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High School ENROLLMENT APPLICATION
Pearblossom Academy, P.O. Box 439, Bogue Chitto, MS 39629

Please provide copy of birth certificate, a small photo of student for our records, and transcript of High School credits earned.
These items can be scanned and emailed to us at registrar@pearblossomacademy.org or faxed: 601-658-0264 or mailed to our office. Remember to check the box under Additional Fees if the program is being sent outside the US; $120 will be charged for shipments outside the USA even if the box is left unchecked. Any science lab shipped outside the USA will incur a $100 additional postage fee.
Parent's Full Name: Student's Full Name:
Address: Date of Birth:   Check if enrolling 2 or more students (Note: You will need to fill out a separate application for each student.)
City:
State:
Zip:
Email Address:
Student Gender: Male   Female
Student Ethnicity:
(Select ONLY ONE)
White (Caucasian)
African American
Hispanic
Filipino
American Indian
Asian/Pacific Island
Other, specify:
Important Notice for students in CALIFORNIA ONLY: All students located in CALIFORNIA who are enrolling in any grade (9 through 12) must complete the online Private School Affadavit form which is available at this link Calif. Dept. of Education Private School Affadavit Form. Failure to file this form could result in mandatory attendance at a local Public School.
Phone
Student has book Young People Ask? Yes   No
Alternate Phone:
Check if you have Internet Access  No Internet
Place in the desired grade:   High School Grades
Check if 2nd Semester Only 9th, 10th, 11th, or 12th1
9th3
10th3
11th
12th
Tuition1 $875 $875 $875 $775
Book Deposit2 $200 each grade
Total Amount $1075 $1075 $1075 $ 975
Down Pmt. $475 $475 $475 $375
No. of Monthly Payments4 8 x $75
Teacher's Editions Not Available.
1Tuition does NOT include (a) the Book Deposit which is also required, (b) an additional $120 fee for shipments outside the USA; $100 for Science Lab shipment outside the USA, and (c) Science Labs if required (see footnote #3 below). The student may work at his or her own pace, generally taking 9 to 12 months to finish; however, an additional $50 fee is incurred for each additional month the student is enrolled beyond the 12th month. For 2nd Semester Only 9th, 10th, 11th, or 12th--must submit transcripts that confirm 1st Semester was completed and passed.
2If student re-enrolls, 100% of Book Deposit is rolled over to next grade upon completion of all scheduled payments and all text books have been returned and received by Pearblossom in good condition; if student graduates or does not re-enroll, only 50% (or $100) of the Book Deposit is refundable assuming that all scheduled payments have been made and all text books have been returned and received by Pearblossom in good condition.
3Students that desire to attend a University (and some Colleges) must take one science lab in 9th and one science lab in 10th.
     Each Science Lab course is an additional $175 fee. Additional shipping fees will be incurred for shipments outside the USA.
4Payments must reach us by the 15th of the month or a late fee of $20.00 will be incurred.
Select 4 different electives in order of your preference. If your first selections are unavailable, we will use the other lower-priority elective selections as alternatives. If no electives are selected, Pearblossom will send any available electives.  Elective Descriptions and Additional Elective Descriptions:
For 11th or 12th Grade:
Previous High School:

Fax No.:
Address:
City:
State & Zip:
Additional Fees:
Required Postage/Handling Fee of $120 for shipping to CANADA, MEXICO, and other addresses outside the 50 States of the USA; $100 additional shipping fee for Science Lab outside the USA
Science Labs: (Check if the college you plan to enroll in requires labs and if they accept credit earned at Pearblossom Academy.)
  $175 Physical Science Lab $175 Biology Lab
Foreign Language: (Note: Required headset consisting of headphones/microphone not included and must be purchased separately.)
$75 Spanish      $75 French      $75 Italian      $75 German      $75 Japanese      $75 Other Foreign Language
Hands-on Art Electives      $75 Drawing Program      $375 Parelli On-Line      $375 Parelli Liberty      $375 Parelli Freestyle      $175 Equip. Kit      $375 Parelli Finesse
Total of Additional Fees: $   If paying by CHECK or Money Order, print this form and send with check - DO NOT PRESS SUBMIT. Note: Check or Money Order must be drawn on a USA bank--not a foreign or Canadian bank--even if funds are shown in USA Dollars. Credit Cards from other countries are acceptable.
15- or 16-digit Charge Card Number: 3 to 4-digit CCV, CVC, or CV2 Code:
ONLY for American Express cards: Download the required form, then scan and email the completed and signed form to info@pearblossomacademy.org or fax to 601-835-1718 or mail to: Pearblossom Academy, P.O. Box 439, Bogue Chitto, MS 39629

