STUDENT RE-ENROLLMENT FORM

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1 For Office Use Only Date Received: Check Number: Amount Paid: Ed-Choice: Financial Aid: Received by: STUDENT RE-ENROLLMENT FORM STUDENT #1 (Legal Name): STUDENT #2 (Legal Name): STUDENT #3 (Legal Name): STUDENT #4 (Legal Name): STUDENT ADDRESS: Street State Zip ETHNICITY: African American American Indian/Alaska Native Asian Caucasian Hispanic/Latino Multiracial Native Hawaiian/Pacific Islander Other FAMILY STATUS: Two parent family Single parent family Legal/joint custody LEGAL CUSTODIAN/GUARDIAN: Parents (in same household) Father Mother Other CHURCH OF ATTENDANCE: It is our expectation that all families attend a Bible-believing church

2 Legal Custodian/Guardian Information: Name If different than student Employer Position Work Phone Cell Phone * * ECA sends many important school notifications via . Please check your often. Mother (Legal Custodian/Guardian) Name If different than student Employer Position Work Phone Cell Phone * *ECA sends many important school notifications via . Please check your often. Do we have your permission to publish your name, address and phone number in our student directory? YES NO LIST THE LAST SCHOOLS ATTENDED: Student s Name Dates Attended Grade Name of School Public school district in which you live: Father/Guardian Signature Mother/Guardian Signature Date Date

3 FAMILY INFORMATION FORM Marital Status: Married Separated* Divorced* Single* *If custody has been awarded to one parent or is shared, a copy of that document must be included with this application. Non-residential/Non-custodial parent (if applicable) Name: : Phone: Relationship: Street State Zip Cell Phone: address: Does non-residential/non-custodial parent have visitation rights? Is the non-residential/non-custodial parent responsible for tuition? YES NO YES NO

4 PARENTAL COMMITMENT FORM Mission Statement Emmanuel Christian Academy recognizes that God, through His Word, the Bible, is the absolute authority and basis for all truth. In total dependency upon Him, desiring to work with the local churches and the evangelical community, we seek to assist Christian families in their Biblical responsibility to train their children to become Christ-like and to fulfill God s purpose for their lives in the home, church and society. Parental Commitment By signing below, we give permission for our child to take part in all school activities, including sporting events, practices and schoolsponsored trips off campus (except as specifically listed below). Further, in the event our child becomes ill or is injured while under school supervision, we authorize the school authorities to take the steps necessary, as designated on the Emergency Medical Release form on file in the school office. We release Emmanuel Christian Academy, its Board of Trustees, employees, agents, and representatives from any claim we may have resulting from any illness or injuries sustained by our child while under school supervision whether at school or off premises. We further agree to hold harmless Emmanuel Christian Academy, its Board of Trustees, employees, agents, and representatives from any injury or damage which may be caused by our child(ren). We acknowledge that our child(ren) s picture may be published in school documents, advertising, social media or on the school website. We will contact the school if we do not agree to our child s picture being published. In signing this registration, we acknowledge the following: Our personal acceptance of and commitment to Jesus Christ as Savior and Lord. Church Attendance: Our commitment to participate in the Christian education of our son or daughter with regular attendance at a Bible-believing church as a family and by exemplifying Christian principles of life in our home. Our agreement to the Statement of Faith and Mission Statement of Emmanuel Christian Academy. ECA Policies: Our commitment to the policies of Emmanuel Christian Academy. Our commitment to agree with any policy implementation. If we disagree with any policy established or implemented by the school, we will not complain to another party. In the spirit of meekness and unity, we will register our concerns with the teacher or principal involved (Matthew 18:15-17). Giving: Our commitment to give to Emmanuel Christian Academy beyond our tuition as God leads and enables. To volunteer a minimum of twenty (20) hours per year for your family. Cooperation: Our commitment to pledge our fullest cooperation to keep doctrinal controversy and denominationalism out of the school at all times (Romans 13:8-10; I Corinthians 12:12-14, 13:1-3; Galatians 5:13-15, 25, 26; Ephesians 4:1-7). Dress Code: Our commitment to uphold the dress code as stated in the student handbook. We recognize the determination of whether our child is in compliance with the dress code is solely with the discretion of ECA and we agree to have a cooperative spirit if any dispute arises with regard to our child in uniform. Discipline: Our commitment to discipline. Upon acceptance at ECA, we hereby give permission for our child s teacher and/or other agents of ministry to determine and enforce classroom regulations in a manner consistent with Christian principles of discipline. We will continue to uphold the authority of the teacher and staff at ECA by recognizing their right to use disciplinary strategies they deem necessary (as approved by the Board and set forth in the student handbook) and will cooperate fully in this regard. We state that all information provided during the application process is true. If any information is found to be false, we realize that our child s enrollment at Emmanuel Christian Academy may be terminated. Signature of Commitment: Father/Guardian Signature Mother/Guardian Signature Date

