2017 NWLA Registration

Please fill out the registration form thoroughly

Full Name: (required)

Your Email: (required)

Your Birth Date: (required)

If under 18 at the start of the academy, do your parents approve of this application?: (required)
YesNoI'm 18 or older

Current School Grade Level: (required)

School Name and City / State of School: (required)

Your Address: (required)

Your City: (required)

Your State: (required)

Your Zip Code: (required)

Your Primary Phone Number: (required)

Your Mobile Phone Number (If Different):


Parent's Full Name (if you are under 18):

Parent's Email (if you are under 18):

Parent's Primary Phone Number (if you are under 18):


Indemnity Agreement:

I will not hold or attempt to hold Northwest Liberty Academy liable for any loss, damage, or injury to person or property caused by any act or neglect of other persons, or caused in any manner other than the willful or negligent act of Northwest Liberty Academy, its agents and employees, and will indemnify and hold Northwest Liberty Academy harmless from any liability for damages or claims against Northwest Liberty Academy arising out of or in any way related to any such loss, damage or injury. I release Northwest Liberty Academy, including its trustees, employees and agents, from me or my child’s physical injury, including death, or illness while at the activity. I/We will assume the risk associated therewith, whether known or unknown to me/us at this time. This release is also intended to include all claims of my family, estate, heirs, personal representatives or assigns.

← Check ONLY if you agree to the Indemnity Agreement.


Authorization for Treatment:

I/We hereby give permission to the medical personnel selected by Northwest Liberty Academy to secure and administer treatment and to maintain and/or release any medical records necessary for insurance purposes as outlined under the HIPAA regulation, and to provide or arrange necessary related transportation for the above named person. I verify that I or child named above is in good health and capable of participating in academy-related activities and, when necessary, will tailor my/their activities to those within the bounds of my/their physical health. I recognize that any medical treatment that is provided to me (or my child) while attending Northwest Liberty Academy will be paid for by my medical insurance company and guarantee payment for services not paid by insurance. I hereby grant Northwest Liberty Academy permission to use, reproduce, and/or distribute photographs, films, video and sound recordings of me or my child without compensation or approval, for use in materials created for purposes of promoting the activities of Northwest Liberty Academy, including the Internet.

← Check ONLY if you agree to the Authorization for Treatment.


Food Allergies and/or Dietary Restrictions:


Please attach two letters of reference and a profile picture of yourself:
(Letters of reference required for students 12-18 yrs only. Not required for returning students.)

Letter of reference #1

Letter of reference #2

A photo of you


Once you have completed your application above, please click here to complete your registration.

The $75.00 registration fee is applied toward your tuition. Your remaining balance will be $275 making your total tuition $350.

You may also opt to pay the entire Tuition when you register, leaving a balance of zero.

Don’t forget about our Refer a Friend Program.

Refer someone who registers and attends for the first time, and you will receive $50.00 off of your own tuition, for each such referral.

We also have a physical mailing address, in case you prefer to pay by check:

Northwest Liberty Academy
2150 W. Champagne Ct.
Eagle, ID 83616