Hilltop Christian School - Registration 16-17

Student Information
GradeFirst NameMiddle NameLast NameBirthdateStreet AddressCity,State ZipBirth Place

Parent / Guardian Information
TypeNameWork PhoneCell PhoneHome PhoneEmailOccupationStreet AddressCity,State Zip

Emergency Contacts Information
NamePhoneAddressRelationship to Student

Student's Physician(s) Information

People who can pick up Student - Enter information for people who will be allowed to pick up your child(ren) from Hilltop Christian School.
NameWork PhoneCell PhoneHome PhoneMessageRelation to StudentStreet AddressCity,State Zip

Media Release - This is to certify that I give permission to use photos and/or videos of my student(s) for use on the website, and in various school publications and printed media.

  Use of Media allowed
  Use of Media allowed only in group photos of videos
  Use of Media not allowed

Payment Options - We offer the option of having your tuition automatically taken from you bank account(s) if you forget to pay it by the 10th to avoid having to deal with the 2% late fee.

  Automatically Debit my checking account if I don't pay by the 10th
  I understand that a 2% late fee will be applied if my tuition is not paid by the 10th

We also offer the option to have your tuition paid automatically each month. You will receive a statement by the 1st of the month and the automatic payment will be made after the 5th of the month. Check here if you would like the convenience of automatic payment.

You also have the option of requesting automatic payments from the PARENT section on the web page.