Welcome to The Learning Stop

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Home School Mini-Courses Enrollment Form

Please complete the below enrollment form and click on the "Submit" button to enroll online. You may also click here to download the Mini-Course Enrollment Form (.pdf format) and mail it to The Learning Stop.

Payment for the session you are enrolling in is expected at the beginning of the first class. We only accept cash or checks for payment at this time.

First Name of Child(ren):
Last Name of Child(ren):
Child or children's birthdate(s):
Child's Age:
Child's Grade Level:
Does your child have any allergies?:	Yes No
If you answered "yes", please list allergies.
Does your child have any medical conditions?:	Yes No
If you answered "yes", please list medical conditions.
First Name of Parent or Caregiver:
Last Name of Parent or Caregiver:
Address #1:
Address #2:
City:
State:	Zip Code:
Phone Number:	- -
E-Mail Address:

Check	Cost	Session
	$25.00	Beginning Geography (Grades 1-4): Monday, October 15, 2007 from 3:30-5:30
	$25.00	Native Americans (Grades 4-6) Thursday, November 8, 2007 from 3:30-5:30
	$25.00	Medieval Times (Grades 5-7) Monday, December 10, 2007 from 3:30-5:30
	$25.00	The Human Body (Grades 1-4) Thursday, January 17, 2008 from 3:30-5:30
	$25.00	New Hampshire (Grades 1-4) Thursday, February 7, 2008 from 3:30-5:30
	$25.00	Our Precious Earth (Grades 1-4) Monday, March 10, 2008 from 3:30-5:30
	$25.00	America and Its Heritage (Grades 5-7) Thursday, April 10, 2008 from 3:30-5:30
	$25.00	Sink or Float (Grades 1-3) Monday, May 12, 2008 from 3:30-5:30
Waiver Consent Agreement: As the child's parent/guardian, please read carefully the waiver below, prior to your child participating in the first class, and indicate your consent by checking off the appropriate box: I have listed, to the best of my knowledge, all allergies and/or medications that my child may have or depend on throughout the day. I understand that it is my responsibility, to provide the Learning Stop, LLC with any and all medications (epee-pens, etc.), paperwork and contact information, in case a need arises for them. I understand that The Learning Stop, LLC and its employees are not responsible for any injuries and/or illnesses that may occur while my child is under their care. I give my consent I do not give my consent Please note: On the first day of class, you will be asked to sign the waiver agreement.
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Interested in home schooling your child? Click here for details on the Home Schooling Program offered through The Learning Stop.