Check ONLY IF you are making a down payment AND desire to make monthly payments using the specified card number. Card will be charged on the 8th of each month until balance is paid in full.
Name on Card:     Expiration Date (mm/yy):     Amount to Charge: $ (must be either the full payment amount or down-payment amount)

Tuition Fee and Enrollment AGREEMENT: I acknowledge that accreditation does not guarantee that Pearblossom Academy credits will be transferable or acceptable to other educational institutions. Pearblossom Academy's accreditation MSA (Middle States Association) is, however, recognized by the United States Department of Eduction. In addition to a diploma, colleges and other educational institutions may require entrance exams such as GED or SAT (or other such tests) as a part of their enrollment process. Also, a $50.00 per month additional fee is incurred for each additional month the student is enrolled beyond the 12th month. I, (type full name of parent/guardian), the undersigned, hereby authorize Pearblossom Academy to obtain a release of student information, including transcripts, from previously attended schools. Should payment remain delinquent in excess of ninety (90) days the student shall automatically be dis-enrolled and an additional $50 processing fee will be required to reinstate enrollment. A $15.00 service charge will be incurred on all returned checks. An $85 fee will be incurred for each replacement text book or DVD. A maximum limit of 12 months is allowed for the enrolled student to complete each grade. A complete refund, less $100.00 shipping/handling or processing fee, will be issued upon cancellation within thirty (30) days from date of receipt of books and upon return of all books and materials. Payments must reach our offices by the 15th of each month or a late fee of $20 will be incurred. Please allow 3-8 weeks for delivery. The parent/guardian is responsible for enrolling the student in Science Labs if such are required by the college or university that the student plans to attend. The parent/guardian is solely responsible for contacting the college/university the student plans to attend--to determine the high school courses required for entrance. Pearblossom Academy's cumulative liability to undersigned or the student or any other party for any loss or damages resulting from any claims, demands, or actions arising out of or relating to this Agreement shall not exceed the enrollment tuition fees paid for the curriculum provided. In no event shall Pearblossom Academy be liable for any indirect, incidental, punitive, special, or consequential damages, including legal fees, lack of transferability of credits, loss of (a) data by means of computer software or USA mail, (b) profits or revenues, (c) employment or education opportunities, whether based in contract, tort or otherwise, even if Pearblossom Academy has been advised of the possibility of any such loss or damage. I understand that Pearblossom Academy shall have the right to legal action for nonpayment of tuition and fees, and the undersigned will be responsible for all costs of collection, including court expenses and reasonable attorneys' fees. Since the attendance laws vary from state to state, Pearblossom Academy urges the undersigned to check state attendance laws; Pearblossom Academy is not responsible for ensuring compliance with state or local truancy laws; that is the responsibility of the undersigned. Furthermore, the undersigned is responsible for the expense of returning and insuring the books and accomplishing any required state testing. Regardless of state testing requirements, Pearblossom Academy highly recommends the student take a nationally normed test at the parent or guardian's expense which can often be accomplished coincident with public school testing. Accreditation and associated requirements are subject to change without notice. Any student found by Pearblossom Academy to be cheating on tests will be disenrolled immediately with NO refund or credits issued. This Agreement constitutes the entire agreement between the undersigned and Pearblossom Academy and supersedes any prior agreements, representations, proposals, or understandings, whether oral or written, with respect to the subject matter of this Agreement. I have read and understand this Agreement as evidenced by my name and date below.

Signature (Type Your Full Name):
Date (mm/dd/yy):What is your age:
   
Pearblossom Academy, Inc.--Quality Education Programs for Grades 9-12