Lighthouse Christian Academy. New Student Enrollment Application

Transcription

1 Lighthouse Christian Academy New Student Enrollment Application

2 Section 1 Parent Information (Complete one per family. Please print.) Father Guardian Other Mr./ Dr. (Circle one.) (First name, middle name, last name) Home address: Home phone: ( ) Cell phone: ( ) Business phone ( ) Employed by: Mother Guardian Other Mrs./Dr./Ms. (Circle one.) (First name, middle name, last name) Home address: Home phone: ( ) Cell phone: ( ) Business phone ( ) Employed by: Marital Status of Parents Married Separated Divorced Single School newsletters are sent via . Please list your , so that you can be kept informed. Home Church: Member: Yes No Church Address: (Street) (City) (State) (Zip code) Pastor s Name: Church Phone Number: ( Siblings: ) Name Age School Attending Why do you want your student/students to attend LCA? Please Note: In the family interview you will be asked to discuss the value of Christian Education. How did you hear about LCA? List any current LCA students you know: List family members that have attended or are attending LCA. Name Years Attended Relationship

3 How does LCA s statement of faith compare to that of your church and family? Are there any areas of disagreement? What type of discipline does/do your child/children receive at home? How is/are your child/children nurtured spiritually at home? What church activities does your family participate in on a regular basis? Briefly share your Christian testimony (at least one parent). A non-refundable application fee of $50.00 per student is due with the application. After placement testing and the family interview have been conducted, and the student is invited to enroll, the completed Financial Contract and the enrollment fee of $ per student ($ if the application was received on or before April 15, 2015) must be submitted before a seat is reserved for each student. Checks should be made payable to LCA. Office use only: Date application received in office: Time application received in office: by Application Fee Received by Date: Enrollment Fee Received by Date: Signed Financial Contract by Date: Complete Application by Date:

4 Parent Agreement The relationship between Lighthouse Christian Academy and the parents of LCA students is critical to the partnership we endeavor to establish. Therefore, please read the following Parent Agreement and indicate agreement/support by initialing, signing, and dating the application. Parental Support: I agree to support the members of the Lighthouse Christian Academy faculty, staff, administration and Board of Trustees. This support includes showing proper respect to all school personnel and agreeing to bring any questions or criticism regarding procedure or discipline directly to the person involved. I agree to use the principles found in Matthew 18:15 ( If your brother sins against you, go and tell him his fault, between you and him alone. If he listens to you, you have gained your brother. ESV) for any issues of concern. Please see the Student/Parent Handbook for more information. Financial Obligation: I agree to meet all of my financial obligations to Lighthouse Christian Academy. All financial obligations are detailed in the signed Financial Agreement Contract. Statement of Faith: I give permission for Lighthouse Christian Academy to teach all elements of the Statement of Faith as found in the Student/Parent Handbook to my student and am willing to support the school in its endeavors to encourage and guide my student in applying these doctrines to everyday living. I realize that a Christian school is not a substitute for the spiritual training, fellowship, and discipline of the home and local church. I agree to pray for the ministry of the school, the staff members, the trustees, and fellow families as I join in partnership with LCA. Policies and Procedures: I will fully support the policies, procedures, and School Code of Conduct as outlined in the current student handbook. I further understand that any violation of these policies and procedures will result in appropriate action by proper school personnel. I will encourage my child to show honor to God, to the Word of God, and to those in authority. Daily Attendance and Participation: I agree to ensure my student s timely attendance on a daily basis unless prohibited by illness or other extenuating circumstances and to encourage my student in the accomplishment of homework, projects, and other school-related activities. I agree to notify the school office immediately when my student is absent. Mandated Testing: I agree to have my child participate in all required standardized testing. School Activities: I give permission for my student to take part in all school activities, including sports and school-sponsored trips away from the school premises and hold the school blameless from any liability because of injury. In case of an accident or serious illness, I (1) request the school to attempt to contact me and (2) if they are unable to reach me, I authorize the school to seek medical attention for my student. Parental Involvement Hours: I agree to donate a minimum of 20 hours (per family). I understand I will be invoiced $15.00 per hour not donated. Student Audio/Visual Reproduction and Use: Unless I notify LCA in writing, I consent to and authorize the use and reproduction by LCA of any and all photographs and any other audio/visual materials taken of my student for promotional material, educational activities, exhibitions or for any other use for the benefit of the school. IMPORTANT - You must notify LCA in writing if you DO NOT consent to this provision now or at any time in the future. I agree that when I am no longer in a position to honor one or more of the above commitments, I will notify the school administrator in writing. In accordance with the tenor and teachings of God s Word, I further agree that a determination of the continuation of this partnership will be made in a manner pleasing to our Lord and Savior, Jesus Christ. (Father s/guardian s signature) (Date) (Mother s/guardian s signature) (Date) Lighthouse Christian Academy, Inc. (LCA) admits students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. LCA does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, tuition assistance programs, athletic and other school-administered programs.

