Beacon Hill Preparatory Institute – Dallas District
http://www.beaconhillprep.org
REGISTRATION FORM
DESCRIPTION:
Beacon Hill Preparatory Institute is a non-profit organization that strives to advance the
academic minds of today's youth. The school is open to all students interested in studies in
Math and English (Reading, Language Arts & Grammar)
Beacon Hill provides students with the opportunity to supplement their scholastic horizons in
these subjects when their local and private school districts are unable to provide such
service.
REGISTRATION:
1. By Mail: Select your course (s), complete the Registration Form (Form A and B), child’s
most recent achievement / ability / TAKS scores, enclose a check or money order to Beacon
Hill, and mail to:
Beacon Hill Preparatory Institute
P O Box 764404
Dallas TX 75376
2. TUITION/FEES:
$325.00 Beacon Hill Math (Independent Learners)
$325.00 Reading For Comprehension (Independent Learners)
$345.00 Math with Special Assistance (Young Learners)
$345.00 Learning to Read (Young Learners)
$50.00 Registration Fee (Per Subject)
CLASS CANCELLATIONS:
Beacon Hill reserves the right to cancel, combine, or divide classes; to change the time,
date, or place of course offerings as necessary; and to do so without incurring any
obligation. The school may discontinue a class at any time if attendance fails to meet
expected levels. Efforts will be made to telephone or email the students before the first day
of a course that is being canceled. This also includes bad weather and emergency
circumstances.
REFUND POLICY:
1. 100% Refund is allowed if canceled by phone or at the school on Saturday before the
1st class starts (excluding the cost of materials).
2. 100% Refund will be issued if Beacon Hill cancels a class.
3. 70% Refund issued if canceled within the 1st 3 weeks of the semester.
4. 50% Refund issued if canceled within the 1st 6 weeks of the semester.
5. No Refund after 6 weeks from the start of the 1st class meeting of the semester.
(Parent Copy)
School Location:
Mailing Address:
Mountain View College
4849 West Illinois Ave, Dallas, TX 75211
P O Box 764404 Dallas, TX 75376
Beacon Hill Preparatory Institute – Dallas District
http://www.beaconhillprep.org
SCHOOL GUIDELINES:
1. Respect school properties and equipments.
2. Parents must pickup your student (s) after their class is over for the day; we cannot
baby sit them.
3. No foul language, fighting, or any violence at the school property.
4. No running anywhere in the building.
5. Keep classrooms, halls, restrooms, and cafeteria clean at all times.
6. No possession of any illegal weapon defined in TX Penal Code Sec. 46.
7. No possession of any illegal drugs or smoking on school property.
8. No stealing from students, staff, or school’s property.
9. School hours: 1:00-3:15 PM every Saturday. Parents must pick up your child (s) by
3:15 PM. Otherwise $5 will be charged for every 15 minutes after school closing.
CLASSROOM RULES:
1. No talking, eating, drinking (except water bottle), playing, violence, or vandalizing in
the classroom.
2. Be punctual to class and be prepared for class with paper, pencil, and class
materials.
