Legacy Homeschool Academy Registration 2024-2025

Legacy Homeschool Academy

2024-2025 REGISTRATION FORM
Student's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
SY '24-'25 Grade*
Student's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
SY '24-'25 Grade
Student's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
SY '24-'25 Grade
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT/GUARDIAN INFORMATION
Full Name*

First NameLast Name
Cell Phone #*

Area CodePhone Number
Alternate Phone #

Area CodePhone Number
Email*
example@example.com
Full Name

First NameLast Name
Cell Phone #

Area CodePhone Number
Alternate Phone #

Area CodePhone Number
Email
example@example.com
EMERGENCY CONTACT INFORMATION: Other than Parent/Guardian
Full Name*

First NameLast Name
Phone #*

Area CodePhone Number
Relationship to Student*
Full Name

First NameLast Name
Phone #

Area CodePhone Number
Relationship to Student
Does your child child have any problems, injuries or allergies that might affect her/him from fully participating in the activities at The Legacy Academy? Please describe and include additional notes to the staff here:
Registration assumes full participation in the ENTIRE year of classes. A deposit of $250 via cash, check (made out to The South Gate), or the Church Center app (choose "Legacy Academy" on the dropdown menu) is required to purchase curriculum and is not included in the tuition amount.
Should be Empty: