ENROLLMENT APPLICATION FORM
 Bridgeway Academy, 334 Second Street Catasauqua, PA 18032
Phone (610) 266-9016 · FAX (610) 266-7817   Email us    bridgewayacademy.com


We have worked hard to make the enrollment process as easy and efficient as possible. However the information needed to ensure accurate and precise official records is  vital. Please allow at least ten minutes to complete this form.
1. FAMILY INFORMATION

Have you already spoken with a member of our staff? If so please specify the name:                                         

Please enter your discount code: (If applicable)

Father’s Full Name Mother’s Full Name

Shipping Address

City State Zip Country

Telephone Work Telephone Cell Telephone

E-mail address I have internet access: In My Home  Other

 

Program:
(Check one or a combination) 		Pre-K 
Traditional Bridgeway (Available 1st -12th)  
Online High School (Available 9th - 12th)  
 
Academic Worldview: Standard - Bible Based
Standard - Secular
 Combination
For Traditional Bridgeway Students Only: Workbook / Textbook
CD-Rom
Online Electives

Format: (Check one or combination): Independent Correspondence      I would like to actively teach:

Referred by: Friend , Magazine , Newspaper

School ,   Flyer/Mailer,    Curriculum Fair,   Internet,  Other  
Grade level of all children in home:  (optional) 
K 1 2 3 4 5 6 7 8 9 10 11 12

2. STUDENT INFORMATION - Pre-K through Kindergarten   

Student's Name Age Grade Birth Date
Example
06/27/91		 M/F Registration
Pre-K/K		 Full Year Price  
1

$145.00

  
2

$145.00

  
3

$145.00

 

 

3. STUDENT INFORMATION - Grades 1 through 8   

Student's Name Age Grade Birth Date
Example
06/27/91		 M/F Registration
Grade K-8		 Choose Tuition Plan  
1

$145.00

  
2

$145.00

  
3

$145.00

  
4

$145.00

All students up to ninth grade who are not currently using a self-instructional curriculum will need placement testing. 

No High School Students? click here

 

4. STUDENT INFORMATION - Grades 9 through 12   

Student's Name Age Grade Birth Date
Example
06/27/91		 M/F Registration
Grade 9-12		 Choose Tuition Plan
1

$195.00
2

$195.00
3

$195.00
4

$195.00

Add Lab Credit: $195 (one time fee)

 Add Lab: Yes No

5. HIGH SCHOOL ENROLLMENT INFORMATION

All High School students must select a course of study. Your projection towards graduation will be based on this selection, and may be adjusted in the future if graduation goals change.

Course of Study

Student’s Name
Honors (26 credits) (Must maintain an "A" average)

College Preparatory (23 credits)

Academic (21 credits)

Vocational (21 credits)

6.  PREVIOUSLY ATTENDED SCHOOL(s) INFORMATION

Attention: Complete the enrollment process before withdrawing your student(s) from the current school.

School Name Address

City State Zip Phone

Dates Enrolled: From to (example 06/99)

School Name Address

City State Zip Phone

Dates Enrolled: From to (example 06/99)
7.  TUITION PLAN    Paid in Full Benefits Package    Payment Plan Fees

Select One Of The Following Three Choices:

1.  Pay Registration Fee Only (Non-Refundable)
2.  Payment in Full - Registration, Tuition and S&H Upon Enrollment

3.  Semester Payment Plan - Registration, 1st Tuition Payment and S&H Upon Enrollment. 
Second Payment Due 4 months after First payment
 Payments automatically debited to your account. 

CLICK HERE FOR PAYMENT SCHEDULE

CREDIT CARD \ CHECKING AUTHORIZATION (payment plan only) 
 I hereby authorize BRIDGEWAY ACADEMY to debit my credit card or checking account as noted below for all tuition charges and unreturned curriculum or CD’s at the end of the school term or upon withdrawal.   I further authorize BRIDGEWAY ACADEMY to charge my specified account as frequently as necessary to meet the TERMS and CONDITIONS of my chosen tuition plan.     It is hereby acknowledged that the discontinuance of the automatic account debiting; or, its automatic rejection for processing, is subject to additional financial charges.   Notification of renewal dates for credit cards is the sole responsibility of the applicant named herein.

4.    Monthly Payment Plan - Registration, Down Payment of $350.00 and S&H Upon Enrollment.
8 More Consecutive Payments Due The 5th Of Each Month.
 Payments automatically debited to your account. 

CLICK HERE FOR PAYMENT SCHEDULE

CREDIT CARD \ CHECKING AUTHORIZATION (payment plan only) 
 I hereby authorize BRIDGEWAY ACADEMY to debit my credit card or checking account as noted below for all tuition charges and unreturned curriculum or CD’s at the end of the school term or upon withdrawal.   I further authorize BRIDGEWAY ACADEMY to charge my specified account as frequently as necessary to meet the TERMS and CONDITIONS of my chosen tuition plan.     It is hereby acknowledged that the discontinuance of the automatic account debiting; or, its automatic rejection for processing, is subject to additional financial charges.   Notification of renewal dates for credit cards is the sole responsibility of the applicant named herein.

 

8. PAYMENT INFORMATION 
1. CREDIT CARD

Card Holder Name    Card Type

Credit Card Number   Exp.Date CVV Code (located on the back of your card)

NOTE: Your curriculum will be immediately processed upon receipt of your tuition payment.

2. CHECK REQUEST (1-2-3 Check Numbers Needed According To Your Payment Plan)

Check No. 1 , 2 , 3 , 4 , 5

Customer Name:

Routing No. |:|:

Please include the following on your check:
* Drivers License #
* Full Name
* Street Address
* Phone Numbers
When you provide a check as payment, you authorize us to use information from the check to make a one-time electronic fund transfer from your account, or to process the payment as a check transaction.

You authorize us to collect a fee as indicated below (plus a bank fee if allowed by your state law) through electronic fund transfer from your account if your payment is returned unpaid.

 

Bank Name & City

Account Number 

Drivers License Number  (required)

 

NOTE: Your curriculum will be immediately processed upon verification of payment.

 
9. PARENT COMMITMENT

Bridgeway Home School Academy provides an easy to use curriculum, parent training, placement testing and assessment, professional teacher support, website and cyber support, online reference library, transcript services, health and safety courses, classical literature, standardized tests, maintenance of records, and all other services as listed in our handbook.  We are committed to helping parents provide a quality education for their children.  Students are accepted regardless of race, creed or color, provided they agree to the policies and procedures of the Academy.

OUR RISK-FREE GUARANTEE: If after 30 days you are not completely satisfied, simply return your curriculum package and receive a full refund on all unused materials (less shipping fees).

By submitting this form, I agree to adhere to the policies and procedures of the Bridgeway Academy. I understand that all materials issued must be completed according to the directions as stated in the handbook (issued with the welcome packet).  Further, I understand that the registration is non-refundable and that NO tuition is refundable after 30 days.

Father’s Name Date    Mother’s Name Date

Both parents must sign unless a single parent home exists.

This is a single parent home and I have legal custody of my child/children. (check)

The following must be checked for Payment Plan option. 
I agree to the credit card/check authorization as stated above.

 

Optional: Help us put a face to our students by  submitting a recent photograph for our records by regular mail. 
This should be updated each year as you re-enroll.