Request Membership in this Organization!

Fill out the form below and click the Continue button at the bottom.

This site may require other information or dues before approving web site membership.

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Parent/Guardian #1 Last Name Parent/guardian #1 First Name Primary Email Username
Password
Confirm Password Brown Parent/guardian #2 First Name Secondary Email If Secondary Email is entered above, should it also receive weekly email and forum notifications, etc.? Yes No Address City State / Province Zip / Postal Code Timezone Phone of Parent/Guardian #1 Enable Text Messages

I am able and agree to receive text messages at the number above.
I understand carrier message and data rates may apply.

Phone of Parent/Guardian #2 Enable Text Messages

I am able and agree to receive text messages at the number above.
I understand carrier message and data rates may apply.

Alternate pickup/release - emergency contact name

Upload Family Photo (Optional) .jpg, .gif or .png

Children

Add Child

Show Child information to other Families
Note: Child information will be available to instructors in either case.

Privacy: Include my family information in the membership on-line directory? Yes No Weekly Email Update: Would you like to receive a weekly email update? Yes No

Forum Emails:

Would you like to receive forum notifications via email (not just the ones you create)? Yes No

Many Emails: Would you like to receive notifications IMMEDIATELY? Yes No

Delivery Type Whole Thread New Part Only

Daily Digest: Would you like to receive notifications ONCE A DAY? Yes No

Classifieds Emails:

Classifieds - Many Emails: Would you like to receive ALL classified notifications IMMEDIATELY via email: Yes No Classifieds - Daily Digest: Would you like to receive ALL classified notifications ONCE A DAY via email? Yes No Message to Homeschool Group Administrator:

Additional Questions

1. Besides parents, please list all other people who are allowed to pick up your student(s) from KHS.   2. Emergency contact #1 (if we are unable to reach either parent/guardian listed above): 3. Phone number of Emergency Contact #1: 4. Name of Emergency Contact #2 5. Phone number of Emergency Contact #2: 6. Name of Health Insurance Provider 7. Policy Number 8. Primary Physician 9. Address 10. Phone 11. Hospital Preference 12. Photo Consent

I understand that my students' photo may be used for promotional purposes by KHS or Refreshing Mountain.
(1 required) I Agree.
13. Christian Worldview

I understand and agree that KHS is a God-honoring homeschool program and that my student(s) will respect such a stance even if they hold other beliefs.
(1 required) I agree.
14. Medical/Wellness Agreement:

I understand that I will be notified in the case of a medical emergency involving my child. If I cannot be reached, I authorize KHS to call a doctor and provide the necessary medical services in the event my child is injured or becomes ill.

I understand that Refreshing Mountain Retreat Center and KHS will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as a parent/guardian.

I understand this homeschool educational service is free of COVID-related restrictions. I may or may not follow any appropriate guidelines to keep my child healthy. I agree to take full responsibility for any possible exposure to COVID or other  while my child(ren) are on-site

I understand that if my child is sick with a fever and/or symptoms I will keep him/her home for the duration of his/her illness and will let the administrator or teacher know.

(1 required) I agree.
15. Participation/Risk

I understand that it is my child´s responsibility to stay on the premises with the assigned supervisor/teacher, follow directions, and demonstrate appropriate behavior and that my child is fully responsible for non-desirable behavior that might result of any type of injury.

I understand that my child will participate in outdoor experiences assigned for the day (non-core days) and that these activities are weather permitting. These may include but are not limited to short hikes, outdoor play, team building, scavenger hunts, etc.

I understand that my child will be required to participate in service projects at Refreshing Camp, which may include picking up trash, sweeping, cleaning the bathroom, etc,. this part of the program is essential, as we develop a heart of service and gratitude towards our host.
(1 required) I agree.
16. Parent's Responsibility

I understand that I am responsible for submitting any paperwork related to the PA homeschool law to my school district and that KHS is not responsible for failure to submit such.  I also understand that I am responsible for ensuring that their child(ren) completes the required 180 days of school (or 900 hours for elementary/ 990 for high school) as stated in the PA homeschool law.

