Agape Christian Academy & High School Enrollment Application & Checklist The following documentation is required to process each application packet: Complete and Sign Enrollment Application Copy of student s social security card Copy of student s birth certificate Copy of last report card High school transcripts Copy of HS student s Driver s License and/or Insurance Copy of parent identification Copy of parent social security card Blue Shot Form Updated (current) Physical Form Notarized Medical Release Form Scoliosis testing documentation for 7 th Grader Step Up For Students Commitment Form Children s First Contract Agreement McKay Confirmation Verified # McKay Contract Agreement
DATE OF ENROLLEMENT PD. AMOUNT PAID PAYMENT PLAN DATE AGAPE CHRISTIAN ACADEMY Enrollment Application CHECK # CASH FINANCE SIGNATURE START DATE STUDENT INFORMATION Last Name First M.I. Date Street Address Apt./Unit # City State ZIP Phone E-mail Address Age Sex Birth Date Last School Attended Last Grade Completed Father s Name Employer Position Business Phone Cell Phone Emergency Phone FAMILY INFORMATION Mother s Name Employer Position Business Phone Cell Phone Emergency Phone Marital Status: Married Widow Divorced Separated Children Not Applying Age: Reason Not Applying: Name: Name: Age: Reason Not Applying: RELIGIOUS INFORMATION It is a requirement for admission to our Christian School that at least one parent of the student must be a professing, born-again Christian. Church Attending Pastor Address Father: Christian Yes or No How do you know? Mother: Christian - Yes or No Has applicant ever made a profession of faith in Christ? Yes or No
APPLICATION AGREEMENT This application must be filled out completely before it can be processed. Application, Registration and Testing fees of $ 50 must accompany the application and are nonrefundable. An interview with the parents and the student will be required before final acceptance. This Christian school has a racial nondiscriminatory policy and, therefore, does not discriminate against members, applicants, students, and others on the basis of race, color or national ethnic origin. The school depends upon financial gifts above and beyond the tuition and thus may conduct annual fund campaigns. The school depends on 100% participation by all parents in the campaign. I hereby pledge to pay my financial obligation to the school on the due date and understand that it may be necessary to withdraw my student if proper arrangements are not make on a past due account. I understand that, if I voluntarily withdraw my child or my child is dismissed from school once classes have begun, I am responsible to pay the full month s tuition for the month used. I also understand that records cannot be forwarded to another school until all financial obligations have been satisfied. I appreciate the standards of the school and do 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 it deems wise and expedient for the training of my student. I understand that this application does not constitute a contract for enrollment until formally accepted by the school administration s sole discretion, has failed to comply with the established regulations and discipline or whose financial obligation remains unpaid. Signature of Father Date Signature of Mother Date SCHOLASTIC INFORMATION Has the student ever been expelled, dismissed, suspended or refused admission to another school? Why? Has the student ever had disciplinary difficulty at school? Why? Does the student have a juvenile or arrest record? Explain: Has the student ever used tobacco or nonprescription drugs of any kind? Explain: Has the student ever failed an academic subject in school? Explain: Please indicate the academic level of the student s previous work: Excellent Good Average Poor GENERAL INFORMATION How did you hear about this school? Reason for selecting this school
Agape Christian Academy STATEMENT OF AGREEMENT APPLICATION FEE: The application fee must accompany the student s application before processing begins. The 10% down payment and the enrollment are comprehensive therefore; they are non-refundable for any reason. METHOD OF PAYMENT: Monthly tuition payments are to be paid in advance and are due and payable on the first of each month. There will be a 3% discount for those who pay the entire school year tuition payment on or before June 10 th. Ten equal payments may be made beginning in August and continuing through May. Students grades and/or report cards will be withheld until all fees are paid or until satisfactory arrangements have been made with the school finance department. SCHOLARSHIP STUDENTS: Parents/Guardians are responsible to make sure all the necessary paperwork is completed by the assigned deadline. Parents/Guardians will be responsible for all payments and/or balances that are not paid by the students scholarship for any reason. LATE CHARGES: There will be a late charge of $30.00 charged to the monthly tuition when it has not been paid by the 10 th of each month. Any student whose tuition has not been paid as of the 10 th of the month will not be accepted back to class until all tuition, as well as late fees are paid. A $25.00 return check charge (NSF) will be on all returned checks. TEXTBOOK POLICY: If a textbook is lost, stolen, or damaged beyond usability, the student will be required to purchase another textbook from the school at its full replacement cost. The books must be returned without excessive wear at the completion of the school year or an additional fee will be assessed. If a textbook is missing for three consecutive class days, it is to be considered lost and another textbook will need to be purchased.
