Enrollment Form

For school year: *

Date of Enrollment *

Date

Student Name *

First Name Middle Name Last Name

Current Grade Level as of August 1 *

Birth Date *

Month Day Year

Student's age at time of enrollment *

Gender

Social Security Number

Required for 8th through 12 grade students

Student E-mail (optional)

1st Parent Name *

First Name Middle Name Last Name

1st Parent e-mail address *

1st Parent Phone Number *

Area Code Phone Number

1st Parent Highest level of education *

2nd Parent Name

First Name Middle Name Last Name

2nd Parent e-mail address

2nd Parent Phone Number

Area Code Phone Number

2nd Parent Highest level of education

Student/Parent Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

County of Residence *

Example: Richmond

I understand that Enrollment fees for Liberty IPS are per family, per school year (for all children in the immediate family). If my child is a graduating Senior, a fee of a minimum of $250 covers their final transcript and diploma, Senior T-shirt, and Yearbook! This fee will be the same regardless of my child's participation in graduation ceremonies - no discounts apply. All the fees associated with Seniors are due no later than January 1 of the student's Senior year. A late fee of $25.00 will be added after January 1 and every additional month following. A credit verification fee of $300 is required per student per high school year completed outside of Liberty IPS. Enrollment is to be paid in full at the time of acceptance into Liberty IPS and an invoice for Credit verification fees will be sent via email. Senior fees can be paid through the website store.

*

If for any reason, I choose to withdraw my child from Liberty IPS during the course of the school year, I understand that my fees are NOT refundable.

*

I understand and acknowledge that annual testing, transcripts and additional copies of my child's diploma and/or report card will result in additional fees not included in my enrollment cost.

*

I understand that all Senior fees must be paid for by January 1st of their senior year and a late fee of $25.00 will be added after January 1 and then every month following.

*

I agree to teach 180 days per year for approximately 4 1/2 hours per day for grades 1-3 and 6 hours per day for grades 4-12. I agree to provide adult supervision when the student is doing school work.

*

I agree to submit monthly attendance reports and quarterly grade reports for each child.

*

I agree to submit annual standardized testing results for grades 3-12 by the end of each school year.

*

I agree to print and sign an Honesty Pledge for each student.

*

I understand that it will be my responsibility to maintain academic portfolios for each child that includes work samples, curriculum lists, lessons plans, reading lists and annual testing results.

*

I understand that while not required to turn portfolios in to Liberty IPS on a monthly basis, I will need to make academic portfolios available upon request for yearly evaluations.

*

I understand that I have 30 days from the time of my enrollment to fill out and return vacination records or vacination exemption to Liberty IPS.

*

I promise to keep my login information safe and confidential to the best of my ability.

*

I promise to notify Liberty IPS immediately if I think my online account has been compromised.

*

I promise to not share my login information with other homeschool support groups, co-ops or extended family members, thus enabling them to access Member Only content. I understand ALL forms obtained from or by Liberty IPS are the property of Liberty IPS and will NOT be shared under penalty of law.

*

I understand that as a parent-teacher of Liberty IPS, I will be held to high standards of honesty and integrity. I understand that it is my responsibility to ensure that all grades, test results and attendance reported to Liberty IPS are correct and accurate to the best of my knowledge. I understand that Liberty IPS cannot be held accountable for any false or faulty information that is presented to them.

Parent-teacher Signature *

Type your name the way it would be signed.

Date *

Date

Upload vaccination Form or vaccination Exemption Form

Browse Files

Must be in pdf format

Here is a link to the State of Ga Immunization form if you need one. https://www.grits.state.ga.us/docs/blank_3231.pdf

For exemption, follow this link:

https://www.gadoe.org/Curriculum-Instruction-and-Assessment/CTAE/Documents/Georgia-Religious-Exemption-Form.pdf

How did you hear about us?

Additional Comments (including referral name if applicable)

Please verify that you are human *

Student Enrollment Form