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Microsoft word - application.doc

Praise Academy / TLC Christian Schools
To provide a Christ centered nurturing environment where students, parents, faculty and staff can grow as a total person in order that they all may become passionate followers of the Lord Jesus Christ. P.O. Box 13, 4052 Hiram Lithia Springs Rd., Powder Springs, Ga. 30127 Phone 770-943-2484 / Fax 770-943-9458 ENROLLMENT APPLICATION
Stud
ent Information
nrolling: __________ Social Security No: ______- ______- _______ Grade Entering: ____________ Applicant’s Name: _______________________________________________________________________ (last name) (first) (middle) (name called) Addres s: _______________________________________________________________________________ _________________/______________/_____________/______________(_____)________________ city) (county) ( state) (zip code) ( home phone no.) Date of Birth: ____/____/____ Age: _____ Place of Birth : ___________________/______________/_____ Sex: M ( ____ ) F ( _____ ) Race (for accreditation) ___________________ # of other children _______ Fam
ily Information
Father’s Name: __________________________________________________________________________ Father’s Employer: _______________________________ Occupation/Title: _________________________ Busine ss Phone: _________________________________ Cell Phone: _____________________________ Mother ’s Name: _________________________________________________________________________ Mother ’s Employer: _______________________________ Occupation/Title: _________________________ Busine ss Phone: _________________________________ Cell Phone: _____________________________ Student Resides with: ______Father ______Mother ______Stepfather ______ Stepmother ______Guardian Please provide following information only if any additional parent addresses other than the students primary residence (legal guardian) will require school correspondence _____________________________________________________Relation: ____________________ Addres s:_______________________________________________________________________________ Employer:_______________________________________Occupation/ Title:__________________________ Other children living at home: ______________________________________________________________ _________________________________________________________________________________ Contact Information
Persons other than parent who can be cont acted in case of emergency: required ______________________________________________________________________________________ ______________________________________________________________________________________ Church Information

Christian experiences: father saved __________ mother saved __________ student saved ___________
Church pa rents attend: ______________________________________Denomination__________________ Address: ____________________________________________ Phone No. _________________________ e: every week ________ fairly regularly __________ seldom ____________ Church student attends if different:________________________________Denomination_______________ Address: ____________________________________________ Phone No. _________________________ Attendance: every week ________ fairly regularly __________ seldom ___________ What othe r church services, religious meetings or seminars does your child attend regularly? (ex: summer camps, ch ildren or youth groups.) __________________________________________________________ ________ ______________________________________________________________________________ Academ ic / Discipline Information
How did y
ou learn about TLC Christian School? _________________________________________________ ou want your child to come to TLC Christian School? _____________________________________ _______________________________________________________________________________________ School student is now attending, or last attended: ______________________________ Grade: __________ Is there a ny specific information you might share with us that would aid in understanding your child, and his particular needs: (i.e. strengths and weaknesses) ______________________________________________ _______________________________________________________________________________ Has your child repeated a grade before? _______________ If yes, what grade? _______________________ Was your child given a battery of tests for any reason other than norm al academic testing? ( ) Yes ( ) No If so, by whom? __________________________________________________________ Do you kn ow the name of the tests that were administered by the above? ________ If yes, please name them ___ ________________________________________________________________________________ In which o f the following subjects is your child strongest? Math _____ Reading _____ Social Studies ______ Language arts _____ Science ______ Which of the following subjects give your child the most difficulty? Math _____ Reading _____ Social Studies ______ Language arts _____ Science ______ child ever been suspended or expelled from school? ________ If so, for what reason: ________ _______________________________________________________________________________ How do y ou discipline your child? What methods do you use at home? ______________________________ _______________________________________________________________________________________ List any special talents, interests, or hobbies of your child: ________________________________________ ________ _______________________________________________________________________________ Transp
ortation Information
Persons N OT approved to pick up your child: __________________________________________________ ________ ______________________________________________________________________________ Persons approved to pick up your child: ______________________________________________________ ______________________________________________________________________________________ Student’s driving to school must turn in a copy of their license and auto insurance card in the office. Student’s drivers license # _________________________ insurance # ____________________________ Medical Information