Agape Christian Academy Statement of Agreement Page 2 WITHDRAWALS: Parents withdrawing a student from school MUST complete the withdrawal process through the school office. Students enrolled for one day in a month will owe the full month s tuition. In order for withdrawal to be valid, parents must sign a withdrawal form indicating their intention of removing their child from school. All tuition payments are non-refundable and all fees owed to the school must be paid before the student records are released. TEACHER REQUESTS: Parents may request a specific teacher (in case of multiple classes) at the time of registration. The administration will consider the request, based on various factors, at the time of student placement. There is no guarantee that a child will be placed with the teacher requested. STATEMENT OF AGREEMENT for the PARENTS and/or GUARDIANS: In signing this statement of agreement, I agree that: 1. I have read the student handbook for Agape Schools. 2. I understand that I have a responsibility to actively support the authority, purpose, philosophy, objectives, policies, procedures, and rules. 3. I understand that Agape Schools reserve the right to dismiss any student for lack of cooperation with the Christian education process by the student, parent, or guardian. 4. I will not file a legal suit against Agape Assembly Baptist Church and/or Schools, on behalf of the student or myself. Signed: Enrolled Child s Name Date Signature of Parent/ Guardian to Child Date
THE PARENT-SCHOOL AGREEMENT IN ORDER TO SOLEMNIFY the desire of the undersigned parties to glorify the Lord with their obedience to Him and to promote a clear understanding of the duties and responsibilities of each party, the undersigned parties adopt the following agreement: I,, for and in consideration of my child,, being admitting as a student at Agape Christian Academy and Preschool, do hereby accept such admission and the duties and responsibilities entailed therein and agree to be bound by the terms of the Agreement: 1. I subscribe without reservation to the Articles of Faith and the Standards of Conduct of Agape Christian Academy and Preschool/Agape Assembly Baptist Church and agree that my family will abide by these doctrines in all aspects of our lives, both at and away from school ministries and functions. I agree to attend one service offered at Agape Assembly Baptist Church at least once a year that my child is enrolled at Agape Christian Academy and Preschool, to expand my spiritual horizons for the sake of my child. I agree to be loyal to the pastor and the church programs in demands, threatening to sue or actually litigating a matter against Agape Christian Academy and Preschool/Agape Assembly Baptist Church clearly violates Biblical teaching and practice and shall constitute sufficient grounds of immediate withdrawal of all my children from enrollment at Agape Christian Academy and Preschool/Agape Assembly Baptist Church. I understand that retaining or instructing an attorney to contact the ministry with regard to a word and in deed. I agree to fulfill all duties and responsibilities of membership in the Agape Assembly Baptist Church. 2. I have read and understand the Student Handbook and I agree with it completely. I agree that my child and I must abide by all of the policies, rules and regulations of the school, including those listed in the Student Handbook, and I agree to support Agape Christian Academy and Preschool with my conduct and my prayers. 3. I understand and agree that the education of my child will be guided by the instructors and other school officials. I agree that my purpose in obtaining a Christian education of my child will be achieved by following the curriculum set him by the instructors and school officials to the best of his/her ability to their satisfaction. I will support the decisions of the instructors and school officials and will never attempt to undermine their authority. I understand and agree that during my child s enrollment the courses offered and the instructors teaching them may change from time to time in the discretion of the school leadership. 5. I understand and agree that my child has no right to publish and distribute a student newsletter or any other publication. I understand and agree that Agape Christian Academy and Preschool/Agape Assembly Baptist Church, has the right, in its sole discretion, to control what is published, circulated, or otherwise distributed at its school to its students or staff, and I will ensure that my child understands this provision. 