FLORIDA REGION STUDENT ACTIVITIES REGISTRATION 2015-2016 SCHOOL: ADDRESS: CITY:_ STATE: ZIP: PHONE: ( ) FAX: ( ) STUDENT ACTIVITIES COORDINATOR: COORDINATOR S EMAIL: *SCREENING REQUIREMENTS* By registering for these events you are agreeing to ensure that all staff and volunteers the school provides meet the school s internal policies and standards as well as state requirements for working with children in a K-12 private school setting. Signature: Title: Date: (Please note: This section must be signed by the Head of School or Principal) Registration: August 3, 2015 until November 2, 2015 $55.00 per event (Check) $58.00 (Credit Card) No registrations will be accepted after November 2, 2015. Registrations will be handled in the order in which they are received. Be sure to register early to ensure a space for your school. Enrollment is limited for many activities! Payment must accompany this registration form. Please send school checks made out to ACSI or credit card payment. NO REFUNDS WILL BE GIVEN IF YOUR SCHOOL CANCELS!! THIS AREA FOR ACSI OFFICE USE ONLY: Date confirmation sent Closed event: Date refund sent Total events Host school Payment Amount Date rcd. 1
Please place a check next to the activities you plan to attend and list your school's coordinator AND their email address. Location Date Grades ART FESTIVALS Clearwater Community Church, Dunedin - 1501 Mar. 3 K-5 Clearwater Community Church, Dunedin - 1502 Mar. 4 6-12 Park Avenue Christian Academy, Titusville - 1503 Mar. 4 K-12 Jupiter Christian School, Jupiter - 1504 April 29 K-12 Your school's art festival coordinator: CREATIVE WRITING FESTIVALS Note: Students not do attend this event. Only the entries are sent to the host site for judging. Orangewood Christian School, Maitland - 1505 Mar. 30 4-12 Westlake Christian School, Palm Harbor - 1506 Apr. 11 4-12 ACSI Florida Regional Office, Dunedin - 1507 Apr. 15 4-12 Community Christian School, Port Charlotte - 1508 Apr. 15 4-12 First Baptist Academy, Naples - 1509 Apr. 22 4-12 Your school s creative writing coordinator: MATH OLYMPICS *Availability is limited for these events in RED. Call the ACSI Florida Regional Office at 727-734-7096 to check for availability before registering for this event EXCEPT if you are hosting this event. Coral Springs Christian Academy, Coral Springs - 1510 Mar. 2 3-8 Potential Christian Academy, Cooper City 1555 Mar. 2 3-8 Merritt Island Christian School, Merritt Island - 1511 Mar. 18 3-8 Rocky Bayou Christian School, Niceville - 1512 Apr. 2 3-8 Clearwater Community Church, Dunedin - 1513 Apr. 8 3-8 Southwest Florida Christian Academy, Ft. Myers - 1514 Apr. 8 3-8 University Christian School, Jacksonville - 1515 Apr. 8 3-8 Foundation Academy, Winter Garden - 1516 Apr. 15 3-8 Northside Christian School, St. Petersburg - 1517 Apr. 15 3-8 Your school's math olympics coordinator:_ MUSIC FESTIVALS (Elementary/Middle School Vocal) Indian Rocks Christian School, Largo - 1518 Mar. 7 3-8 Coral Springs Christian Academy, Coral Springs - 1519 Mar. 8 3-8 Your school's elementary choir coordinator: 2
