Address:  ____________________________________________________________

____________________________________________________________________

Home Phone:  ____________________  Work Phone:  _______________________

Cell Phone:  ______________________   E-Mail:  __________________________

(Please note if you desire to have the above information included in the

directory ____ Or for office use only_____)

Children’s names, ages, and birth dates (only those attending):

Name:  __________________________________________________ Sex: __M __F

Birthdate:  ______/______/______      Age as of Sept. 1 _____                  Grade:  _________

Polo shirt size:  YXS    YS    YM    YL    AS    AM    AL    AXL    AXXL  (circle one)

Name:  __________________________________________________ Sex: __M __F

Birthdate:  ______/______/______      Age as of Sept. 1 _____    Grade:  _________

Polo shirt size:  YXS    YS    YM    YL    AS    AM    AL    AXL    AXXL  (circle one)

Name:  __________________________________________________ Sex: __M __F

Birthdate:  ______/______/______      Age as of Sept. 1 _____    Grade:  _________

Polo shirt size:  YXS    YS    YM    YL    AS    AM    AL    AXL    AXXL  (circle one)

Name:  __________________________________________________ Sex: __M __F

Birthdate:  ______/______/______      Age as of Sept. 1 _____    Grade:  _________

Polo shirt size:  YXS    YS    YM    YL    AS    AM    AL    AXL    AXXL  (circle one)

Do(es) your child(ren) have any mental, emotional, or physical handicaps which may affect their participation in this program?

__Yes __No   If yes, please explain on a separate piece of paper.

__ For 7^th-12^th grade students:  If you would like to register for a la carte classes please indicate which classes you would like to enroll your child in:  ____________________________________________________________________

The Cordis Academy admits students of any race, color, and national or ethnic origin.

Insurance Company: ___________________________  Policy Number: __________

Homeschool group affiliation: _____________________________________

Church you attend: ______________________________________________

Pastor’s name: _________________________________________________

Withdrawal Policies:

The Cordis Academy bases its annual budget on the number of students enrolled in the program.  We do not accept new students once classes have begun.  Therefore, parents are obligated to pay for their children for the entire school year.  Exceptions to this policy include:

ð  Death of a parent

ð  Moving more than 30 miles from a Cordis Academy location

ð  Parent becoming unemployed

NO exceptions are given for the following reasons:

ð  Child re-enrolled in school

ð  Child is tired of the program

ð  Child has too many other activities

Please prayerfully consider this commitment before applying.  You will be liable for payment for the full year after the August 1^st deadline.

Registration fee:  $180.00 (January- February 28), $200.00 (March-May 31)

                                 $220.00 (after June 1), $240.00 (after August 1)  per student

                                 Payment plans are available.  Registration fees cover the costs of the uniform shirt, rent, supplies, insurance, etc needed to run the school for the year.

Tuition Payment: K- 6^th grade monthly tuition payment for a full time Master’s/Masterkey/Portfolio student is $125 ($1125.00 yearly tuition)  and $145.00 ($1,305.00 yearly tuition) for students not attending Master’s Academy  and from Sept.-May (9 payments).  Please note that no tuition will be due in August.    A $20.00 late fee will be applied each month that the tuition is late.  Failure to pay tuition for more than two months will result in dismissal.  7^th -12^th grade monthly tuition payment for a fulltime Masterkey/Portfolio Academy student is $135.00 ($1,215.00 yearly tuition) and $155.00 ($1,395.00 yearly tuition) for students not attending Masterkey or Portfolio Academies from Sept.-May (9 payments). Please note that no tuition will be due in August.    A $20.00 late fee will be applied each month that the tuition is late.  Failure to pay tuition for more than two months will result in dismissal.

A la Carte Class offerings for 7^th-12^th grade students:  Cost - $45.00 per class per month with a registration fee of $50 per class; Study Hall – monthly tuition payment is $20

___ I would be interested in working to help cover tuition costs by being a teacher aide or childcare worker (circle applicable)

___ I would be interested in teaching at Cordis Academy in the following subject(s): ____________________________________________________________________

  **Please note that all applying to work with Cordis Academy will be subject to a background check

My signature below indicates that I have read this brochure and understand the above rules and obligations of Cordis Academy.  It also absolves Cordis Academy from any liability if any member if my family, including myself, incurs injury while at Cordis Academy.  I hereby authorize the director to seek emergency medical assistance, if necessary, for the above named child(ren).  I understand that efforts will be made to contact me in case of emergency.

Signature: _______________________________________ Date: _________

Signature: _______________________________________ Date: _________

                                (Note, both parents must sign registration form)

Registration is on a first come, first served basis.  All applications must be received by August 1^st.  ALL registration fees are non-refundable.  Mail this form along with the registration fee to: MAFA, c/o Wasby, 4633 Jefferson Ridge Way, Marietta, GA 30066