I understand that I am responsible for providing lunch, snacks, and water bottle for my student(s).

I understand that I will be responsible for providing a personal electronic device for my child (4th grade and up) to be readily available for his/her peuse as they navigate through math and other curricula.

I understand that it is the parent's responsibility to provide any materials needed to complete assignments and classwork.
(1 required) I agree.
17. Parents are expected to help:

Option 1: Choose one of the following ways to fulfill your commitment (in addition to serving in the cleaning rotation).

Organize socials/fellowship with co-op families
Organize safety/field day
Plan and organize classroom meals (Thanksgiving, Christmas, Easter)
Set up and tear down for both end-of-semester programs.

Option 2 (DEFAULT):  Help in the classroom all day 2-3 time per semester (in addition to serving in the clean-up rotation)

Clean up rotation for options 2 & 3: Scheduled for 2-3 times per semester. Please arrive on site by 3pm and plan to complete cleaning by 4pm.

If you do not fulfill these responsibilities, you must pay an opt-out fee of $150 per semester. I commit to fulfill these responsibilites.
I wish to opt out and pay the $150/semester fee.
18. FINANCIAL COMMITMENT AGREEMENT

I understand that KHS reserves the right to charge an additional fee partway through the year if a child may need additional assistance or supervision due to learning delays, behavioral challenges or other educational needs. Parents will be advised in advance if this is the case.

I understand that no refunds will be issued for multiple absences, rather the teacher will work with parents to help the student make up any missing lessons, work, and/or assignments (when applicable).

I understand that my committed tuition is used to secure materials and teachers for the classes in which my child(ren) is/are participating.

I understand that I am making a financial commitment to pay the full required tuition even if I decide to withdraw my child(ren) or adjust the track my child(ren) attends. Exceptions will be considered for extenuating circumstances.

(1 required) I agree.
19. Discipline Acknowledgement & Agreement

I understand that KHS reserves the right to put behavior charts in place for any child who repeatedly 'tests their limits' with authority in his/her classroom. This includes but is not limited to, disrespectful behavior toward the teacher or helper, disobedience, inappropriate physical contact (rough play, etc.), disruptions to the class, outbursts, etc.

I understand that I may be requested to pick up my child before the end of the day if he/she becomes aggressive, non-responsive to requests made by staff, or disruptive to the educational environment.

I have read and understand the Discipline Guidelines and have read and/or shared this information with my children who will attend KHS in 2024-25

I fully understand that these guidelines are not all-inclusive; if other situations not listed in the Discipline Guidelines arise, other disciplinary actions may be required and will be determined by the severity of the infraction.
(1 required) I agree.
20. IMPORTANT: I agree to fill out and submit Refreshing Mountain's yearly Release form when I receive it via email.
(1 required) I agree.
21. Your type named below will serve as your signature affirming that you have read, understood, and agreed to the above statements.  Your typed name also authorizes KHS to invoice you according to the financial agreement above. 22. Discounts are available...

1) 5% discount on the tuition of additional children OR

2) 5% discount on family's tuition for payment made in full by August 1 PR

3) 15% discount for students enrolled in both hybrid and co-op tracks.

Families may only claim one of these discounts. If any are applicable, please select the ONE you wish to claim.

Additional Children
Paid in Full by August 1
Dual Enrollment
None are applicable to my family

Payment Instructions

Please select the registration fee for your family (1 student =$50, 2 students =$100, 3+students = $150)

Make checks payable to Kingdom Homeschool Services and mail to KHS, 314 Adamstown Road, Reinholds, PA 17569.

Your registration will not be final until your registration payment is made. Please remit within 10 days.

Be sure to review all your information before clicking "Continue."

Payment Options

$50.00 – Registration fee for 1 student
$100.00 – Registration fee for 2 students
$150.00 – Registration fee for 3+ students