Medina Homeschool Enrollment Form
Please complete this enrollment form to select your classes at Medina Homeschool for the year 2025-2026. Please complete a form PER student. For more information about Medina Homeschool and the enrollment process, please visit: www.mcws.org/medinahomeschool. Any questions regarding enrollment can be directed to Maha at medinahomeschool@mcws.org.
Please Note: You may still select your preferred courses on this form, but some classes are already full. We will review each registration and follow up with you to confirm which classes your child has a spot in.
Student Information
Legal Name
*
First Name
Middle Name
Last Name
Grade
*
Please Select
K
1
2
3
4
5
6
7
8
9
10
11
12
Gender
*
Please Select
Male
Female
N/A
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Email
*
example@example.com
Parent(s)/Guardian(s) Information
Parent 1 Name
*
First Name
Last Name
Parent 1 Phone Number
*
Parent 1 Email
*
Parent 2 Name
First Name
Last Name
Parent 2 Phone Number
Parent 2 Email
Emergency Information
Please provide the name and contact information of an emergency contact who can be reached if the parents are unavailable.
Name
*
First Name
Last Name
Relationship
Please Select
Parent
Guardian
Spouse
Sibling
Grandparent
Aunt/Uncle
Cousin
Friend
Neighbor
Other
Phone Number
*
Health Information
Family Doctor
First Name
Last Name
Phone Number
Please let us know if your child has any allergies.
*
Please Select
No allergies
Yes (indicate allergies below)
Please list your child's allergies, if applicable.
List medications if this child is currently taking, if applicable.
MEDICAL WAIVER AND LIABILITY RELEASE
*
Medical Care Authorization: In case of an emergency, I authorize emergency medical care for my child(ren) in the event that I cannot be reached. I agree to bear all costs associated with any necessary medical treatment. I release Medina Homeschool, its staff, volunteers, and the Medina Activity Center from claim or liability due to sickness or injury.
Liability: I acknowledge the risks associated with the activities offered by the Medina Homeschool, including but not limited to baking, painting, STEM experiments, physical fitness, and outdoor activities, for both on-site and off-site classes. I agree to release and hold harmless Medina Homeschool, its staff, volunteers, and partnering organizations (including, but not limited to MCWS and OVA), from any and all liability, claims, or demands arising out of my child(ren)’s participation in these activities, except in cases of gross negligence or willful misconduct.
If your student has a severe medical condition, please fill out the MMAP form (https://www.oxfordschools.org/documents/for-families/medical-plan-and-medication-forms/736153) and submit it to both Oxford Virtual Academy (OVA) and Medina Homeschool. Please indicate below if you have completed this or is not applicable.
*
Please Select
Yes
No (Will do it later)
N/A
Enrollment Type
Note: if your classes will be funded by OVA, we will be in communication with OVA to confirm your funding status. If you are a self-pay student, we will email you an invoice. If you are an OVA funded student but would like to take additional courses, you may do so at the self-pay rate.
Please indicate your enrollment type.
*
I am a self-pay student. The fees per semester are as follows: $150 for on-site classes, $240 for ice skating, $270 for swimming & Phys Ed, $420 for horseback riding, $330 for gymnastics, and $450 for kindergarten.
I am currently enrolled with OVA as a part-time student (eligible for 4 fully funded courses).
I am currently enrolled with OVA as a full-time student (eligible for 2 fully funded courses).
I am currently enrolled with OVA as a full-time student, but will be switching to part-time for the Fall 2025 semester (eligible for 4 fully funded courses).
I am currently enrolled with OVA as a part-time student, but will be switching to full-time for the Fall 2025 semester (eligible for 2 fully funded courses).
I am applying to be a new part-time student with OVA for the Fall 2025 semester (eligible for 4 fully funded courses).
I am applying to be a new full-time student with OVA for the Fall 2025 semester (eligible for 2 fully funded courses).
I am applying to be a new part-time Kindergarten student with OVA for the Fall 2025 semester (eligible for 6 fully funded courses).
I am applying to be a new full-time Kindergarten student with OVA for the Fall 2025 semester (eligible for 2 fully funded courses).
