A Christ-centered, mission-minded school providing excellence through academic leadership!

2016-2017 Registration Form

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STUDENT INFORMATION

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Last name:

First name:

Middle name:

Preferred name:

Gender:

Age:

Birth Date:

Race:
Grade to Enter:

Student Address:

Home Phone:

County:

Father's email:

Mother's email:


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STUDENT HISTORY:

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Last school attended:

School city & state:

Grades completed:

Has the student repeated grades?

If yes, which grade?

Has the student experienced serious disciplinary problems: suspension, probation, or expulsion?

If yes, please explain.

Has the student ever had an IEP?

Has the student ever been in special education classes?


Additional Information:

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PARENT/GUARDIAN INFORMATION:

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Father's Information:
name:

home phone:

cell phone:

address:

employer information:

marital status:
spouse:


Mother's information:
name:

home phone:

cell phone:

address:

employer information:

marital status:
spouse:


Guardian Information (if needed):
name:

home phone:

cell phone:

address:

employer information:

marital status:
spouse:


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SIBLING INFORMATION:

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EMERGENCY CONTACT:

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In case of emergency, person to notify other than parent:

relationship:

home phone:

cell phone:

address:



Does your family attend church:

If yes, please enter the church name:

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***No person shall be denied enrollment, be excluded from participation in, be denied the benefit of, or subject to discrimination in any program or activity, on the basis of sex, race, color, national origin or ethnic group.***

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MEDICAL INFORMATION:

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Does this child have any special medical needs?

If yes, please explain medical need:

Emergency contact:

person to notify in case of a medical emergency:

phone:

relationship to student:

student's name:


I understand that all medication must be submitted to the school office and administered by the school staff.
My signature below grants permission for medications sent to school to be administered to my child with the
proper authorizations and at the appropriate time. (Additional forms must be submitted.)


father/guardian signature & date:

mother/guardian signature & date:





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Registration Fee ________
Recent Report Card ________
Birth Certificate ________
Immunization Cert. ________
Eye Examination ________
Dental Examination ________
Physical Examination ________

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For Office Use Only

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LITTLE FLOCK CHRISTIAN ACADEMY TUITION POLICY AND FINANCIAL OBLIGATION

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We understand that tuition and other fees are necessary in order for Little Flock Christian Academy to successfully fulfill its mission. We also understand that Little Flock Christian Academy has financial and contractual agreements with faculty, staff, vendors, etc. which are made well in advance of the school year. We therefore, commit ourselves to promptly meet our financial obligations in accordance with Biblical stewardship. We also understand and agree to comply with the following tuition policy:

1. All registration fees are non-refundable and non-transferable and must be paid in full before your student’s placement is guaranteed.
2. Families with students grade K-8th withdrawing after the first day of the first quarter, but before the beginning of the third quarter will be responsible for a half year’s tuition.
Families with students grade K-8th withdrawing after the first day of the third grading period (second semester) will be responsible for the full year’s tuition.
3. Families with students grade 9 - 12 withdrawing after November 15th will be responsible for the full tuition.
4. High school students can provide their own laptop or lease one from the school for $300 per year. (Students must have a laptop.)
5. No portion of the tuition shall be excused for a student who either is dismissed or withdraws for disciplinary reasons.
6. In our attempt to keep expenses at a minimum, each family will be required to volunteer at least 10 hours per school year (completed by May 1) i.e., chaperon a field-trip, grade papers, serve lunch, fall festival, etc. Families wishing to opt-out of the mandatory volunteer hours can do so by paying a one-time fee of $100.
7. Tuition is charged on an annual basis. However, for the convenience of the parents, tuition may be paid in ten equal payments from JULY THROUGH APRIL. Monthly payments must be paid through Smart Tuition using automatic debit. Smart Tuition Admin fee of $50.00 will be paid by each family. Tuition due dates (1st or 15th of the month) are chosen by each individual and past due notices will be sent if payment is not received by the due date. If the tuition payment is received after the due date, the account is considered delinquent and a late fee will be applied in the amount of $50.00.
8. If a tuition payment is not received within 30 days of the due date, the student will be suspended until full payment is made. All tuition accounts must be paid in full before a student may return to LFCA. Days missed will be counted as excused absences and students will be permitted to make up any class work or tests for full credit.
9. If payment or written arrangement have not been made with the family once an account is 60 days past due, the account will be turned over to a collection agency.
10. Any check returned to LFCA for any reason will result in a charge of $20 to the student’s account to cover fees and additional bookkeeping. After the second returned check, cash payments must be made for all future installments. Smart Tuition will add additional fees for ACH failures.
11. Accounts must be settled in full before any student records are forwarded to a requesting school or before final report cards are sent home.


I (we) have read and agree to abide by the terms of Little Flock Christian Academy’s Tuition Policy and Financial Obligation. All signatures are legal and binding.


parent/legal guardian signature & date:

additional parent/legal guardian signature & date:

student's name:


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LITTLE FLOCK CHRISTIAN ACADEMY SCHOOL CONTRACT

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This agreement is entered into between Little Flock Christian Academy and
1. We have carefully examined and agree with the Christian purpose and doctrinal basis of Little Flock Christian Academy and desire the school to work with us in the total education of our child(ren).
2. We pledge our loyalty to the aims and ideals of the school and will bring any and all questions and criticisms directly to the administration so that they may be properly addressed by those in authority.
3. All accounts and obligations to the school must be satisfied before academic transcripts and final reports can be released.
4. The school agrees to work closely with parents or guardians to help their child(ren) realize their full spiritual and academic potential. The school also agrees to work closely with the parents to help students resolve school-related problems. This cooperation includes provision of competent teachers, a full-balanced curriculum, regular reporting of academic achievement, and supervision of students and the school program.
5. Students new to LFCA or those returning after a withdrawal are accepted on a trial basis for the first grading period.
6. The school reserves the right to dismiss any student who does not cooperate with the educational process or adhere to the standards of conduct established by LFCA as acceptable for students both on and off campus.
7. I agree to insist that my child submit to the school’s programs, academic disciplinary regulations, and all other requirements instituted by the administration, and carried out by my knowledge and belief.
8. I understand that LFCA does not provide and is not responsible for any before or after school child care.
9. I give LFCA permission for my child(ren) to take part in school activities and periodic field trips away from school premises.
10. I agree to submit a background check application in order to volunteer for ANY school activities.
11. I give permission for my child’s teacher and/or administrator of the school to make and enforce classroom and school regulations and consequences in a manner consistent with Christian principles and discipline as set forth in the Parent-Student Handbook.
12. It is my understanding that the policy of LFCA is to make no refunds on registration fees. I also understand that my tuition payments are due no later than the 1st or 15th of each month (July-April) and late charges will be added as stated in the handbook for any payments made after the due date.
13. I further agree to hold the school and its agents, harmless for the liability to my child or any guardian or parent thereof because of any claims on behalf of my child against the school or any agent thereof because of injury or alleged injury to my child. Should legal action, for any reason be taken against Little Flock Christian Academy or any employee thereof, on my child’s behalf and the school or its agents not be found at fault, I agree to pay any attorney fees, court fees, damages or other costs that Little Flock Christian Academy or its agents should incur to defend itself against such action.
14. I agree to keep all immunizations records up to date according to state law.

We have read this contract and handbook and hereby agree to the terms described above. All signatures are legal and binding.

student's name/signature & date: (high school student's signature required):

father/guardian signature & date:

mother/guardian signature & date:

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***No person shall be denied enrollment, be excluded from participation in, be denied the benefit of, or subject to discrimination in any program or activity, on the basis of sex, race, color, national origin or ethnic group.***

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