Word of God Academy Student Enrollment Packet Pre-K Campus (2, 3, and 4 year olds) 6645 Industrial Drive Shreveport, LA 71118 318.698.4093 fax 318.698.4119 Elementary Campus (K-6 th Grade) 2820 Summer Grove Drive Shreveport, LA 71118 318.687.9003 fax 318.687.9607 Middle and High School Campus (7-11 th Grade) 6645 Industrial Drive Shreveport, LA 71129 318.698.4110 fax 318.698.4119 www.wogacademy.org Mission Statement It is the mission of Word of God Academy to provide Academic Excellence in a Christ-centered environment. Vision Statement To advance a Christian school of academic excellence so that our leaders of tomorrow will know the truth of God s Word and be equipped both academically and spiritually to advance the Kingdom of God in their homes, churches, communities, nation and world for Christ. New Student Application Fee: $75 (Non-refundable) Registration Fee Grades K-11: $500 (Non-refundable) Registration Fee for Pre-School: $150 (Non-refundable) Non-Discriminatory Policy Word of God Academy admits students of any race, color, national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the academy. The academy does not discriminate on the basis of race, color, national or ethnic origin in administration of its educational policies, admission policies, financial aid, and other academy-administered programs. FOR OFFICE USE: Student s Name Application for Fall/Spring of Applying for Grade Date Application Received Application Fee Received Registration Fee Received Date Contract Recorded 1 Word of God Academy Academic Excellence in a Christ-Centered Environment
APPLICANT INFORMATION Child s Legal Name (Last Name) (First Name) (Middle) (Preferred Name) What grade is your child entering? Male Female Birth date Social Security Number Is your child a United States citizen? Yes No What grade is your child entering? Does anyone have a Durable Power of Attorney for this child? Yes No If yes, please give the name of the person with power of attorney. (This person MUST be included in the family information section of the application and a copy of the power of attorney must be kept with the student s records). Name of person with Power of Attorney ETHNICITY Hispanic/Latino American Indian or Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander White Multiracial Other (Please Specify) APPLICANT S CURRENT SCHOOL Name of School Grade(s) Attended Phone ( ) (Area Code) Fax ( ) (Area Code) Has your child been suspended from or asked to leave any school? Yes No If yes, please explain Has the applicant ever skipped or repeated a grade? Yes No If yes, please explain DROP OFF/PICK-UP AUTHORIZATION The following people, in addition to the legal parent or guardian, are authorized to pick up and deliver this student to school. 1. Name Relationship Home Phone Cell Phone Address City State Zip Code 2. Name Relationship Home Phone Cell Phone Address City State Zip Code *If for any reason someone besides those people listed above need to pick up your child, you MUST come to the school office and add their information to this application. 2 Word of God Academy Academic Excellence in a Christ-Centered Environment
APPLICANT S FAMILY INFORMATION Applicant lives with Check all that apply Parents are married Parents are separated Parents are divorced Father has custody Mother has custody Parents have joint custody Mother has remarried Father has remarried Parent(s) are deceased Father s Name Address City State Zip Code Home Phone Cell Phone Email Mother s Name Address City State Zip Code Home Phone Cell Phone Email Occupation/Employer Occupation/Employer Work Phone Work Phone Religious affiliation (optional) Place of Worship (optional) Religious affiliation (optional) Place of Worship (optional) Stepparent s Name Stepparent s Name OTHER INFORMATION AND MEDICAL HISTORY Who referred you to Word of God Academy? What do you expect your child to gain from his/her experience at WOGA? Has the applicant ever consulted with a professional for testing or guidance? Yes No Has the applicant ever been diagnosed as having ADD, ADHD, learning disabilities, speech/language, and/or psychological concerns or has a current IEP or IAP? Yes No If yes, to any of the above, please explain Does the applicant regularly require any medication? Yes No If yes, please explain and list the medications 3 Word of God Academy Academic Excellence in a Christ-Centered Environment
OTHER INFORMATION AND MEDICAL HISTORY (CONTINUED) Describe any other special circumstances not explained above that may affect the applicant s performance in school. If you have documentation for any of the above, please share with administration during the interview and please include any copies of the results of the testing. Emergency Contact Information In case of emergency and the parent(s) cannot be contacted, please provide us with an alternate contact. 1. Name Relationship Home Phone Cell Phone 2. Name Relationship Home Phone Cell Phone Please provide the following medical information: Applicant s Doctor Phone Address City State Zip Code Hospital Preference Applicant s Dentist Phone Address City State Zip Code Does the applicant have any allergies? Yes No If yes, please explain Please list any medical condition(s) AUTHORIZATION In signing this application, I understand that it authorizes Word of God Academy to investigate my child s academic record and to secure other pertinent information necessary to reach an admission decision. I also voluntarily waive the right of access to all information and materials of any kind received by Word of God Academy from any source in connection with the application. The signature also indicates an understanding that the contents of the application including health history may be shared with necessary school personnel on a need-to-know basis, to help ensure this child s safety and well-being while at school or during school related activities. *Note: Before enrollment for the 2015-16 school year is finalized, all past due tuition must be paid in full. Father/ Guardian Signature Date Mother/Guardian Signature Date 4 Word of God Academy Academic Excellence in a Christ-Centered Environment
Please read the following enrollment information. Word of God Academy General Enrollment Information 1. New students are considered enrolled at Word of God Academy ONLY AFTER the enrollment payment is made. 2. Returning students will be considered enrolled at Word of God Academy ONLY AFTER the enrollment packet is complete and registration payment is made. 3. We must have a copy of each student s birth certificate, health record, social security card and school records from any previous school(s) including standardized test scores at the time of registration. 4. Be sure to read all documents. Both father and mother are required to sign all forms for registration to be considered complete. 5. High School students that have a valid driver s license must register their car through the Principal s office and will be assigned a parking area. 6. No 9 th graders may drive to school. 7. Kindergarten students must be five years of age on or before September 30. 8. Grade level entrance tests will be given to all new students to help ensure proper grade level placement. 9. Registration fees are due at the time the student is registered. 10. Classes are subject to close without notice. 11. Students will be registered in the order that registration fees are paid. When a class becomes full, a waiting list will be started for the next class. It is important to register early. 12. A registered student will not receive a class schedule or classroom assignment if a balance remains on the previous year s account. 13. Tuition is due on the 1 st of the month. Payments are considered late on or after the 10 th of the month and a LATE FEE of $50 will be added to the payment. 14. Student uniforms are mandatory. They MUST be purchased at Land s End or Shreveport Gymnastics to ensure uniformity. Questions concerning school uniforms should be addressed to the school office. 5 Word of God Academy Academic Excellence in a Christ-Centered Environment
Application Checklist (For Office Use Only) (Initial and Date) Application completed in its entirety Non-Refundable Application Fee of $75 Paid Copy of Birth Certificate Copy of Immunization Record Copy of Social Security Card Copy of Latest Report Card Copy of Attendance Record Copy of Suspension Record (if applicable) Entrance Test Scores Parents Interviewed Parent Contract for School Partnership Signed Statement of Cooperation Signed Financial Contract Signed Permission to Use Photos Signed Registration Fee of $500 Paid Enrollment Date 6 Word of God Academy Academic Excellence in a Christ-Centered Environment