Committed to Bible-Centered Education VALLEY CHRISTIAN ACADEMY Box 279 Osler, SK. S0K 3A0 Phone: (306) 239-2196 Email: vca@spiritsd.ca STUDENT APPLICATION 2019 2020 Notes: * Please complete all parts of this application for each student applying ** Students who are not accepted for this school year must re-apply EVERY YEAR to remain on the waiting list. *** Applications will be accepted starting the first school day in September for the following school year. Enrollment for Kindergarten for the following year is decided by our Board in November, and for Grades 1 12 in March. Applications received after the enrollment has been done, will be added to the waiting list and would only be considered if there s room in the grade for which they are applying. It is not generally our practice to accept students mid-year, as usually our classes are full. Entry Grade: September 2019 General Information Student s Name: Last First Middle Home Address: Street City Province Postal Code Land Location: (If rural) Quarter Section Township Range Meridian Mailing Address: (if different from Home Address) Box # City Province Postal Code Personal Information Home Phone: Date of Birth: / / Gender: Male Female MM DD YYYY SK Health Number: Page 1 of 5
Immigration/Ethnicity Saskatchewan Resident: Yes No Immigration Status (Citizenship): First Country of Citizenship: Country of Birth: Primary Contacts Contact 1: Email: **Receive Attendance Alerts: Yes No Employer: Contact 2: Email: **Receive Attendance Alerts: Yes No Employer: ** At least one contact must receive attendance alerts Additional Contact Contact 3: Page 2 of 5
Medical Information Medical Information/Allergies: Medical Alert: (medical conditions that may be life threatening ie Epi-pen, epileptic, severe allergy, etc) Medications: School Administered Self Administered Religious / Family Information Are you members of the Bergthaler Mennonite Church Yes No Church you re attending: Has either parent attended VCA? Yes No Name (s) of alumni / Maiden Name (if applicable) Are there any siblings attending VCA: Name: Last Name First Name Grade Name: Last Name First Name Grade Scholastic Information School last attended: School Name Address Phone Number Principal: Dates of Attendance: Has your child ever been expelled, dismissed, suspended or refused admission to another school? No Yes Please circle academic level of pupil s previous work: Excellent Good Average Poor Has your child ever repeated a grade in school? No Yes Page 3 of 5
Has your child ever received special education assistance? No Yes DECLARATION BY STUDENT: I have read the Student Handbook (on our website vca@spiritsd.ca) and agree to abide by the principles and guidelines stated. Student s Signature Fee Information Tuition Fees: Cost per month Bergthaler Church Member Non-Bergthaler Member 1 st child - $125.00 1 st child - $135.00 2 nd child - $ 95.00 2 nd child - $105.00 3 rd child - $ 85.00 3 rd child - $ 95.00 4 th child - $ 65.00 4 th child - $ 75.00 Remaining children - $65.00 Remaining children - $75.00 *Kindergarten children are charged half of the designated amount in their category. PARENT S PLEDGE: I hearby pledge to pay my financial obligations to the school on the date due and understand that it may be necessary to withdraw my child if proper arrangements are not made on a past due account. I give permission for my child to take part in all school activities, including sports and school-sponsored trips away from the school premises. I agree to uphold and support the high academic standard of the school by providing a place at home for my child to study and giving my child encouragement in the completion of any homework or assignments. I support the standards of the school and will not tolerate profanity, obscenity in word or action, dishonor to the Godhead and the Word of God, or disrespect to the personnel of the school. I hereby agree to support all regulations of the school in the applicant s behalf and authorize this school to employ discipline as it deems wise and expedient for the training of my child. DECLARATION OF PARENTS: I have read the Student Handbook and Parent s Pledge and agree to abide by the principles and guidelines stated. Father s Signature Mother s Signature Guardian (if applicable) Date FOR OFFICE USE ONLY: Date of Receipt: If back-dated, original date of application: Page 4 of 5
I hereby authorize Prairie Spirit School Division and consent to all except for the following: Check the boxes to say no for the indicated option: Photography Media Coverage Sports Media Coverage Websites Internet Use Supporting Agencies School Directory (if applicable) Home Phone Contact 1 Email Contact 2 Email Home Phone & Contact 1 Email Home Phone & Contact 2 Email All None Graduation (If applicable) Print Only Print & On-line Political Congratulations None Authorized Signature Date Photography: During the school year, there are occasions where photographs of your child may be taken by staff of Prairie Spirit School Division. These photos may appear in school division publications (brochures, annual reports, newsletters, etc.) Student names will not appear in division publications. Composite or Class Photos may be displayed throughout the school Media Coverage: Media coverage would include the use of your child's first and last name and photograph and may included being videotaped or interviewed. Some media may also release information on the Internet (i.e., a newspaper digital version). Sports Media Coverage: Photographs, interviews and video recordings taken on school property and at athletic events for television, radio, newspapers, media websites and social media. Media coverage typically includes your child's first and last name. Websites: The Prairie Spirit School Division (PSSD) website, www.spiritsd.ca, contains information about our school division as well as web pages for many of our schools. The PSSD encourages schools to use their web sites to communicate with parents and with the public, providing both educational resources and news about the school. The Division website is used to help the community learn more about our schools and our Division. Anyone with the internet is able to access these pages from virtually anywhere in the world. Student photos are sometimes posted on the division's website or on a school website to showcase particular events or activities. Personal information may be used to recognize the student accomplishments or participation in academic or extracurricular activities. Identification of students in photos on a website is by first name and first initial of last name only. Photos of large groups or action shots where students cannot be identified may be posted without parental permission. Internet Use: The internet and networked computers are educational resources that our schools provide for our students' use. Responsible use of the network/internet has the potential to expand our students' information horizons and to help them develop lifelong research skills. Access to the network/internet is a privilege, not a right. Inappropriate use will result in the loss of that privilege. The school will determine what inappropriate use is and will decide logical consequences of misuse. Guidelines: 1) Generally, a student's conduct with the network/internet is governed by the same expectations which guide his/her behavior at school. 2) All students will be instructed in the acceptable use of the Internet before they may access the Internet. They must complete this Network/Internet Acceptable Use Permission Form before access can be granted. 3) Access will only be provided while a student is under the supervision of a teacher or responsible adult. 4) Students will use the network/internet for Educational purposes. 5) Students will not create, distribute, download or save any text, sounds, graphics or other material which are obscene, harassing, racist, malicious, fraudulent, libelous or which may affect the integrity of a computer or computer network. The school/access providers are the sole arbiters in determining what materials or activities may fall into these categories. 6) Students will respect others by not attempting to read, copy or change files or passwords belonging to other people, either locally or on the Internet unless authorized to do so by those individuals. 7) Students will respect copyright laws and rules regarding plagiarism. Network/Internet access will only be provided to students who have the approval of their parents / guardians. At any point, parents/guardians are free to ask that their child no longer be given access to the Internet. Sponsoring Agencies: Periodically supporting agencies request student demographic information to provide additional services relating to the health and well-being of the child, i.e. for developing consent lists for immunization. Only minimal required information is released. School Directory: Some schools distribute a copy of a school/class directory to each family/class member. The information included in the directory includes the student's name, parent/guardian names, home phone, parent/guardian emails as authorized by the parent/guardian.. Page 5 of 5