3. Respect and listen to the teacher as well as respecting other classmates.
4. No parents allowed in the classroom.
CONSEQUENCES:
1st Violation:
2nd Violation:
3rd Violation:
4th Violation:
Warning
Parent conference
Loss of Points Exchange or School Awards
Possible suspension or expulsion from the school without tuition refund
CONTACT INFORMATION:
Charnella Derry, President & Co-Founder
972-329-7779 (office)
info@beaconhillprep.org
(Parent Copy)
School Location:
Mailing Address:
Mountain View College
4849 West Illinois Ave, Dallas, TX 75211
P O Box 764404 Dallas, TX 75376
Beacon Hill Preparatory Institute – Dallas District
http://www.beaconhillprep.org
NEW ______
STUDENT REGISTRATION FORM
FORM “A”
Date: __________________________________
RE-ENROLLMENT ______
Referred by: ____________________________________
Student’s Name: ________________________________________________________________________________________
Sex: Male / Female
Grade Level: ______________
Birthday: _______________________
Public / Private School Attending____________________________________________________________________________
Father’s Name: _________________________________________________________________________________________
Home Phone: _____________________
Work Phone: ______________
Cell Phone: _____________________
Mother Name __________________________________________________________________________________________
Home Phone: ____________________
Work Phone: ______________
Cell Phone: ____________________
Student’s Address: _____________________________________________________________________________________
_____________________________________________________________________________________
Parent’s Email: ________________________________________________________________________________________
(PLEASE PRINT CLEARLY) – Email for announcement information
Previously Attended Supplemental School:
Never Attended ________
School
Grade Level: __________
Name__________________________________________________________
OFFICE USE ONLY:
PAYMENT:
NO CASH ACCEPTED
CLASS SELECTION
Tuition Paid to: BH _________ MVC _______________
MVC -UPPER SCHOOL MATH
1:00 / 2:15
Registration Fee: $__________ Tuition Fee: $_________
MVC-UPPER SCHOOL READING
1:00 / 2:15
Credit Card: ___________________________________
MVC-MIDDLE SCHOOL MATH
1:00 / 2:15
Debit Card: ____________________________________
MVC-MIDDLE SCHOOL READING
1:00 / 2:15
MVC-LOWER SCHOOL MATH
1:00 / 2:15
X_____________________________________________
MVC-LOWER SCHOOL READING
1:00 / 2:15
Money Order # __________________________________
MVC-HIGH SCHOOL MATH
2:15
Check # _______________________________________
CONCORD – 3 yrs – 3rd Grade
5:00 / 6:00
Mon____ Tues ____ Math_____ Reading _____
Exp: _______________ CW#: ____________
T-Shirt: Size: __________________________________
CONCORD – 4TH – 12th Grade
5:00 / 6:00
(YXS - AXL $14.00 2XL $15.00 3XL $16.00 4XL $18.00)
Mon ____ Tues ____ Math ____ Reading _____
Payment $_____________________________ (Ck / CC / MO)
(Beacon Hill Copy)
School Location:
Mailing Address:
Mountain View College
4849 West Illinois Ave, Dallas, TX 75211
P O Box 764404 Dallas, TX 75376
Beacon Hill Preparatory Institute – Dallas District
http://www.beaconhillprep.org
COURSE SELECTION AND WAIVER OF LIABILITY
Form B
INSTRUCTIONS:
Select the course for your child(s). Circle the appropriate class.
Special Note: Parents who want to volunteer in the classroom may contact the teacher.
Students who want to volunteer, please contact Charnella Derry
CLASS TIME
COURSE NAME
FEE
1:00 & 2:15
(See signup sheet)
Reading
$345 / 325
Math
$345 / 325
12:15/1:15
THE M.A.S.T.E.R.S. – Exposure to Enrichment Activities in:
MATH, ART, SCIENCE, TECHNOLOGY, ENTREPRENEURIAL,
READING, SPANISH & SPORTS (untraditional)
$0
Donations are highly encouraged to help offset the cost of enrichment activities!!!
WAIVER OF LIABILITY:
A waiver of liability is required for enrolling in courses, which present a potential risk of
physical injury to any student. Beacon Hill assumes no responsibility for accidents, which
might cause physical injury to students enrolled in these courses. While we take
precautions to minimize potential hazards, it is each student’s responsibility to take
necessary safety measures to protect him or herself from injury.
I or We have read and understood the above registration information and the Beacon Hill
regulations. Beacon Hill will give due notice to all changes to requirements, procedures,
registration, and regulation information. It is the responsibility of the students and parents
to keep informed of all these changes. Beacon Hill is not liable or responsible for the
consequences of not being informed of these changes.
__________________________
___________________________
__________________________
PARENT NAME
PRINT & SIGNATURE
___________________________ __________
STUDENT NAME
DATE
PRINT & SIGNATURE
(Beacon Hill Copy)
School Location:
Mailing Address:
Mountain View College
4849 West Illinois Ave, Dallas, TX 75211
P O Box 764404 Dallas, TX 75376
Beacon Hill Preparatory Institute – Dallas District
http://www.beaconhillprep.org
Agreement of Parental Commitment and Understanding
Form C
I understand that the purpose of Beacon Hill Preparatory Institute is to provide children of
all abilities the opportunity to attain proficiency and confidence in math and reading.
