Application for Enrollment - Faith Christian Academy

Student Information

Name*

First Middle Last

Preferred Name

Birthday*

Age*

Place of birth*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Education Information

Grade to Enter*

School last or presently attending*

Mailing Address of previous school*

Will before or after care be required?

Before School (6:30—8:00 a.m.)
After School (3:00—6:00 p.m.)

Has your child previously attended FCA?*

If yes, in what grades?

Student's Grades have been*

Superior
Above average
Average
Below average

Has student failed any grades?*

If yes, what grade?

Has student ever been

Suspended
Expelled
Asked to withdraw

Does the student have diagnosed learning disabilities or does he struggle in any subject area?

If yes, please explain

Does the student have a current IEP or 504?

Family, Parental, or Guardian Information

Father's Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Business Phone

Employer*

Occupation*

Day/Night Shift*

Marital Status*

Married
Divorced
Widowed
Remarried
Separated

Mother's Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Business Phone

Employer*

Occupation*

Day/Night shift?

Marital Status*

Married
Divorced
Widowed
Remarried
Separated

Are both parents the natural parents of the child?

If no, do you have legal custody of the child?

If the child does not live with both parents, please specify with whom they live:

Are there any unusual factors in the child’s life, such as adoption, serious illness, absence of either parent, or any other circumstances about which you feel the school should be made aware?

If there are other children in your family, please include their name, age, and school:

Name of person responsible for paying tuition, if other than parents:

Address

Street Address Address Line 2 City State ZIP Code

Email

Home Phone

Business Phone

Religious Information

Church now attending*

Attendance*

Regular
Occasional
Seldom
Never

Is student a church member?

Address

Street Address Address Line 2 City State ZIP Code

Pastor’s Name

Youth Pastor’s Name

Has the student had a born again experience with Jesus Christ?

General Information

How did you learn about Faith Christian Academy?*

If you were recommended by a friend or relative, please give their name

State the reason(s) you wish to enroll your child(ren) at FCA:*

Emergency & Medical Information

Emergency Contact (other than parent or guardian)*

Home Phone*

Cell Phone*

Work Phone

Contact’s relationship to you:*

Relative
Friend
Guardian
Other

If other, please specify

Student’s Physician

Office Phone

Is the student allergic to any “over-the-counter” medicines? If so, please explain*

Is the student taking any prescription medication daily? If so, please explain*

Is there any medical reason that the student cannot participate in the physical education program? If so, please explain*

Has the student ever been treated for any emotional, mental, nervous disorder? If so, please explain*

Faith Christian Academy’s Statement of Faith

Faith Christian Academy’s Statement of Faith: We believe the Bible to be the plenary, verbally inspired Word of God, the only infallible, authoritative rule of faith and practice. We believe that there is one God, eternally existent in three persons, the Father, the Son, and the Holy Spirit. We believe in the Deity of Jesus Christ, His virgin birth, His sinless life, His vicarious death through His shed blood, His ascension to Heaven, and His personal premillennial return. We believe that salvation is by grace through faith alone and that all people are sinners in need of being saved. We believe in the present ministry of the Holy Spirit who enables the believer to live a godly life. We believe in the spiritual unity of believers in our Lord Jesus Christ.

Have you read the Statement of Faith and do you understand and accept it?*

Yes
No

Statement of Coooperation

I give Faith FWB Church/Faith Christian Academy permission for my child to take part in all church/school activities, including bus trips, sports activities, and church/school-sponsored trips away from the church premises. I also believe that discipline is necessary for the welfare of each student, as well as for the entire church school. I give permission for my child’s teacher and/or agent of the church school to make and enforce classroom regulations in a manner consistent with Biblical principles and discipline as set forth in the Scriptures. I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED IN ATTENDING FAITH CHRISTIAN ACADEMY, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT TO DAILY SCHOOL ATTENDANCE, INCLUDING TRANSPORTATION TO AND FROM SCHOOL AND ANY ASSOCIATED ACTIVITIES. In consideration for my Child being permitted to attend Faith Christian Academy, I do hereby agree to hold the Faith Christian Academy and Faith FWB Church, and its agents, employees, and volunteers harmless from, and to indemnify for, any and all liability, actions, causes of actions, claims, expenses, including attorneys fees, and damages on account of injury to my Child, even injury resulting in death, which may arise in connection with my Child’s participation in the daily school attendance and any other associated activities which are not the result of gross negligence, intentional neglect, or willful or wanton conduct by the ministry, or its agents, representatives, or employees. I further agree to indemnify Faith Christian Academy and Faith FWB Church, and its and their agents, officers, and employees, for injury to third parties or damage to their property for which my Child may be liable in connection with School attendance or participation in any other associated activities. This Statement of Cooperation will be in effect for as long as my child(ren) listed (or others to be enrolled) attend this church/school whether it be in the nursery, kindergarten, elementary, junior high, or senior high school. I understand that should my marital status change, that it is my responsibility to have a corrected Statement of Cooperation signed, updated, and delivered to the school.

Have you read the Statement of Cooperation and do you understand and accept it?*

Yes
No

By Signing this Application, I Understand That:

1. I am agreeing to the terms and conditions of the previous Statement of Cooperation. 2. My child will be trained in accordance with the previous Statement of Faith and principles found in God’s Word. 3. As a parent, I promise that I will pay my school bills on time. If all my delinquent accounts have not been paid and brought up to date after a total of 30 days has elapsed, I understand that the school can do the following: Withhold a child from going to class, Withhold a report card, Withhold cumulative records/transcripts until the account has been satisfied. 4. It is my understanding that the school policy states that there will be no refunds on registration fees. 5. Since the fees do not cover the actual cost of educating our child(ren), I recognize that our support is needed in prayer, service, gifts, and fundraising. 6. In full cooperation with the school, I will attend the Open House and Parent-Teacher Fellowship meetings. 7. I sincerely pledge my loyalty to the aims and ideals of the school in spiritual teachings as well as academic training. I promise not to make detrimental remarks about Faith Free Will Baptist Church or Faith Christian Academy and will bring any and all questions and criticisms directly to the administration so that they may be properly considered by those in authority. 8. The administration has full responsibility for placing my child in the proper grade. 9. The teacher and administration are given full discretion in the discipline of our child(ren). This includes issuing demerits and detentions, suspension, and expelling from the school program in accordance to the merit and demerit systems. 10. The school reserves the right to dismiss any student who does not cooperate with the educational process, or whose behavior is out of harmony with the school’s philosophy. The administration will determine if a student’s actions, attitude, or behavior merit expulsion. 11. We give permission for our child(ren) to take part in any and all school activities, class field trips, including sports and school-sponsored trips and activities, and absolve the school from liability to us and our child because of any injury to us or our child at school or during any school activities which are not the result of gross negligence, intentional neglect, or willful or wanton conduct by the ministry, or its agents, representatives, or employees.

Signature/Name of Parent Completing the Application

First Last

Date Application is Submitted