5 Section 2 New Student Application One Per New Student (Please use a separate sheet of paper if additional space is needed Student s legal name: (as it appears on birth certificate) (Last name) (First name) (Full middle name) Applying for Grade (Please circle one.) Half-day K Full-day K Male Female Date of Birth Student s Social Security No. Place of Birth: Is the student a US citizen? In which Indiana County does the student reside? In which public school district does the student reside? To which public school would the student be assigned? With which parent(s)/guardian(s) does the student primarily reside? If separated/divorced, information relating to the student on a weekly basis will be sent home to the parent with whom the child legally resides. If requested in writing, we will provide both parents with information in accordance with court-ordered custody arrangements. Please provide LCA with a copy of the custody arrangements and the rights to information settlement. Federal regulations mandate that we ask the following questions: Student s Ethnicity: Is the student Hispanic or Latino? Please choose one of the following: Yes, Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture of origin, regardless of race). No, not Hispanic or Latino Student s Race: (Choose one or more.) American Indian or Alaskan Native Black Asian Hispanic Native Hawaiian/Pacific Islander White (not of Hispanic Origin) Please list the school(s) previously attended: 1. (Name) (Complete address) (Phone) (Grades/dates attended) (Reason for leaving) 2. (Name) (Complete address) (Phone) (Grades/dates attended) (Reason for leaving) Describe the student s interests, talents, and abilities. List any special programs or activities in which the student has participated. Has the student ever been retained in or advanced a grade? Yes No If yes, please explain.

6 Has the student ever been tested for learning disabilities or special needs? Yes No If yes, please explain if needed. Does the student have a current or previous IEP (Speech or other) or 504 Plan? Yes No If yes, please provide documentation. Does the student take any routine prescription medications? Yes No If yes, please list them. Has the student had any history of physical (e.g. seizures, allergies) or emotional conditions? Yes No If yes, please explain if needed. Are there any unusual factors in the student s life? (e.g. death in the family, recent separation/divorce, relocation, prolonged illness or physical limitations) Yes No If yes, please explain if needed. Has the student ever received counseling for personal, family, or event-oriented issues? Yes No If yes, please explain if needed. Has the student ever served detention, suspension and/or been expelled from a previous school? Yes No If yes, please explain. Has the student ever been arrested or detained by law officers? Yes No If yes, please explain. Give any additional information that would be helpful in meeting the student s needs. Office use only (Please initial each when complete. When everything is checked off, the application should be filed in the student s folder.) Student assigned to grade by. Admission Letter Records Sent For Records Received Immunization Record PowerSchool Quick Books STN Center LCA ID Home Language Survey WIDA Placement Test Student Folders Made Enrollment Tally Sheets Beacon List Class Lists Pastor s List Stat Sheets Constant Contact Student Excel Spreadsheet Gains/Losses (if after the start of school) Cumulative Enrollment Card