Protégé Education - education with purpose
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REGISTRATION IS CLOSED
Online Application 2017-2018 (Complete one per family)
Family Information
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Indicates required field
Answer for family
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New
Returning
Application Date
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Mother's Name
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First
Last
Father's Name
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First
Last
Parent's Email #1
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You may include more than one email address
Parent's Email #2
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Mother's Occupation/Employer
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Phone
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Father's Occupation/Employer
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Phone
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Home Address
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Line 1
Line 2
City
State
Zip Code
Country
Mother's cell
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Father's cell
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Other phone
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Emergency Contact (other than parent)
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First
Last
Relationship to student
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Phone Number
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To facilitate communication, Protégé will have a roster that will have email and phone numbers listed for teachers and families enrolled. Please indicate here if you would like your information omitted from the roster
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Please omit me from the roster
Name Student #1
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First
Last
Gender
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Male
Female
Birthdate month/day/year
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Age
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Grade in September
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Enrollment Options
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Full time student (Monday, Wednesday & Thursday)
A la carte (registering for individual classes)
Student Email (if applicable)
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List Individual Classes
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Name: Student #2
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First
Last
Gender
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Male
Female
Birthdate month/day/year
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Age
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Grade in September
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Student Email (if applicable)
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Enrollment Options
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Full time student (Monday, Wednesday, Thursday)
A la carte (registering for individual classes)
List Individual Classes
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Name: Student #3
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First
Last
Gender
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Male
Female
Birthdate month/day/year
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Age
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Grade in September
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Student email (if applicable)
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Enrollment Options
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Full time student (Monday, Wednesday, Thursday)
A la carte (registering for individual classes)
List Individual Classes
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Name: Student #4
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First
Last
Gender
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Male
Female
Birthdate month/day/year
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Age
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Grade in September
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Student email (if applicable)
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Enrollment options
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Full time student (Monday, Wednesday, Thursday)
A la carte (registering for individual classes)
List Individual Classes
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Will you be paying for any course with charter school funds? If so, please list each course here.
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Additional Family Information
Do you have other children not registering for Protégé? Please list names and ages.
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How long have you been homeschooling?
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How did you hear about us?
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What school are you currently registered with?
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Is there anything we need to know about your family or student that would be important for us to know?
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Please list two references for your middle or high school student.
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Please list all schools your child has attended.
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*$75 Registration Fee per family. Make check payable to Protégé Education.
General Information
Please read the following information carefully and sign below.
1. Protégé Education is a community focused on providing quality education to homeschooled students - it meets on Mondays, Wednesdays and Thursdays at Saint James United Methodist Church,
2033 E Washington Blvd, Pasadena, CA 91104.
Students may only be on campus during Protégé hours, and they MUST be attending a class, study hall, or be with a parent to be on campus.
2. Students are not allowed to leave campus without a parent/adult. If a student is on campus for more than one class,
please provide a nutritious snack and/or lunch and water for your child.
3. Protégé is not an offical drop off program. If you are leaving the campus, we request that you confirm with another parent or a teacher that they will be responsible for your child in your absence. Make sure to indicate this on the sign-in sheet. In the case of an emergency or that your child needs you, we ask that you be within 15-20 minutes of the campus.
4. It is our priority to make Protégé Education a safe and respectful place for your children to learn and grow. Please be
advised that Protégé Education has a
Code of Conduct
that outlines safety rules and expectations of behavior. Every student/family is required to have this signed form on file.
5. Depending on enrollment numbers and needs, parents may be asked to volunteer throughout the year. (e.g. assisting in
the classroom, lunch supervision, assisting with special events, etc.)
6. Protégé Education is a service for homeschooled students it is not a school.
Contact us at
protegeedu@gmail.com
Parent Signature
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Submit