Smart PDF Form

Student's Name:

Age:

Grade 2026-2027:

(Each student must have a separate form)

Parent's Name:

Address:

Parent E-mail Address: (must have)

example@example.com

Student E-mail Address: (must have for Google Classroom)

example@example.com

Cell Phone:

Format: (000) 000-0000.

Emergency Contacts and Phone Numbers:

Payment method:

Allergy, medical, emotional, learning concerns or any other pertinent information we need to know:

[Must be signed by one parent.] I will not hold the director, any teacher, the facility, or anyone associated with The Eclectic Academy of Learning responsible for any damage and/or loss to my child's property or any injury to my child. I also understand that I am committing to remain in the program for the full year, and subsequently pay the monthly tuition by the 15th of each month. I understand that the registration fee is nonrefundable. Cost for the course is $850/student. Payments can be made in one installment of $850, per semester ($425), or monthly ($85) August-May. Classes run Thursday, August 13th 2026 to May 13th 2027 and meet 12:30am-2:00pm at Windsor Forest Baptist Church, located at 12521 White Bluff Road in Savannah.

Signature

*To register for classes:

At the completion of this form, please send registration fee of $100 (per student) via check to Joanna Bender, 121 Brandywine Road Savannah, GA 31405, or send payment via Zelle to (912) 433-6147 or Venmo to Joanna-Bender. Please note student's name in the memo
Supply and lab/experimental fees are $150/student for the year. This can be paid at once along with registration or per semester ($75/semester) at the start of the school year.

Human Anatomy & Physiology Grades 9-12

2026-2027 Registration Form.

Textbook

Materials