Mom's Info

Mom's Name

Mom's Email *

Mom's Phone *

Dad's Info

Dad's Name

Dad's Email

Dad's Phone

Child's Info

Last Name of Child

First Name of Child

Date of birth

Home School Level

Enrollment Information

Enrollment Fee ( One Time per family and non-refundable)

$ 200 - New Family

$175 - Returning Family

Already chosen for another child

Enrollment Options

Enrollment Only - $200

Enrollment + Membership - $235

Membership Only - $55/yearly

One Time Copy Fee

$50 per Family

How do you wish to pay tuition?

In Full

Monthly

Does the child have any allergies or illnesses that Nehemiah Academy should be aware of? if so, what are they. if the answer is NO, just put NO.

In case of emergency and a parent cannot be reached, who should we call?

Who is authorized to pick-up your child(ren) ? (Give names and numbers; if we do not know them, please tell them that we will ask for ID with a picture.)

Does your family attend church regularly? if so, which one?

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.