6. I understand and agree that attending Agape Christian Academy and Preschool is a privilege and the school reserves the right to suspend or expel my child from the school in accordance with its official policies as determined by the school. Notwithstanding anything to the contrary contained herein, this Agreement does not bind either party to any specific period of enrollment. Either party may terminate this Agreement without cause upon seven (7) days written notice. I understand that no rights or presumptions of continued enrollment are conferred or implied by this Agreement or by a number of consecutive Agreements. I further agree that no right to notice of renewal or non-renewal of the Agreement is conferred or implied. 7. I agree to pay all tuition and fees in a timely manner as set forth in the Agape Christian Academy and Preschool s Financial Information Statement. I understand that monthly tuition payments are due on the first day of each month. I further understand that if I fail to make a timely payment, my child may be withdrawn from school and I may be subject to late-payment fees and other costs, including any necessary costs of collection in accordance with school policy. 8. As Agape Christian Academy and Preschool is a Christian ministry organization, both parties agree that they would never make demands, threaten to sue, actually litigate any matter whatsoever relating to or resulting
from this Agreement. I understand that making potential claim or dispute will be interpreted as a threat to sue. Accordingly, the parties agree to resolve all potential claims, disputes or causes of action through binding arbitration using the procedures outlined in the attached procedures. a. I agree to follow the Biblical pattern of Matthew 18:15-17 and Galatians 6:1 and always give a good report. All differences are to be resolved by utilizing Biblical principles-always presenting a united front b. The parties agree that the methods outlined in this section (8) shall be the sole remedies for any and all controversies or claims arising out of the enrollment relationship or this Agreement and expressly waive their right to file a lawsuit against one another in any civil court for such dispute, except to enforce a legally binding arbitration decision. c. I acknowledge that I have read and understand the Procedures for Arbitration adopted by Agape Christian Academy and Preschool and agree to abide by the procedures outlined therein. d. I agree to do everything in my power to avoid involving Agape Christian Academy and Preschool & Agape Assembly Baptist Church in any legal proceedings which may take place or legal requests for documents or testimony of school officials concerning the custody and/or education and upbringing of my child. I understanding that if, in spite of my and my attorney s best efforts, any school official is legally compelled to provide testimony or documentation beyond a copy of my child s standard academic records, that my child may be immediately dis-enrolled from Agape Christian Academy and Preschool & Agape Assembly Baptist Church and that my account may be charged for any and all expenses incurred in complying with such legal process. 9. The parties agree that there are no other agreements or understandings between them relating to the subject matter of this Agreement. This Agreement supersedes all prior agreements, oral or written, between the parties and is intended as a complete and exclusive statement of the agreement of the parties. Neither this Agreement nor its execution have been induced by any reliance, representations, stipulations, warranties, agreements or understandings of any kind of other that those expressed herein. If any provision of this agreement is found to be void or void able, it shall not affect the validity of any other provision. Both parties shall remain bound by all other provisions. 10. I certify that I will explain this Agreement and its meaning to my child. I will assist the school in every way necessary to ensure my child abides by all the terms of this Agreement. 11. I understand that this Agreement shall not take effect until fully executed by all parties. IN WITNESS WHEREOF, the parties have executed this Agreement on the day of, 20. BY Mother BY Father I understand this agreement and its content and agree to abide by its terms and all rules which apply to students. BY Student (7 th Grade and Above) ACCEPTED AND APPROVED BY Principal
