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 InformationStudent Name* First Last Expected Incoming Grade Level*Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeDOB* Date Format: MM slash DD slash YYYY Address InformationCurrent Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian InformationParent Contact Name* First Last Parent Contact Email* Enter Email Confirm Email Parent Contact Phone Number*Program InformationProgram 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?*FriendRelativeWebsite SearchFacebookInstagramNotice of RightsWellmont 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 TuitionPay in FullChoose 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 MethodCredit CardTotal $0.00 Credit Card Card Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.