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

Attention:    (required)  Coupon Code:

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

Type: (Check one or combination): Workbook  CD ROM (must pay in full)   Standard   Bible Based Combination

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 - Grades K 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

$95.00

  
3

$240.00 (family total)

  
4

$240.00 (family total)

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

 

5. STUDENT INFORMATION - Grades 9 through 12   
Shipping & Handling Fee of $35
Student's Name Age Grade Birth Date
Example
06/27/91		 M/F Registration
Grade 9-12		 Choose Tuition Plan
1

$195.00
2

$145.00
3

$145.00
4

$145.00

4. HIGH SCHOOL ENROLLMENT INFORMATION

All High School students must select a course of study. Your projection towards graduation will be based on this selection.

Course of Study

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

College Preparatory (23 credits)

Academic (21 credits)

Vocational (21 credits)

5. BRIDGEWAY MEMBERSHIP INFORMATION (Required for bridgewaymembers content)
Preferred Username: (Please indicate your preferences exactly as you would want it to be.)
Preferred Password:   (Please indicate your preferences exactly as you would want it to be.)
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.  Pay in Full - Registration & Tuition Upon Enrollment

3.  2 Payment Plan - Registration & 1st Tuition Payment  Upon Enrollment. 
2nd Payment Due January 5.
 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.    4 Payment Plan - Registration & 1st Tuition Payment. 
3 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.

 

7. PAYMENT INFORMATION 
1. CREDIT CARD

Card Holder    Card Type

Credit Card Number   Exp.Date

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. |: |:

Bank Name & City

Account Number 

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

 
10. PARENT COMMITMENT
Bridgeway Academy provides an easy to use curriculum, parent training, placement testing and assessment, professional teacher support, E-Zines, 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.

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 14 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.