MEDICAL RELEASE FORM (This Form Must Be Notarized) TO: EMERGENCY PERSONNEL I HEREBY GIVE CONSENT TO ANY EMERGENCY MEDICAL PERSONNEL TO ADMINISTER NECESSARY TREATMENT TO MY CHILD, IN THE EVENT OF ANY EMERGENCY AT WHICH TIME I CANNOT BE REACHED; I GIVE CONSENT TO TRANSPORT BY AMBULANCE IF SITUATION WARRANTS IT. I HEREBY GRANT PERMISSION FOR MY SON/DAUGHTER TO PARTICIPATE IN ANY EXTRA CURRICULAR ACTIVITIES. I WAIVE, RELEASE, ABSOLVE, AND HOLD BLAMELESS AGAPE CHRISTIAN SCHOOLS, ITS ADMINISTRATOR, TEACHERS, SUPERVISOR, PHYSICAL EDUCATION DIRECTORS, MANAGERS PERSON TRANSPORTING MY CHILD TO AND FROM SCHOOL ACTIVITIES, AND OTHER PARTICIPANTS, FROM ANY CLAIM ARISING OUT IF INJURY OR SICKNESS TO MY CHILD. IF IN THE OPTION OF A PROPERLY LICENSED AND PRACTICING PHYSICIAN, MY CHILD NEEDS MEDICAL OR SURGICAL SERVICES WHICH REQUIRE MY CONSENT BEFORE BEING SUPPLIED, AND I CANNOT BE REACHED, I AUTHORIZE, APPOINT AND EMPOWER THE PRINCIPAL, OR HER DESIGNEE, TO FURNISH ON BEHALF SUCH WRITTEN OR ORAL AUTHORIZATION AS MAY BE REQUIRED. FUTHER, I RELEASE THE ADMINISTRATION, OR HIS/HER DESIGNEE, AND AGAPE CHRISTIAN SCHOOLS FROM ANY LIABILITY WHICH MIGHT ARISE FROM THE GIVING OF SUCH AUTHORIZATION, IT BEING MY DESIRE THAT MY CHILD BE FURNISHED WITH SUCH MEDICAL OR SURGICAL SERVICES AS SOON AS REASONABLY POSSIBLE AFTER THE NEED ARISES. ATTENTION PARENT: PLEASE SIGN BELOW IN FRONT OF NOTARY SIGNATURE OF PARENT OR LEGAL GUARDIAN DRIVERS LICENSE STATE OF FLORIDA COUNTY OF ORANGE ON THIS DAY OF 20 CAME BEFORE ME WITH IDENTIFICATION AND EXECUTED THE SAME. NOTARY PUBLIC MEDICAL INFORMATION (FILL OUT COMPLETELY) HOME ADDRESS NAME OF FAMILY PHYSICIAN PHONE ALLERGIES OF CHILD OR PHYSICAL IMPAIRMENTS LIST ANY MEDICATION(S) CHILD MAY BE ALLERGIC TO: DATE OF LAST TETANUS SHOT INSURANCE COMPANY POLICY # EMERGENCY CONTACT NAME PHONE
PICK UP PERMISSION FORM CHILD S FULL NAME I hereby give permission for my child to leave the school with the following persons named below. It is the responsibility of the parents to notify the school in writing of any changes. NAME RELATIONSHIP/ PHONE # Please list names of persons NOT able to pick up your child: If there is a separation or divorce custody problem of which we should be aware, please explain. Signature of Parent or Guardian Date
AGAPE CHRISTIAN ACADEMY Faith Family-Future RELEASE FOR SCHOOL RECORDS I DO HEREBY AUTHORIZE (Name of School Student is leaving) (STREET) (CITY/STATE) (ZIP) (PHONE) Please release all records and information regarding: (Including High School Transcripts and Last Report Card and/or Progress Report) (STUDENT NAME) (DATE OF BIRTH) SEND RECORDS TO: AGAPE CHRISTIAN SCHOOLS 2425 N. HIAWASSEE RD. ORLANDO, FL 32818 Agape Christian Academy (Grades K5-8 th Grades) Phone: 407.298.1111 ~ Fax: 407.298.0400 Agape Christian High School (Grades 9 th -12 th ) Phone: 407.297.7373 ~ Fax: 407.298.0400 PARENT SIGNATURE DATE
AGAPE CHRISTIAN ACADEMY 2425 N. Hiawassee Road ~ Orlando, FL 32818 Phone: 407-298-1111 ~ Fax: 407-298-0400 High School Phone: 407-297-7373 ~ Fax: 407-298-0400 STUDENT REFERENCE (To be completed by Principal, Teacher, or Counselor.) (Prior to acceptance) STUDENT NAME: CURRENT GRADE: SCHOOL CURRENTLY ATTENDING: The above student has applied for admission to Agape Christian Schools. Your assistance is requested in providing as much information below as possible in order to better meet the needs of this student. How long this student been at your school? Has this student maintained at least ninety percent (90%) attendance? Yes No 1. Please rate the following areas with a check mark: General attitude E-excellent G-good F-fair U-unsatisfactory Effort Cooperation Relationship with Teacher Relationship with Peers Study Habits In your own words, how would you describe the above student? Please return this form directly to Agape Christian Academy. Preparer s Signature Date
AGAPE CHRISTIAN ACADEMY TUITION SCHEDULE 2010-2011 Faith Family Future ALL FEES ARE NON-REFUNDABLE TUITION FEE $ 5,000.00 NEW ENROLLMENT APPLICATION FEE (1 st Child) $ 200.00 ADDITIONAL CHILD (REN) 150.00 RE-ENROLLMENT FEE (Existing Students Only) $ 150.00 TESTING FEE -REQUIRED FOR ALL NEW STUDENTS $ 200.00 (Payable in Cash & Due Prior to Testing) BOOKS: K5-8 th Grades $ 300.00 9 th - 12 th Grades $ 350.00 CASH PAYERS (Responsible for Testing, Registration, Books & 10 Monthly Tuition Payments) ATHLETIC FEES AND GRADUATION FEES DUE AT SIGN UP! *Athletic Fees (Per Sport) Graduation Fee K-5...$ 50.00 Cheerleader $ 50.00 8 th Grade.. $ 75.00 Girls Basketball $ 60.00 12 th Grade..$ 100.00 Boys Basketball $ 70.00 Football $ 70.00 Track & Field $ 60.00 Volleyball $ 60.00 Baseball $ 70.00 Band $ 60.00 (Use of Marching Band Uniform)