Class Selection
Please select your preferred on-site classes to be held on Mondays at the MAC from the options below. Indicate your first and second choice for each hour you're interested in. Due to limited capacity, enrollment is not guaranteed for every class, especially for the off-site classes. Spots will be filled on a first-come, first-served basis. Also, please note that classes will only be offered if the minimum required number of students enroll. If a class does not meet the enrollment threshold, it may be canceled, and families will be notified in advance. Thank you for your understanding and support.
1pm-4pm
*
1pm - 2pm
*
2pm - 3pm
*
3pm - 4pm
*
4pm - 5pm
*
5pm - 6pm
*
Select the off-site classes you would like to include in your schedule. Note: OVA Funded students can only select TWO of the following: Swimming, Archery, Phys Ed, Ice Skating. If you would like to select all three, one of these will be considered a self-pay class. Also if OVA funded for Horseback riding, there is an additional out of pocket cost of $100. NOTE: All classes will require parents to sign a waiver. These will be emailed to you once your registration in the course is confirmed.
All Grades: Boys Swimming at PARC Plymouth (Tuesday 1pm-2pm)
All Grades: Girls Swimming at PARC Plymouth (Tuesday 2pm-3pm)
All Grades: Girls Swimming at PARC Plymouth (Thursday 10:30am-11:30am)
All Grades: Boys Phys Ed at PARC Plymouth (Tuesday 2pm-3pm)
All Grades: Girls Phys Ed at PARC Plymouth (Tuesday 1pm-2pm)
Grades K-12: Girls Gymnastics at Michigan Academy of Gymnastics Westland (Thursday 1pm-2pm)
Grades K-12: Boys Gymnastics at Michigan Academy of Gymnastics Westland (Thursday 2pm-3pm)
Grades 2-12: Horseback Riding at Willowbrooke Farm (Tuesday 12:30pm - 2pm)
FULL - Grades 2-12: Horseback Riding at Willowbrooke Farm (Tuesday 2:15pm - 3:45pm)
Grades 2-12: Horseback Riding at Willowbrooke Farm (Wednesday 12:30pm - 2pm)
FULL - Grades 2-12: Horseback Riding at Willowbrooke Farm (Wednesday 2:15pm - 3:45pm)
Grades 2-12: Horseback Riding at Willowbrooke Farm (Thursday 12:30pm - 2pm)
FULL - Grades 2-12: Horseback Riding at Willowbrooke Farm (Thursday 2:15pm - 3:45pm)
Grades 3-12: Archery Level 1a at MCWS (Saturday 11:45am-12:45pm)
Grades 3-12: Archery Level 1b at MCWS (Saturday 12:45pm-1:45pm)
Grades 3-12: Archery Level 2 at Livonia Archery Range (Saturday 2:30pm-3:30pm)
Authorization and Acknowledgement
MEDIA RELEASE
*
I understand that members of Medina Homeschool may use various media to record classes and events and to recognize families and their participation and accomplishments, such as yearbook, graduation, performances, field trips, etc. By becoming a member of Medina Homeschool, I grant permission to use my child’s image/likeness and voice in different forms of print, digital or electronic. This includes but is not limited to public display of flyers, special events, advertisement, internet or print.
STUDENT ENROLLMENT FEES: All self-pay and part-time students must pay an enrollment fee of $15 per year (non-refundable). A link to pay this fee will be emailed to you with your student(s) schedule(s). Your student will not be officially registered until this fee is paid. Please select:
*
I understand I must pay the $15 enrollment fee before my student is officially registered (self-pay OR part time OVA student)
I am a full time OVA student
GUIDELINES AND POLICES: https://tinyurl.com/medinaguidelines
*
I have read and agree to the Medina Homeschool General Guidelines and Polices
Do you have any questions/comments/concerns?
Next Steps: The Medina Homeschool staff will send you a class schedule based on your selection, along with an invoice and payment link for your enrollment fees and any applicable course fees. Once payment is received, we will send you a confirmation, completing your registration.
*
I understand and would like to proceed
Submit
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