curriculum was used for Latin?Logic Experience*Has instruction been received by your child(ren) for LogicYesNoLogic Curriculum*What curriculum was used for Logic?Homeschool Choice*Why have you chosen to homeschool your child(ren)?Classical Christian Understanding*What is your understanding of the Classical Christian approach? Have you used this in your own schooling?Note: We would appreciate your support in answering the following questions as candidly as possible. SRCCHA is not staffed to handle children with serious learning disorders, behavioral issues or physical disabilities. We provide only group tutoring and a safe environment for children to learn. (If more than one child is applying, please note which child you are referring to when answering.) Learning DisordersDoes your child have any condition (learning disorders) that may affect his/her academic achievement or class involvement and would require regular or special attention? If so, please specify:Behavioral IssuesDoes your child have any behavioral issues that may affect his/her class involvement and would require regular or special attention?Previous SuspensionHas your child ever been suspended by a previous academic setting? If so, please specify:Father's Testimony*For the father, briefly summarize your personal testimony of salvation. Please include your views on Jesus Christ.Mother's Testimony*For the mother, briefly summarize your personal testimony of salvation. Please include your views on Jesus Christ.ReferencesDo you know anyone who currently attends SRCCHA? This person(s) may be used as a reference for your family. SignaturesConfirm Accuracy* We (I) hereby certify that all the foregoing information is accurate and true. We (I) have carefully considered enrolling our child(ren) in the Severn Run Classical Christian Homeschool Academy. We (I) agree to submit to the philosophy, programs, academic and disciplinary rules outlined by the Board in the Family Handbook. We (I) understand that admission is granted by the Board, and that such admission may be terminated at any time. Parent Signature* Payment InformationApplication Fee Price: $50.00 Application Fee Price: $100.00 Student 1 Applicant Assessment Fee (K) Price: $25.00 Prospective Student 1 Applicant Assessment Fee (G1) Price: $25.00 Returning Student 1 Applicant Assessment Fee (G1) Price: $25.00 Prospective Student 1 Applicant Assessment Fee (G2) Price: $25.00 Returning Student 1 Applicant Assessment Fee (G2) Price: $25.00 Prospective Student 1 Applicant Assessment Fee (G3) Price: $25.00 Returning Student 1 Applicant Assessment Fee (G3) Price: $25.00 Prospective Student 1 Applicant Assessment Fee (G4) Price: $25.00 Returning Student 1 Applicant Assessment Fee (G4) Price: $25.00 Prospective Student 1 Applicant Assessment Fee (G5) Price: $25.00 Returning Student 1 Applicant Assessment Fee (G5) Price: $25.00 Prospecitve Student 1 Applicant Assessment Fee (G6) Price: $25.00 Returning Student 1 Applicant Assessment Fee (G6) Price: $25.00 Prospecitve Student 1 Applicant Assessment Fee (D1) Price: $25.00 Returning Student 1 Applicant Assessment Fee (D1) Price: $25.00 Prospecitve Student 1 Applicant Assessment Fee (D2) Price: $25.00 Returning Student 1 Applicant Assessment Fee (D2) Price: $25.00 Student 2 Applicant Assessment Fee (K) Price: $25.00 Prospective Student 2 Applicant Assessment Fee (G1) Price: $25.00 Returning Student 2 Applicant Assessment Fee (G1) Price: $25.00 Prospective Student 2 Applicant Assessment Fee (G2) Price: $25.00 Returning Student 2 Applicant Assessment Fee (G2) Price: $25.00 Prospective Student 2 Applicant Assessment Fee (G3) Price: $25.00 Returning Student 2 Applicant Assessment Fee (G3) Price: $25.00 Prospective Student 2 Applicant Assessment Fee (G4) Price: $25.00 Returning Student 2 Applicant Assessment Fee (G4) Price: $25.00 Propsective Student 2 Assessment Assessment Fee (G5) Price: $25.00 Returning Student 2 Assessment Assessment Fee (G5) Price: $25.00 Prospective Student 2 Applicant