5 FINANCIAL COMMITMENT FORM Student Name: Grade Level: 1. We understand Emmanuel Christian Academy is a community of Christians intentionally joined together for academic progress, personal development and spiritual growth. We are a Christ-centered K-12 school committed to strong academics and advancing the Gospel of Jesus Christ in a broken world. We seek to honor Him by integrating biblical faith and learning while our hearts and lives embrace the process of maturing in Christ. The Emmanuel community consists of those who, in furtherance of our mission, are living together in intentional, voluntary fellowship, aware that we are called to live our lives before a watching world. Although centered on the ECA campus, this community is not defined by geography, but rather by membership in the ECA educational mission. 2. We realize the Registration Fee is Non-Refundable. We agree to pay the tuition according to the following arrangements (please see the tuition chart on the back of this form). Our payment preference is (initial one of the following): 10 Monthly FACTS payments payable on the 5 th or the 20 th of each month, July through April (a onetime yearly set-up fee of $38 will be charged by FACTS). 2 semi-annual payments payable on July 1 st and January 1 st (receives a $50 credit per child) 1 annual payment due on July 1 st (Receives $100 credit per child) 3. We understand that if my/our account is 60 days delinquent that the result may be the suspension of our student(s) from ECA until the account is current or acceptable arrangements have been made with the Business Manager. Before a student will be placed on a class list for a new school year, all tuition and other school charges must be current and paid in full from the previous school year. No senior will receive a diploma and/or transcripts until account is paid in full. 4. We understand that there will be a $25 charge for any check returned to the school by the bank. 5. We agree to pay the balance of our account before any report cards, transcripts and/or any student records will be released. We understand this information cannot be released if my/our account is delinquent. 6. Tuition does not fully cover the cost of education at ECA donations and charitable giving help offset the cost of each child s tuition by over $1,000. For this reason, families are encouraged to volunteer and support, financially and/or otherwise, the school, the annual Fall Fun Festival, Spring Serve-A-Thon event, and classroom projects. A great school requires great volunteers and great supporters! 7. We understand there is a $250 Early Withdraw Fee if our student(s) is/are withdrawn after July 1 st. Father/Guardian Signature: Mother/Guardian Signature: Date Date This listing of key financial policies represents an abbreviate listing and is not all inclusive, due to space limitation. Any further questions or discrepancies should be directed to the Business Manager.

6 FINANCIAL FACT SHEET Reenrollment Fee: March 1 st through May 1 st o $65 per student After May 1 st o $135 per student The Reenrollment / New Student Registration fees are due upon completion and return of the enrollment kit. New Student Registration Fee: $155 per student Activities Fee: $75 per student TK 6th $85 per student (7 th 8 th ) $100 per student (9 th -12 th ) The Activities fee must be paid by July 1 st, 2014, or added to your FACTS tuition payment schedule. Please make arrangements with the Business Office. Early Withdrawal Fee: $250 after July 1 st Athletic Fee: Athletics fees may vary per sport and are charged per student, per sport. Tuition: The oldest enrolled student is charged full tuition. A family discount for additional children will be calculated as 10% of the second oldest child, 25% of the third oldest, and 40% of any additional children s tuition. While the percentages remain the same this year as last year, they will be applied differently. This year, the total discount will be divided equally amongst all children's tuitions (for example, a $571 discount will be provided for a second 9 th 12 th grader, and the discount will be divided equally between the two students, resulting in a $ savings discounted off of each child s tuition). Feel free to contact us if you have any questions. TK 6 th Grade: $5,236 7 th 8 th Grade: $5,473 9 th 12 th Grade: $5,878 Payment Options: 10 Monthly FACTS payments payable on the 5 th or the 20 th of each month, July through April 2 semi-annual payments payable on July 1 st and January 1 st o This payment option earns a $50 credit per student, which is applied towards tuition when the second payment is received 1 annual payment due on July 1 st o This payment option earns a $100 credit per student, which is applied towards tuition when payment in full is received

7 2177 Emmanuel Way Springfield, Ohio Ph: (937) Fax: (937) Referral Rewards Program We appreciate the commitment and dedication your family has shown toward Emmanuel Christian Academy. We would like to reward your faithfulness. Do you know families who have expressed a desire to provide a Christian education for their children? Emmanuel Christian Academy will credit your account $ for each new family who subsequently enrolls because of your direct recommendation. This credit will be applied toward tuition only. For current families on the Ed Choice Scholarship, this $100 credit will be used to offset the difference between the scholarship money received from the State of Ohio and the actual cost of tuition. Referral Rewards Term and Conditions The referring family must have a student enrolled at ECA and return Part A to the office. The new family must include Part B with the enrollment application and registration fee. The referral credit will be applied with in the academic year when the new family enrolls in ECA. There is no limit to the number of families you may refer. The referral family will be notified of credit received when the referred family enrolls. Referral Rewards will not be posted to your account until September 1. If you refer a family that enrolls mid-year, your Referral Reward will be posted one month following the new family s enrollment Emmanuel Christian Academy Referral Rewards Program (Part A) (To be filled out by Referral Family) Instructions Part A 1. Inform a family about the services you receive from Emmanuel Christian Academy. 2. Ask the family to fill out Part B, and enclose it with the ECA Enrollment Application. 3. Return Part A to Emmanuel Christian Academy. 4. Notification of $ credit will be made after Sept. 1 st. Referral Family (Current ECA family) Name Date Phone Referred Family (Applying family) Parent/Guardian Name Phone Emmanuel Christian Academy Referral Rewards Program (Part B) (To be filled out by Referred Family) Referred Family (Applying family) Name Date Phone Referral Family (Current ECA family) Parent/Guardian Name Phone Instructions Part B 1. Contact Emmanuel Christian Academy to request an enrollment application by calling Complete and include all requested information. 3. Include Part B with the ECA application. Note: Application and Part B must be received together.

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