I understand that Beacon Hill furnishes the structure and the guideposts. But, the real keys
to success are parental persistence and the student’s daily effort. Together, great things
can be accomplished.
Therefore, I understand that for my child to be successful in this program, I must ensure
that they complete their homework on a daily basis.
I understand that I have signed up my child to attend Beacon Hill at a specific time.
I understand that if I am late, then I will either stay with my child in the waiting area until
the next available open spot or accept that my child will be able to utilize (to the best of
Beacon Hill’s ability) the rest of their scheduled time before the next child arrives.
Parent’s signature:
________________________________________________________
Parent Name Printed: _______________________________________________________
Date: _____________________________
Photo and Video Release:
I ____________________________ give consent to use my child’s image in any photo or
video marketing materials created by Beacon Hill Preparatory Institute.
Parent’s Signature _______________________________________
Date ________________
(Beacon Hill Copy)
School Location:
Mailing Address:
Mountain View College
4849 West Illinois Ave, Dallas, TX 75211
P O Box 764404 Dallas, TX 75376
Beacon Hill Preparatory Institute – Dallas District
http://www.beaconhillprep.org
Beacon Hill Preparatory Institute
2011 FALL CALENDAR
(Mountain View College – Saturday Classes)
AUGUST 20, 2011
AUGUST 27, 2011
SEPTEMBER 3, 2011 – LABOR DAY HOLIDAY – NO CLASSES
SEPTEMBER 10, 2011
SEPTEMBER 17, 2011
SEPTEMBER 24, 2011
OCTOBER 1, 2011
OCTOBER 8, 2011
OCTOBER 15, 2011
OCTOBER 22, 2011
OCTOBER 29, 2011
NOVEMBER 5, 2011
NOVEMBER 12, 2011
NOVEMBER 19, 2011
NOVEMBER 26, 2011 – THANKSGIVING HOLIDAY – NO CLASSES
DECEMBER 3, 2011
SATURDAY, DECEMBER 10, 2011
BEACON HILL AWARDS BALL – LOCATION TO BE ANNOUNCED
School Location:
Mailing Address:
Mountain View College
4849 West Illinois Ave, Dallas, TX 75211
P O Box 764404 Dallas, TX 75376
Beacon Hill Preparatory Institute – Dallas District
http://www.beaconhillprep.org
Beacon Hill Preparatory Institute
2011 FALL CALENDAR
(Concord – Monday Classes)
(Concord – Tuesday Classes)
AUGUST 22, 2011
AUGUST 23, 2011
AUGUST 30, 2011
AUGUST 30, 2011
SEPTEMBER 5, 2011
SEPTEMBER 6, 2011
(LABOR DAY HOLIDAY – NO CLASSES)
SEPTEMBER 12, 2011
SEPTEMBER 13, 2011
SEPTEMBER 19, 2011
SEPTEMBER 20, 2011
SEPTEMBER 26, 2011
SEPTEMBER 27, 2011
OCTOBER 3, 2011
OCTOBER 4, 2011
OCTOBER 10, 2011
OCTOBER 11, 2011
OCTOBER 17, 2011
OCTOBER 18, 2011
OCTOBER 24, 2011
OCTOBER 25, 2011
OCTOBER 31, 2011
NOVEMBER 1, 2011
NOVEMBER 7, 2011
NOVEMBER 8, 2011
NOVEMBER 14, 2011
NOVEMBER 15, 2011
NOVEMBER 21, 2011
NOVEMBER 22, 2011
(OBSERVING THANKSGIVING HOLIDAY – NO CLASSES)
NOVEMBER 28, 2011
NOVEMBER 29, 2011
DECEMBER 5, 2011
DECEMBER 6, 2011
SATURDAY, DECEMBER 10, 2011
BEACON HILL AWARDS BALL – LOCATION TO BE ANNOUNCED
School Location:
Mailing Address:
Mountain View College
4849 West Illinois Ave, Dallas, TX 75211
P O Box 764404 Dallas, TX 75376