Distance Learning Student Application

K-6 Distance Learning Student Registration

Welcome to Wellmont Academy's Distance Learning Program!
A $100 Registration Fee is required to submit your registration form.

Student Information
Student Name*
First Last
Expected Incoming Grade Level*
DOB*
Date Format: MM slash DD slash YYYY
Address Information
Current Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Information
Parent Contact Name*
First Last
Parent Contact Email*
Enter Email Confirm Email
Parent Contact Phone Number*
Program Information
Program Entrance Date*
Date Format: MM slash DD slash YYYY
Homeschool Status*
- If I sign up my student as a homeschool student for Distance Learning, I understand that I am responsible to sign up my child as a Homeschooled student with my local county and to find out what their requirements of me are while I participate in the Wellmont Academy Distance Learning Program. I understand that Wellmont Academy will not participate in this process with me.
How did you hear about Wellmont?*
Notice of Rights
Wellmont Academy of Tampa Bay, Inc. admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of it's educational policies, admissions policies, scholarship and load programs and athletic and other school-administered programs.
Registration Fee
Price: $100.00
Application Fee
Price: $25.00
Distance Learning Tuition
Pay in Full
Choose this option if you'd like to pay in full now. If you would like to pay in monthly installments, there will be a link at the end of this application to set up a payment plan.
- Distance Learning Tuition
Payment Method
- Credit Card
Total
$0.00
Credit Card

Card Details

Cardholder Name
Name
This field is for validation purposes and should be left unchanged.

K-6 Distance Learning Student Registration

Welcome to Wellmont Academy's Distance Learning Program! A $100 Registration Fee is required to submit your registration form.

Student Information

Address Information

Parent/Guardian Information

Program Information

Notice of Rights

Welcome to Wellmont Academy's Distance Learning Program!
A $100 Registration Fee is required to submit your registration form.