Mount Zion Christian Academy Boarding Student Application Packet

Mount Zion Christian Academy Boarding Student Application Packet Contents Tuition and Fee Schedule (Undergraduate)... 2 Tuition and Fee Schedule (Postgraduate)... 3 Application... 4-12 Records Release Form... 13 Unsupervised Liberty Release Form... 14 Boarding Student Checklist... 15

Mount Zion Christian Academy 2015-2016 Boarding Tuition and Fee Schedule (Undergraduate) Tuition Tuition for boarding students is $12,000 per academic year and includes the following: Tuition (non-refundable)...$4,970 Room/Board...$3,040 Meals Boarding students in grades 9 through 12 must purchase an MZCA meal plan each semester. Acceptable forms of payment include: cash, money orders, and credit cards. Meals are provided as follows: 3 meals per day (Mon Fri) 2 meals per day (Sat Sun)...$2,990 Transportation School-related activities only...$1,000 Fees Registration*... $500 Standardized Testing... $65 Graduation (Grade 12 only)... $65 Computer Lab... $25 Science Lab... $25 Athletic Participation... $50 *Registration fees are non-refundable and non-transferable. All fees and tuition payments are non-refundable. Payment Options Two (2) payment options are available for boarding students: Option 1: Two (2) semester installments of $6,000 each, payable by the first day of August and January Option 2: Four (4) quarterly installments of $3,000 each, payable by the first day of August, October, January, and March Payment Types Tuition payments are acceptable in the following forms only: Cash Money Order Certified Check Credit/Debit Card Tuition does not include the following: Books Uniforms Athletic Events Special Events Note: A 10% fee is automatically assessed for all past due accounts and returned checks. Students are considered enrolled for the entire school year; therefore, budgets and teacher contracts are set accordingly. Students withdrawing between October 1 and May 30 will be assessed a $500.00 Withdrawal Fee. This is a per-student fee. Additionally, the full month s tuition is due for any month in which a student attends at least one school day. All fees are due in full and are non-refundable. Official transcripts, report cards, and records cannot be released if an outstanding balance remains at MZCA.

Mount Zion Christian Academy 2015-2016 Postgraduate Tuition and Fee Schedule Tuition Tuition for postgraduate students is $12,000 per academic year and includes the following: Tuition (non-refundable)... $4,970 Room/Board... $3,040 Athletics Transportation... $1,250 Lodging... $1,490 Meals... $1,250 Fees Registration*... $500 Standardized Testing... $65 Computer Lab... $25 Science Lab... $25 Meals All postgraduate students must purchase a meal plan from North Carolina Central University each semester. Acceptable forms of payment include: cash, money orders, and credit cards. *Registration fees are non-refundable and non-transferable. All fees and tuition payments are non-refundable. Payment Options One (1) payment plan is available for postgraduate students: Two (2) semester installments of $6,000 each, payable by the first day of August and January. Payment Types Tuition payments are acceptable in the following forms only: Cash Money Order Certified Check Credit/Debit Card Tuition does not include the following: Books Uniforms Athletic Events Special Events Note: A 10% fee is automatically assessed for all past due accounts and returned checks.

Mount Zion Christian Academy Home of the Mighty Warriors - "Achieving Excellence Through Jesus Christ" 3519 Fayetteville Street Durham, NC 27707 Telephone (919) 688-4245 Ext. 243/244 Fax (919) 688-2201 Apostle Donald Q. Fozard, Sr., Superintendent Welcome to Mount Zion Christian Academy Each new applicant must submit the following documentation: Full registration fee Completed application forms Copy of recent physical Copy of immunization record Copy of birth certificate Copy of social security card Copy of current transcript (Grades 9-12) Signed Record Release Form - 3 -

MOUNT ZION CHRISTIAN ACADEMY "Achieving Excellence through Jesus Christ" 3519 Fayetteville Street, Durham, N.C. 27707 (919) 688-4245 ext. 243 or 244 Fax (919) 688-2201 Founder and Superintendent, Apostle Donald Q. Fozard, Sr. REGISTRATION/APPLICATION FORM Circle One: New Enrollment Re-Enrollment Grade to Enter Boarding Day School Registration Fees (Non-Refundable/Non-Transferable): Day School: $150.00 Boarding School: $500.00 Name Student Information (Last) (First) (Middle) Age Sex and Place of Birth Social Security Number - - Home Phone ( ) - Address (City) (State) (Zip) The last grade successfully completed Grades have been: Above Average Average Below Average Has student failed any grades? Yes No If yes, what grade(s)? Last school attended: Has the child ever been expelled, dismissed, suspended or refused admission to another school? If yes, please explain.

