Academy Registration

* indicates a required answer.

This online registration form must be filled out for each student.

1. *

Students Name:


Please list the names and ages of this students siblings:

3. *

Home Phone Number:


Cell Phone Number:

5. *

Email Address:


Email address for student if different from parents:


Indicate male or female:

Male Female

Students Current Age:

9. *

Students Date of Birth (mm/dd/year):


How did you hear about the James River Home School Academy?


How many years have you homeschooled?

This will be my first year 1 - 3 years
4 - 6 years 7 or more

Have you previously attended any home school co-ops, academy's,  or taken classes, etc.? And if so, please answer the following information:


yes no

Name of Home School Co-op or Academy:


Number of years attended:


Reason for Leaving:


Has this student ever been suspended from any public or private school, or any home school academy or co-op because of discipline problems?  Or has this student ever been charged with an offense by the police?

yes no

If you answered yes to either of the above please explain below:

18. *

Does the student have any special needs that would hinder their learning, or that the teacher would need to know?

Please note: Our teachers are not trained for special needs.

Please list two character references, such as your Pastor, Sunday school teacher, close friend, employer, etc., for this student, and provide two letters of recommendation; one must be a character reference, and one may be an academic reference. You can mail the reference letters to JRHSF - 3374 Medway Lane, Powhatan, VA 23139.  

19. *

In the space below, please provide the name, address, phone number, and length of time this reference has known the student.


20. *

In the space below, please provide the name, address, phone number, and length of time this reference has known the student.


I will complete the Required Medical Information form online, and then print, sign, and return it, if it has not been filed or if the information previously provided has changed.

yes previously filed

The Required Medical Information is on-file online and current.

yes no

My child is home-educated and we have read and agree to abide by the James River Home School Academy Student and Parent Code of Conduct and Dress Code.

I will send two letters of reference for this student.

JRHSF has my permission to use photographs taken of my child to be used in any and all publications related to the James River Home School Academy and the James River Home School Foundation.

 (1 required)
I accept

James River Home School Academy Registration Form

The Registration Fee for participation in the James River Home School Academy for the 2013-2014 school year is $40.00 and the Technology Fee is $10 per student per year. A $25.00 deposit is requested with Registration and the balance can be paid prior to the start of class to the James River Home School Foundation.

 Tuition for any classes will be paid directly to the instructor. 

Checks can be made payable to:
 James River Home School Foundation 
and mailed to:
James River Home School Foundation
3374 Medway Lane
Powhatan, Va 23139