Rise Homeschool Classes

Rise Homeschool Classes

Registration Form
Please complete the following registration form for all students enrolling in Rise Homeschool Classes. PLEASE SELECT THE APPROPRIATE SCHOOL YEAR WHEN REGISTERING FOR CLASSES.

REGISTRATION FEES ARE NON-REFUNDABLE.
Registering Guardian's Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Information
Student One*

First NameLast Name
Birth Date *

MonthDayYear
Date
Grade for 2025 -2026 School Year*
Gender*
Student Two

First NameLast Name
Birth Date

MonthDayYear
Date
Grade for 2025 - 2026 School Year
Gender
Student Three

First NameLast Name
Birth Date

MonthDayYear
Date
Grade for 2025 -2026 School Year
Gender
Student Four

First NameLast Name
Birth Date

MonthDayYear
Date
Grade for the 2025-2026 School Year
Gender
Student Five

First NameLast Name
Birth Date

MonthDayYear
Date
Grade for the 2025 - 2026 School Year
Gender
Current Residence Information

Emergency Contacts
Name*

First NameLast Name
Relation to Student*
Phone Number*
Please enter a valid phone number.
Emergency Contact 2
Relation to Student
Name

First NameLast Name
Phone Number

Area CodePhone Number
Physician and Medical Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.*
Insurance/Health Coverage (Company)*
Preferred Hospital*

My Products*

2025 - 2026 Fall RegistrationOne Time Fee

$175.00 Quantity

BETA Elementary

$16.00 Quantity

BETA Junior

$24.00 Quantity

BETA Senior

$32.00 Quantity

No Registration Fee Due

$ Free Quantity

Total

$0.00

Were You Referred to the Program? Please add the name of the family/person who referred you.
Should be Empty:

Emergency Contacts