Has the child ever been in trouble with the law, arrested, etc.? If yes, please explain. Does the child have any physical handicaps? If yes, please explain. Please give any additional information that might be helpful to the teacher(s), (family situations, discipline problems, etc.). Please give reason for selecting this school. School recommended by: Church now attending: Pastor's name Phone ( ) -

Father's Name Employer Work Phone Address (If different) Parent Information Email Cell Phone Mother's Name Employer Work Phone Address (If different) Email Cell Phone Student lives with: Parents Mother Father Guardian Guardian's Name: Address (If different) Employer Work Phone E-mail Statement of Cooperation I have completed all the sections of this registration form to the best of my ability, and believe the statements are accurate. I will support the policies and procedures of Mount Zion Christian Academy if my child is accepted. I also understand that all tuition payments and all fees are non-refundable. Parent/Guardian Signature

Special Transportation Agreement In order for your child(ren) to be transported off campus for field trips, sporting events etc., we need your permission. Please sign the following release. I agree to let my child(ren) be transported to and from off campus school activities by authorized school or church staff members. I release Mount Zion Christian Academy and Mount Zion Christian Church from liability for injury to my child(ren) during such trips. This agreement will remain legitimate as long as my child(ren) are enrolled at Mount Zion Christian Academy. Parent/Guardian Signature Authorized Pick-Up List Student Health/Emergency Medical Information Please note that this information will stay on file as long as your child attends MZCA. Therefore, we need parents to keep this information up-to-date. Name of Student(s) / _/ List the names and phone numbers of two responsible adults we can contact in the event that an emergency occurs and we are not able to reach you. 1. Name Home Phone Work Phone 2. Name Home Phone Work Phone Name of child's physician Phone Dentist preferred Phone

Does the child have health insurance? Yes No If yes, please give name of insurance company Hospital preferred: Does your child have any allergies? Is your child on any medications? Does your child have any health problems which would exempt him/her from physical education, vigorous exercise, or walking long distances? Yes No If yes, please describe below. If your child's health changes, it is your responsibility to notify us in writing and by telephone. In the event of an accident or illness, I hereby grant permission to the authorized staff and representatives to administer necessary first aid and/or to take my child, by car or ambulance, to a medical facility for additional treatment. I give permission to a doctor or nurse to administer the necessary medical attention in case of an emergency. I give permission for my child to be admitted to the hospital if necessary. I hereby release Mount Zion Christian Academy and Mount Zion Christian Church from any liability. Parent/Guardian Signature

Code of Conduct A pledge of conduct is required from all Mount Zion Christian Academy students. This pledge is not designed to usurp parental authority or influence, but to set some behavioral standards which reflect Christian principles-both during and after school hours. Please consider this pledge seriously; it is an important part of the application. The pledge must be signed by parents and students each year upon re-enrollment. Specific guidelines and standards have been established for students at Mt. Zion Christian Academy. The students are taught moral and ethical principles based upon the W ord of God. Standards are established to help shape students' behavior. Please read carefully and sign the following Student and Parent Pledges. Details concerning the behavior standards and dress code standards are found in the school handbook. All new students will be required to submit to a random drug test. Student Pledge As a student at Mount Zion Christian Academy, I agree to uphold the school's standards of behavior and maintain Christian standards of honesty, courtesy, morality, and respect for authority. At school or away, I will not smoke, use narcotics, drink alcoholic beverages, nor abuse other similar substances. I will not steal, cheat, swear, or use indecent language. I will not bring weapons, dangerous objects, or firearms to school. I will dress and act in a decent and respectful manner at all times. I will not have a rebellious spirit or a continued negative and uncooperative attitude. I realize that my failure to uphold these standards may be grounds for expulsion. Additionally, I agree to support the decisions and policies of the teachers and school administration. I will strive to speak positively about my school at all times. (Parents of younger children, please read and discuss with your child(ren). Student's Signature Parent Pledge I agree with the above Code of Conduct and will require consistent behavior from my child in accordance with these standards. Parent/Guardian Signature

Statement of Faith A. The Scriptures. The Bible is the inspired Word of God, the product of Holy Men of old who spoke and wrote as they were moved by the Holy Spirit. The New Covenant, as recorded in the New Testament, we accept as an infallible guide in matters pertaining to conduct and doctrine. (II Timothy 3:16; I Thessalonians 2:13; II Peter 1:21). B. The Godhead. Our God is one but manifested in three persons - The Father, the Son, and the Holy Spirit (Philippians 2:6 and Matthew 3:16-17). God the Father is greater than all; the Source of the Word (Logos) and the Begetter (John 14:28; John 16:28; John 1:14). Jesus is the Son of God, One with the Father, the Word flesh-covered, the One Begotten, and has existed with the Father from the beginning (John 1:1; John 1:18; John 10:30). The Holy Spirit proceeds from both the Father and the Son and is eternal (John 15:26). C. Man, His Fall and Redemption. Man is a created being, made in Likeness and image of God, but through Adam's transgression and fall, sin came into the world. "All have sinned and come short of the glory of God." "As it is written, there is none righteous, no not one." Jesus Christ, the Son of God, was manifested to undo the work of the devil and gave His life and shed His blood to redeem and restore man back to God (Romans 5:12; Romans 3:9-10; I John 3:8; Galatians 3:13-14). Salvation is the gift of God to man, separated from works and the law, and is made operative by grace through faith in Jesus Christ, producing works acceptable to God (Ephesians 2:8). I have read the Statement of Faith of Mount Zion Christian Academy and am in agreement with its doctrine and principles. Parent/Guardian Signature Student Signature