Location Date Grades MUSIC FESTIVALS (Middle/High School Vocal) Indian Rocks Christian School, Largo - 1520 Mar. 4 6-12 Your school's secondary choir coordinator: MUSIC FESTIVALS (Instrumental Concert Band) Skycrest Christian School, Clearwater - 1521 Mar. 3 4-12 Your school s instrumental music coordinator: MUSIC FESTIVALS (Instrumental Solo/Ensemble) Westlake Christian School, Palm Harbor - 1522 Apr. 23 4-12 Calvary Christian Academy, Ft. Lauderdale - 1523 May 7 4-12 Your school s instrumental music coordinator: MUSIC FESTIVALS (Piano) Keswick Christian School, St. Petersburg - 1524 Mar. 16 2-12 Ocala Christian Academy, Ocala - 1525 Apr. 14 2-12 Your school's piano festival coordinator: SCIENCE FAIRS Orangewood Christian School, Maitland - 1526 Mar. 9 3-12 Bethany Christian School, Ft. Lauderdale - 1527 Apr. 21 3-12 Your school's science fair coordinator: SPEECH MEETS (Elementary) Northwest Christian Academy, Miami - 1528 Feb. 25 1-6 Bell Shoals Baptist Academy, Brandon - 1529 Mar. 10 1-6 _ 3
SPEECH MEETS (Middle School) Location Date Grades Westlake Christian School, Palm Harbor - 1530 Feb. 18 6-8 Northwest Christian Academy, Miami - 1531 Feb. 26 6-8 _ SPEECH MEETS (Senior High) Northwest Christian Academy, Miami - 1532 Feb. 26 9-12 _ SPELLING BEES (Grades 1-4) Merritt Island Christian School, Merritt Island - 1533 Feb. 12 1-4 Coral Springs Christian Academy, Coral Springs - 1534 Feb. 17 1-4 Southwest Florida Christian Academy, Ft. Myers - 1535 Feb. 19 1-4 Aletheia Christian Academy, Pensacola - 1536 Feb. 26 1-4 Westlake Christian School, Palm Harbor - 1537 Feb. 26 1-4 Sheridan Hills Christian School, Hollywood - 1538 Mar. 1 1-4 Foundation Academy, Winter Garden - 1539 Mar. 4 1-4 Trinity Christian School, Palm Beach Gardens - 1540 Mar. 10 1-4 First Christian Academy, New Port Richey - 1541 Mar. 11 1-4 Promise Land Academy, Jacksonville - 1542 Mar. 17 1-4 Your school's grades 1-4 spelling coordinator: SPELLING BEES (Grades 5-8) Sheridan Hills Christian School, Hollywood - 1543 Feb. 12 5-8 Promise Land Academy, Jacksonville - 1544 Feb. 18 5-8 Real Life Christian Academy, Clermont - 1545 Feb. 19 5-8 Boca Raton Christian School, Boca Raton - 1546 Feb. 24 5-8 Westlake Christian School, Palm Harbor - 1547 Feb. 25 5-8 Aletheia Christian Academy, Pensacola - 1548 Feb. 26 5-8 Central Baptist Christian School, Brandon - 1549 Feb. 26 5-8 Community Christian School, Port Charlotte - 1550 Feb. 26 5-8 Merritt Island Christian School, Merritt Island - 1551 Feb. 26 5-8 Your school's grades 5-8 spelling coordinator: 4
NUMBER OF EVENTS ATTENDING: Minus TOTAL NUMBER OF ACTIVITIES HOSTING: TOTAL NUMBER OF ACTIVITIES: REGISTRATION FEES: TOTAL AMOUNT TO BE PAID: X $ 55.00 (Check) OR X $ 58.00 (Credit Card) $ Credit Card Information: Visa MasterCard #: Expiration Date: 3 Digit Security Code: Name on card: _ Checks for the full amount, made out to ACSI, or credit card payments with the applicable processing fee must accompany this form. NO REFUNDS will be given if your school cancels, so please plan carefully. If your school is hosting an activity, no registration fee ($55.00) will be required; however, your school still needs to register for the activity, AND the participation fee(s) will be due on or before the participation deadline. SCHOOL ACCIDENT INSURANCE REQUIREMENT All schools participating in an event with the Association of Christian Schools International should ensure that they have adequate insurance coverage for students and sponsors/teachers. ACSI does not assume responsibility for these coverages. The school s student accident insurance should cover most reasonable and customary medical expenses. Worker s compensation coverage should cover employees/teachers. Activities include, but are not limited to: art, cheerleading, math, music, science, speech, and spelling events. PLEASE SEND THIS FORM AND CHECK OR CREDIT CARD INFORMATION TO: ACSI-FLORIDA, 461 PLAZA DRIVE, SUITE C, DUNEDIN, FLORIDA 34698 Phone: (727) 734-7096 Fax: (727) 734-3666 5