Blaze - Course Registration Form
Student's Full Name (one student per form) *
Your answer
What class(es) are you registering for? *
Required
My child has met all the prerequisites for these classes. *
Required
Gender *
Have you attended a Blaze University class or workshop before? *
Student Birthdate *
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Grade when class begins: *
Your answer
Student Cell Phone *
Your answer
Student Email *
Your answer
Address *
Your answer
Mom's First and Last Name *
Your answer
Dad's First and Last Name *
Your answer
Mom's Cell Phone *
Your answer
Dad's Cell Phone *
Your answer
Parent Contact Email *
Your answer
Does your family attend church regularly? *
Does the student have any allergies? If so, please describe. *
Your answer
Parents and students, please read the following policies and check that you agree:
Code of Conduct *
Blaze requires students to be respectful of everyone at all times. It is also expected that students attend regularly, avoid all forms and appearances of cheating, refrain from using swear words or crude language, obey basic classroom rules, and participate in homework and class activities. If a student or parent fails to be respectful and honor such basic expectations, it could result in the unenrollment of a student from any Blaze class at any time. If this happens, no refund will be given.
Required
Dress Code *
No particular dress code is required beyond avoiding any clothing or accessories deemed obscene, offensive, inappropriate, or distracting from the educational environment. Some examples of unacceptable choices are visible underwear, miniskirts, and spaghetti straps.
Required
Books and Supplies Required *
A list of books and supplies required can be found on the syllabus, which will be released no later than July 1. The cost of these supplies is not included in the tuition. Students are also required to supply their own computers for homework and occasional in-class assignments.
Required
Parent Involvement *
Classes are intended to be independent of parent help with the main exception that parents do need to take an active role in ensuring homework is completed thoroughly and in a timely manner. However, parent involvement beyond that is highly encouraged but not expected. As a college preparatory school, Blaze students need to complete their homework in order to grow and learn. Furthermore, with limited classroom time a week, homework is an imperative component of academic success.
Required
I have read and agree to the above policies and procedures for Blaze. *
Student Electronic Signature
Your answer
Parent Electronic Signature *
Your answer
*
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Parent or Legal Guardian Emergency Consent and Release
If I am unable to be reached prior to my child needing emergency treatment following an injury, I hereby authorize the release of any and all medical information concerning my child to appropriate medical personnel and/or any appropriate healthcare provider or insurance company.

In consideration for being permitted to participate in a Blaze class, I agree to release Blaze and First Montgomery Baptist Church, including its director, volunteers, agent or facilities, from any liability or any claims or damages related to injury, death or property damage.
I HAVE READ AND AGREE TO THESE TERMS *
Electronic Signature of Parent/Guardian:
Your answer
Date *
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Photo and Video Release
I hereby grant Blaze permission to use my child's photograph and video images in any and all publicity for Blaze, including all social media outlets, without payment or other compensation in perpetuity. I hereby authorize Blaze to record, edit, alter, copy, exhibit, publish, or distribute all photos and images of my child. I waive the right to inspect or approve the finished product including written or electronic copy wherein my photo appears.
Electronic Signature of Parent/Guardian
Your answer
Or
I choose to opt out of this. Please do not post any pictures of my child. I understand this means that sometimes my child will be left out of group pictures
Payment and Refund Policy:
A one-time, non-refundable $25 registration fee, and separate deposit, will be required to hold a place for your student in class. This initial deposit will be one-fourth of the yearly tuition and is fully refundable until July 1. Please see the payment screen for exact tuition payment installments per class. Tuition can be paid in full or paid in installments according to the payment schedule.

The Payment Schedule:

Due date Amount Due Details
At time of registration $25 Registration fee, one-time, 1 fee for all classes, non-refundable
At time of registration 1/4 of yearly tuition Deposit covers the first quarter of the
yearly tuition, fully refundable until July 1 (1 of 4)
On or before September 1 1/4 of yearly tuition Second tuition payment (2 of 4)
On or before November 1 1/4 of yearly tuition Third tuition payment (3 of 4)
On or before January 1 1/4 of yearly tuition Fourth and last tuition payment (4 of 4)

By signing this form parents legally agree to pay for a full school year. If payments are not made at any time according to this payment schedule, Blaze can unenroll the student from the class. Space in class is only guaranteed when payment and registration paperwork is received on time. Additionally, a late fee of $20 will be assessed for any payments that do not meet the scheduled due dates.

Refund Policy:
Full refunds of tuition will be given until July 1 of that school year. After that time, no refunds will be given. All classes have individual minimum student number requirements to make. By July 1, Blaze will release if each class has met the minimum number requirements and will refund any payments accordingly.
I have read and agree to the payment and refund policy of Blaze. *
Electronic Signature of Parent/Guardian
Your answer
Date *
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