General Information ** please complete one for each child** Father’s Name __________________________________________________________________________ Mother’s Name _________________________________________________________________________ Student’s Name _________________________________________________________________________ Mailing Address _________________________________________________________________________ City ____________________________________ State ________ Zip ______________________________ Telephone: (_____)____________________ Email: ________________________
(This address will be used for billing purposes) Cell Phone: (_____)____________________ Grade level of your child (in the fall) _____ Age _____ Umbrella School ______________________________ Father’s occupation ______________________ Mother’s occupation (if applicable) _____________________ How would you like to be billed? _____ monthly ____ semester (5 months) ____ year (10 months)
Does your child have any learning deficiencies? _____ if so, please explain on the back of this page ** This information will be kept strictly confidential...our knowledge of any area in which your child struggles will simply help us serve him/her better in the classroom.
Hilger Higher Learning seeks to provide quality education to students from families with varying financial means. In order to provide this service, we need families who are willing to sponsor some of our low income families. Hilger Higher Learning matches your gift 2 to 1! If you would like to provide scholarship money for a family and partner with HHL in this great endeavor, please initial below:
_____ Yes, I would like for you to add $5 to my monthly bill to help a needy family.
_____ Yes, I would like to help a needy family in the specific amount of $_________ per month.
_____***If you are a family that has a specific financial need in order to participate in our courses, please initial here. You will need to print off, fill out, and send in our Financial Aid Form to qualify. Please go to our Registration & Calendar page to print off the application. We will not consider your need until all of this is complete and in our office. We will communicate your scholarship in your acceptance letter or someone will contact you concerning your need.
1121 Mountain Terrace Lookout Mountain GA 30750 706.956.8344 www.hhlearning.com
Payment Guidelines: Please initial each of the following:
_____ I agree to pay 10 monthly payments beginning in August and ending in May, or 2 semester payments (5 months at a time), or 1 yearly payment, depending on the box I checked above. (If you are registering for a one semester class, you agree to pay 5 monthly payments. Invoices are sent out via email around the 5th of each month and are due upon receipt.)
_____ I understand that my invoice is DUE UPON RECEIPT and is considered LATE if Hilger Higher Learning does not receive my monthly payment by the last day of the month. I realize I will be charged a $10 late fee if my check is not received by the end of the month, or if I have not contacted HHL to make other arrangements. _____ I understand that all checks must be sent to Hilger Higher Learning or dropped in the secure “lock-box”, located in the teachers’ office of the church. _____ I understand that payment is required for each class, even if my child is absent. _____ I agree to pay a $20 charge on any returned check. _____ I agree to pay a $75 charge per class if I withdraw after the second week of class. This INCLUDES dropping at the end of the semester; unless the class is only one semester. _____ I understand that all registration fees and payments are non-refundable (with the exception of a class not forming or a class time changing). _____ I understand that if my account becomes overdue by 2 months or more, I will be responsible for all collection’s fees if I’m delinquent in paying. I further understand all registration fees and tuition payments will be forfeited if my child is dismissed at any time during the year.
Please fill out the following information for the courses you have chosen for your child. Course schedules and registration fees can be found on our website (www.hhlearning.com). Registration fees for each class MUST be sent in along with this form.
Course Chosen Day and Time Registration Fees
Total registration fees to be sent in with registration form: ____________
*** If the aforementioned and future headings, as outlined in this registration, along with the terms and conditions as stated, are not met and/or if biblical behavior is not kept throughout the school year and/or over the summer, we reserve the right to ask the student to discontinue classes at Hilger Higher Learning. We have a zero tolerance policy if items such as, including but not necessarily limited to: alcohol, drugs, or tobacco are possessed, consumed or joked about by a student. Additionally, if a student is caught cheating on a test or quiz, he/she will be subject to dismissal from, and at the sole discretion of, from Hilger Higher Learning.***
1121 Mountain Terrace Lookout Mountain GA 30750 706.956.8344 www.hhlearning.com
Agreement Information
We, the parents/guardians of ___________________________ (student’s name) have read, understand and agree with the standards, payment guidelines, criteria, terms and conditions stated in this form. We/I further understand that failure of the student and/or parent/guardian to comply with these standards, payment guidelines, criteria, terms and conditions may result in the student being dismissed from his/her enrollment at Hilger. Thus, we are committed to the guidelines stated in this form. We understand that our child is attending classes at First Alliance Church at his/her own risk. We will not hold Hilger Higher Learning, First Alliance Church, or any teacher or employee affiliated with Hilger Higher Learning liable in any way.
Signed by parent/guardian ______________________________________ Date ____________
Signed by student _____________________________________________ Date ____________
You will be sent an acceptance letter (containing rules, regulations, textbook information, and a calendar of events) once your registration form has been processed and accepted. You will also receive an HHL handbook/directory at our parent meeting or during the first week of school if you can’t make it to the parent meeting. Please allow 2-3 weeks for your registration to be processed. Also, please do not purchase books until you have received an acceptance letter.
Hilger Higher Learning reserves the right to refuse any student for acceptance into our program, at Hilger Higher Learning’s sole discretion. We strive to keep high standards for our students, and we want the environment of our program to remain positive, encouraging and beneficial for all of the students enrolled. In order to do that, we would like for you to fill out this questionnaire which will provide us with some important information about your family. Before doing so, please read over our Philosophy and Our Partnership sections on the Home page of our website, as well as the information on our Parents page, to make sure they are in line with what you are seeking to do in the home.
Please fill out ONE per family. However, if you are a returning family you can skip this part and move on to the Health and Emergency information on the last page.
Questionnaire: We require that at least one parent or guardian has a profession of faith in Jesus Christ and be in regular attendance at a local Christian church. We are a distinctly Christian tutorial program providing quality educational classes from a Biblical perspective for children of Christian families.
If yes, please give the reason (if more room is needed, please use the back of this or another piece of paper), how long ago, and how you and your spouse dealt with your child during this situation.
Health and Emergency Information
Drug and other allergies: ______ YES (list below) _____ NO
Any prescribed medications: _______ YES (list below) ______ NO
Past medical history and/or other pertinent information you think HHL should know:
1121 Mountain Terrace Lookout Mountain GA 30750 706.956.8344 www.hhlearning.com