Connection Tutorial Registration
Please answer all questions to begin the registration process for the 2021-2022 school year. Note: You will not be registered for classes until you submit your deposit and registration fees along with your medical form at the end of this document.
How many children are you registering? *
Name and Grade of each student? *
(ex. Dan Smith 7, David Smith 11)
Homeschool umbrella school? *
Support Group
What homeschool support groups do you participate in?
Guardian name? *
Guardian email? *
Guardian phone number? *
House address? *
(ex. 111 East Memphis Cove)
City, State, Zip code? *
(ex. Memphis, TN 38120)
Emergency Contact Name *
This person can not be the same as the guardian from above. It may be another parent.
Emergency Contact Phone# *
Learning Disabilities
If your student(s) have been diagnosed (or suspected of having) any learning disabilities it would be extremely helpful for each of their tutors to know in order to best help them succeed in the classroom. eg. Dan - ADHD/Dyslexia
Health Issues
We are sensitive to all the needs of students. Please list any health issues any of the enrolled students may have so we can best accommodate them. eg. Dan - peanut allergy (severe/has EpiPen)
Primary Care Physician *
If different for each child, please list each.
Insurance
Please enter Insurance company followed by policy number.
Medical Waiver *
Waive and Release Statement: I hereby give my permission for my child/ren listed above to take part in ​The Connection ​ sponsored classes. I authorize any representative of ​The Connection ​ to render immediate first aid to my child and/or to transport him/her to a medical treatment facility and/or to call ambulance. It is understood that all costs for transportation arrangements and costs associated with examination and treatment are SOLELY at my expense. I further give my permission and authorize any representative of ​The Connection ​ to secure needed medical attention or treatment on the advice of any licensed physician and from a licensed physician, hospital, or medical clinic in the event that I cannot be reached for such permission. I release any representative of ​The Connection ​ and/or ​Collierville First Baptist Church, Byhalia Road, ​ Collierville, TN 38017 ​ as a group or individually from any and all liability for accident, injuries, or loss of life suffered or for efforts to administer first aid for same as a result of involvement with ​The Connection ​ classes and activities. I further understand and agree that in the event that the above-named sons/ daughters are involved in activities that violate or compromise the rules, or purposes of ​The Connection ​ or ​Collierville First Baptist Church ​ , I will pay and accept full responsibility. I understand that I am responsible for how my child arrives and leaves the campus. I have read and understand this Medical Release and Waiver. I accept and assume any and all risks of accident, injury, or loss of life associated with the activities of ​The Connection. ​ This release is valid and irrevocable for the current calendar year of ​The Connection​ activities.
Cancellation policy? *
By completing this form, you agree to the policy that no tuition refunds will be offered after August 3, 2021; please make class decisions accordingly. We need these commitments to make sure class offerings are available.
Required
Tuition Agreement *
By completing registration, you, the parent or legal guardian, have agreed to partner with The Connection for the educational needs of your child(ren) for the 2021-2022 school year. You agree to our Goals and Objectives, and understand that all Fees, Tuition, and class deposits are required at time of registration. Registration Fees and Class deposits are non-refundable, no exceptions. It is with this understanding that all checks returned for insufficient funds during the year will incur a $30 insufficient funds fee. We thank you for your enrollment and value your family’s participation at The Connection.
Goals and Objectives *
The goals and objectives can be viewed on the registration page of our website. Please look these over yourself and with your child before starting school. Selecting yes below will notify us that you are aware of these and will do your best to adhere to the goals and objectives of The Connection Homeschool.
Ready to submit the Enrollment Form?
Once you submit your enrollment form, move on to Step 2: Course Selection Form. Take a minute to look over the Courses tab and the Schedule tab on our website to help you decide which classes your student should take. You will complete a Course Selection Form for each of your students.
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