HOME SCHOOL ACADEMY APPLICATION FOR RE

Bridgeway Academy Referral Program

Refer 10 families to Bridgeway Academy and earn a free computer when they enroll and pay tuition in full;
OR
Refer a family and receive $25.00 per referral for each family that enrolls and pays tuition in full -- Payable at the end of the school year.

Call for referral coupons!

BRIDGEWAY ACADEMY
APPLICATION FOR RE-ENROLLMENT
334 Second St. Catasauqua, PA 18032 (610) 266-9016

Attention: (required)		Discount Code:
Father's Last Name:		Mother's Last Name:
Father's First Name:		Mother's First Name:
Email Address:		Home Phone:
Email Address:		Cell Phone:
Street Address:		City:
		State:
		ZIP:

Curriculum Choices:
Type: (Check all that apply): Workbook CD ROM (must pay in full) Standard - Secular Standard - Bible Based Combination

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

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

GRADES 1 THROUGH 8 STUDENTS

Names of Children Re-enrolling

Gender

Age

Grade

Birthdate

Registration

Choose Tuition Plan

$145.00

HIGH SCHOOL STUDENTS

Names of High School
Students Re-enrolling

Gender

Age

Grade

Birthdate

Registration

Choose Tuition Plan

$195.00

Add Lab Credit: $195 (one time fee)

Add Lab: Yes No

Grade level of all children in home: (optional)
K 1 2 3 4 5 6 7 8 9 10 11 12

I would like CD ROM courses where available Workbooks Christian curriculum

HIGH SCHOOL STUDENTS
PLEASE SELECT A COURSE OF STUDY:
Technical/Vocational (21 credits) Business/Academics (21 credits) College Preparatory (23 credits) Honors (26 credits, must maintain an A average)

NOTE: Generally, high school students must complete full academic courses for credit and pay a minimum year's tuition in order to be eligible for graduation. (Final requirements for graduation will be determined on an individual student basis and can only be determined after receipt of all official transcripts). High School tuition covers 5 courses -College and Honors tracks will require more credits, which can be purchased individually or otherwise provided. Most states require state history, which is available from the Academy as an extra course.

TUITION PLAN Paid in Full Benefits Package Payment Plan Fees

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.

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.

PAYMENT METHOD

1. CREDIT CARD
Card Holder Name Card Type

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

Total Payment Enclosed $

2. CHECK REQUEST (1-2-3-4 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 enrollment will begin processing immediately upon verification of payment.

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.