1105 58 th Avenue, Vero Beach, Florida 32966 Phone: 772/794-4655 www.mastersvb.org Application for Enrollment Preschool
APPLICATION INSTRUCTIONS Thank you for your interest in Master s Academy! Preschool applicants must be three years old by September 1 st to be enrolled and must be toilet trained. Current physical and health immunization form must be turned in prior to enrollment. To begin the enrollment process, submit the following: Application for Enrollment, completed, signed, and dated by both parents Enrollment fee: $75.00/student for Preschool Birth certificate (copy is acceptable)
1105 58 th Avenue, Vero Beach, Florida 32966 Phone: 772/794-4655 www.mastersvb.org Please Print Legibly. STUDENT ENROLLMENT APPLICATION Note: Completion of the application does not guarantee enrollment. Application is for Full-Time Student Home School Student Athletic Program Performing Arts Program Student Name: [Last] [First] [Middle] Birthdate: / / Gender: Male Female Grade applying for: Home Address: [Street] [City] [Zip] Master s Academy does not discriminate on the basis of race, color, national or ethnic origin. Ethnicity: African American Asian Caucasian Hispanic Other: Parent Marital Status: Married Separated Single Divorced Widowed Father or Guardian Stepfather Mother or Guardian Stepmother Name: Occupation: Employer: Home Phone: Cell Phone: Work Phone: Email Address: Primary Language Spoken: Name: Occupation: Employer: Home Phone: Cell Phone: Work Phone: Email Address: Primary Language Spoken: Education History List all schools previously attended (including Master s Academy, if previously enrolled): None Grade Grade Grade Preschool Program Selection: 7:30-8:30 Drop-Off (no extra cost) Noon Program Extended Program Full Day Program
The following are the basic tenets of historic, orthodox Christianity: We believe: the Bible to be the inspired and only infallible authoritative Word of God. there is one God, eternally existent in three persons: Father, Son and Holy Spirit. in the deity of the Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory. that man is sinful by nature and that regeneration by the Holy Spirit is essential for salvation. in the continuing ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a holy life. in the resurrection of both the saved and the lost; they who are saved unto eternal life, and they who are lost unto eternal damnation. in the spiritual unity of the believers in our Lord Jesus Christ. in the creation of man by the direct act of God. that the Church is the body of believers added by Christ with the mission of preaching and teaching the gospel of salvation to the world. Are you personally in agreement with and committed to the tenets stated above? Father: Yes No Mother: Yes No Do you desire that your child receive training in these doctrines at school, and will you support the school in its endeavors to encourage your student in applying these doctrines to life? Yes No Church membership and regular attendance at a local Christian church are expected of the family, including the student. Does your family attend church weekly together? Yes No If no, please explain: Will you endeavor to seek a church home that is in agreement with the above tenets of Christianity? Yes No Name of Church: Church Address: Phone Number: Name of Pastor/Priest: Why do you desire for your child(ren) to receive a Christian education? Family Characteristics The following are intended to acquaint you with the essential matters in the development of students at Master s Academy, the topics that we will discuss at the interview, and what we look for and evaluate when making decisions about applicants. They help us learn about you, but also reveal to you significant characteristics of our school. Lengthy essays are not required! Spiritual: The home is to be the center of spiritual growth and instruction. Describe how you nurture your children spiritually.
Discipline: What are your expectations for your child s general behavior, and how are deviations from this behavior handled at home? How does your child respond to authority? Character: What three (3) words best describe your child? List your dependent children, if any, who will not be enrolled at Master s Academy for the next school year. Name Grade School Financial Information Person responsible for paying tuition and other charges, if other than parents: Name: [Last] [First] [Middle] Address: E-mail: Phone: Limited tuition assistance, if available, depends upon verification of need, availability of funds, and completed admissions process. Verification of Accuracy Father s Signature Date / / Mother s Signature Date / / Referral Please tell us how you heard about Master s Academy: (Check all that apply) Referred by a current school family or employee: (Name) Referred by a friend or relative: (Name) Radio advertisement: (Station) Attended an event where Master s Academy was represented: (Event) Website: (Web Address) Advertisement in publication: (Title) Attended a sports event: (Event) Read a brochure: (How did you receive it?) Referred by a school: (Name) Other: (please specify)
OFFICE USE ONLY Non-refundable registration fee of $150.00 per student (Grammar, Middle, High); $75.00 per student (Preschool) Registration Received / / By: (initials) Amount: $ Check #:
HEALTH HISTORY Student Name: [Last] [First] [Middle] Birthdate: / / Gender: Male Female Grade applying for: Please check the appropriate box for each item, and explain any yes responses in the blank provided. No Yes Rheumatic Fever Physical limitations: No Yes Asthma, Reactive Airway Disease Triggers: No Yes Other Chronic Respiratory Problems: No Yes Allergy to Insect Bites Insect(s) No Yes Other Allergies: No Yes Diabetes Insulin? No Yes: Time given: No Yes Heart Disease Type: Severity? Severity? Special Diet? No Yes: Activity restrictions: No Yes Epilepsy, Convulsions, Fits List any aura preceding episode: No Yes Headaches Frequency: Severity: Prescribed Medications/Dosage: No Yes Eye/Vision Problems Type: Corrective Glasses Contact Lenses No Yes Hearing Problems Hearing Aids: No Yes No Yes Posture, Back, Neck, Scoliosis, Spinal Problems Explain: No Yes Sickle Cell Disease Trait: Usual Symptoms: No Yes Bladder/Kidney Disease Frequent bedwetting: No Yes Frequent Urination: No Yes No Yes Bowel Disease/Problems No Yes Has Taken Medication/Poison Accidentally Long-term Effects: No Yes Other Serious Illnesses/Accidents requiring hospitalization Date: Long-term effects: Other Medical Problems Conditions: Attention Disorder: Type: Rx: No Yes No Yes Asperger s Syndrome Autism Cancer Cerebral Palsy Emotional Disorders Immune Deficiency Hemophilia Muscular Dystrophy Tourette Syndrome Other No Yes Special Health Procedures/Appliances Needed: No Yes Can the student participate in the school s regular physical education program? No Yes Necessary limits on physical activity: Verification of Accuracy Father Emergency #( ) Date / / Mother Emergency #( ) Date / /