Photo Release Waiver Authorization and Release I hereby grant permission to Mount Zion Christian Academy, and its officers, trustees, employees, agents, students, representatives, successors, licensees and assigns (hereinafter "the Academy") to photograph my image, likeness, or depiction and/or that of my minor children (if applicable). I hereby grant permission to the Academy to edit, crop, or retouch such photographs, and waive any right to inspect the final photographs. I hereby consent to and permit photographs of me and/or those of my minor children to be used by the Academy worldwide for any purpose, including educational and advertisement purposes, and in any medium, including print and electronic. I understand that the Academy may use such photographs with or without associating names thereto. I further waive any claim for compensation of any kind for the Academy s use or publication of photographs of me and/or those of my minor children (if applicable). I hereby fully and forever discharge and release the Academy from any claim for damages of any kind (including, but not limited to, invasion of privacy; defamation; false light or misappropriation of name, likeness or image) arising out of the use or publication of photographs of me and/or those of my minor children (if applicable) by the Academy, and covenant and agree not to sue or otherwise initiate legal proceedings against the Academy for such use or publication on my own behalf or on behalf of my minor children. All grants of permission and consent, and all covenants, agreements and understandings contained herein are irrevocable. I acknowledge and represent that I am over the age of 18, have read this entire document, that I understand its terms and provisions, and that I have signed it knowingly and voluntarily on behalf f myself and/or my minor children (if applicable). Signature Print Name Print Name of Minor Child Print Name of Minor Child Print Name of Minor Child Print Name of Minor Child Print Name of Minor Child

Mount Zion Christian Academy Home of the Mighty W arriors - "Achieving Excellence through Jesus Christ" Records Release Form 3519 Fayetteville Street Durham, North Carolina 27707 Telephone (919) 688-4245 Ext. 242 Fax (919) 688-2201 (Name and Address of Previous School) (Name of Pupil) (Grade) (Age) ( of Birth) Send records to: Mount Zion Christian Academy 3519 Fayetteville Street Durham, North Carolina 27707 Birth Certificate Immunization Records Transcript (Cumulative Folder) Achievement Test Scores (SATIACTIPSAT) Discipline Records Other (IEP, 504, etc.) Parent/Guardian Signature

Residential Life Unsupervised Liberty Release Form I,, give my child,, permission to participate in unsupervised liberty. I understand that by signing this form, I am releasing Mount Zion Christian Academy, Mount Zion Christian Church, Inc., and its employees from any and all liability while my child is on unsupervised liberty. In addition, if a student is to be released into the custody of someone other than a parent/guardian for liberty, or if a student requests to spend the weekend away from the boarding facility, written permission must be received from the parent/guardian. Mount Zion Christian Academy, Mount Zion Christian Church, Inc., and its employees will be released from any and all liability while the student is on weekend liberty. Students will be provided a pass once permission is granted by the parent or guardian. Mount Zion Christian Academy has a great interest in the health and welfare of your child. Thank you for your support. In His Service, Peggy A. McIlwain Principal, M.Ed. Parent/Guardian's Signature Caretaker's Signature Principal's Signature Academy does reserve the right to use appropriate selection criteria in fulfillment of its stated goals and objectives.

MOUNT ZION CHRISTIAN ACADEMY BOARDING STUDENT CHECK LIST TOILETRIES soap deodorant toothpaste other needed items LINEN/TOWELS blanket (1) twin bed sheet set (2) bath towels (2) bath cloths (2) pillow, twin-size (1) SCHOOL SUPPLIES King James Bible notebook (binder) loose leaf paper composition notebook pens pencils black marker (1) dictionary RECOMMENDED ITEMS small storage trunk with lock for personal items iron laundry bag (1) shower shoes Note: Please label all personal items. Due to limited space, students should bring only five (5) sets of causal wear/shoes. Students should also bring the following for Sunday morning worship services: one (1) dark suit or two (2) dress shirts two (2) pairs of dress slacks neck tie Academy does reserve the right to use appropriate selection criteria in fulfillment of its stated goals and objectives.