Assessment Fee (G6) Price: $25.00 Returning Student 2 Applicant Assessment Fee (G6) Price: $25.00 Prospective Student 2 Applicant Assessment Fee (D1) Price: $25.00 Returning Student 2 Applicant Assessment Fee (D1) Price: $25.00 Prospective Student 2 Applicant Assessment Fee (D2) Price: $25.00 Returning Student 2 Applicant Assessment Fee (D2) Price: $25.00 Student 3 Applicant Assessment Fee (K) Price: $25.00 Prospective Student 3 Applicant Assessment Fee (G1) Price: $25.00 Returning Student 3 Applicant Assessment Fee (G1) Price: $25.00 Prospective Student 3 Applicant Assessment Fee (G2) Price: $25.00 Returning Student 3 Applicant Assessment Fee (G2) Price: $25.00 Prospective Student 3 Applicant Assessment Fee (G3) Price: $25.00 Returning Student 3 Applicant Assessment Fee (G3) Price: $25.00 Prospective Student 3 Applicant Assessment Fee (G4) Price: $25.00 Returning Student 3 Applicant Assessment Fee (G4) Price: $25.00 Prospective Student 3 Applicant Assessment Fee (G5) Price: $25.00 Returning Student 3 Applicant Assessment Fee (G5) Price: $25.00 Prospective Student 3 Applicant Assessment Fee (G6) Price: $25.00 Returning Student 3 Applicant Assessment Fee (G6) Price: $25.00 Prospective Student 3 Applicant Assessment Fee (D1) Price: $25.00 Returning Student 3 Applicant Assessment Fee (D1) Price: $25.00 Prospective Student 3 Applicant Assessment Fee (D2) Price: $25.00 Returning Student 3 Applicant Assessment Fee (D2) Price: $25.00 Student 4 Applicant Assessment Fee (K) Price: $25.00 Prospective Student 4 Applicant Assessment Fee (G1) Price: $25.00 Returning Student 4 Applicant Assessment Fee (G1) Price: $25.00 Prospective Student 4 Applicant Assessment Fee (G2) Price: $25.00 Returning Student 4 Applicant Assessment Fee (G2) Price: $25.00 Prospecitve Student 4 Applicant Assessment Fee (G3) Price: $25.00 Returning Student 4 Applicant Assessment Fee (G3) Price: $25.00 Prospective Student 4 Applicant Assessment Fee (G4) Price: $25.00 Returning Student 4 Applicant Assessment Fee (G4) Price: $25.00 Prospective Student 4 Applicant Assessment Fee (G5) Price: $25.00 Returning Student 4 Applicant Assessment Fee (G5) Price: $25.00 Prospective Student 4 Applicant Assessment Fee (G6) Price: $25.00 Returning Student 4 Applicant Assessment Fee (G6) Price: $25.00 Prospective Student 4 Applicant Assessment Fee (D1) Price: $25.00 Returning Student 4 Applicant Assessment Fee (D1) Price: $25.00 Prospective Student 4 Applicant Assessment Fee (D2) Price: $25.00 Returning Student 4 Applicant Assessment Fee (D2) Price: $25.00 Student 5 Applicant Assessment Fee (K) Price: $25.00 Prospective Student 5 Applicant Assessment Fee (G1) Price: $25.00 Returning Student 5 Applicant Assessment Fee (G1) Price: $25.00 Prospective Student 5 Applicant Assessment Fee (G2) Price: $25.00 Returning Student 5 Applicant Assessment Fee (G2) Price: $25.00 Prospective Student 5 Applicant Assessment Fee (G3) Price: $25.00 Returning Student 5 Applicant Assessment Fee (G3) Price: $25.00 Prospective Student 5 Applicant Assessment Fee (G4) Price: $25.00 Returning Student 5 Applicant Assessment Fee (G4) Price: $25.00 Prospective Student 5 Applicant Assessment Fee (G5) Price: $25.00 Returning Student 5 Applicant Assessment Fee (G5) Price: $25.00 Prospective Student 5 Applicant Assessment Fee (G6) Price: $25.00 Returning Student 5 Applicant Assessment Fee (G6) Price: $25.00 Prospective Student 5 Applicant Assessment Fee (D1) Price: $25.00 Returning Student 5 Applicant Assessment Fee (D1) Price: $25.00 Prospective Student 5 Applicant Assessment Fee (D2) Price: $25.00 Returning Student 5 Applicant Assessment Fee (D2) Price: $25.00 Total $0.00 You're almost finished! Once you click the Submit button you will receive instructions on how to pay the application fee via check and move your family along in the next step in the process.Was this form easy to use?*YesNoCommentsPlease let us know of how this form can be improved.EmailThis field is for validation purposes and should be left unchanged.