Is student currently on medication? ______________ If so, please explain: ___________________________ _______________________________________________________________________________________ d address of student’s physician: ____________________________________________________ ________ __________________________________________________ Phone No. ___________________ Name an d address of student’s dentist: _______________________________________________________ __________________________________________________________ Phone No. ___________________ Please list any medical problems of which we need to be aware of: (ex. diabetes, epilepsy, sight/hearing problems, allergy to bees, allergic to any medication) ____________________________________________ ________ _______________________________________________________________________________ I give per mission for ____________________________ to take _____ Tylenol _____ Advil ____ Benadryl do want to be contacted before my child takes any medicine. ______ I do not want to be contacted before my child takes any medicine. Parent / Guardian Signature _______________________________________________________________
CERTIFICATE OF IMMUNIZATION
GEOR GIA LAW REQUIRES A CERTIFICATE OF IMMUNIZATION TO BE COMPLETED BY YOUR DOCTOR OR TH E HEALTH DEPARTMENT BEFORE A STUDENT ENROLLS IN SCHOOL. STUDENTS MAY NOT AT-TE ND TLC CHRISTIAN SCHOOL WITHOUT H AVING A BIRTH CERTIFIC ATE AND CERTIFIC ATE OF IMMU- Field Trip Information
onally, classes will take short field trips for concept reinforcement. I hereby give permission for my ake short spontaneous trips throughout the year. (Parents will be notified before each field trip). I release T LC Christian Schools and all TLC staff members from all liability for any accident or injury involving my child f or the duration of such trips. ________ ________________________________ ________________________________________ Parent/Guar dian Signature Date Corporal Punishment
I/We understand that all discipline will be administered in love and care. Corporal punishment will be used
only after all other measures have been exhausted. I/We understand the school will notify me first before any corporal punishment is given and request that I/We as a parent of ____________ will come to the school and administer the punishment. I/We give permission for our child ______________ to be disci-plined by means of corporal punishment if the circumstance works where I am not able to come and give punishm e nt and feel the school should administer the punishment. _______________________________________ ________________________________________ Parent/Guar dian Signature Date Weapon / Drug / Alcohol
I understa nd that my child’s personal belongings (books, coat, pocket book, desk, cars, etc) can be searched at any time while on campus for possession of drugs, alcohol, or weapons ( knives, guns or any item inten ded for weapon use.) If found on possession or in any personal belongings I realize this is grounds for immediate dismissal and law enforcement to be called. _______________________________________ ________________________________________ Parent/Guardian Signature Date _________________________________________________ Student Signature Philosophy Support
I have read and fully understand the material presented to me, such as the purpose, goals, and philosophy of the school. I pledge my cooperation with TLC Christian Schools: To nurt ure my child, in scriptural prin-ciples, and Christian teaching in the classroom. I further support the school as an extension of the home: I understand that in order to receive maximum benefits from the educational program offered to my child, there must be clear and open dialogue regarding past and present educational experiences or potential learning _______________________________________ ________________________________________ Financial Support
stand t hat I am responsible for all financial obligations that are incurred by the registration of my child in TLC Christian Schools. Tuition payments are due on the 5th of each month. Accounts will be considered delinqu ent after the 15th of the month and the account will be assessed a $20.00 late fee. If an account becomes more than 30 days delinquent the parent will be asked to withdraw their child from school and/or meet with the school board. The student can be reinstated when the account is brought current. If a check is returned it must be replaced in cash. If a second check is returned then all fees must be paid in cash for the rem ainder of the year. We cannot accept post dated checks. Accounts must be paid in full before a stu- an graduat e or be considered for enrollment for the next school year. ________________________________________ ________________________________________ Parent/G Regist ration
The information provided in this application is to the best of my knowledge complete, accurate, and true. I
understand that the registration fee must be paid before a child is enrolled and that it is non-refundable and
the full matriculation fee is due by July 1st and is non-refundable. I understand that before my child c an
attend the first day of school that all fees and first month’s tuition must be paid. I understand that a school
transcript or last report card, birth certificate, and a current immunization form must be turned into the school
office before my child can attend the first day of school.
________________________________________ ________________________________________
Parent/Guardian Signature
Non-Discriminatory Admissions Policy
Total Learning Center Christian Schools admits students of any race, color, national or ethnic origin to all rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on basis of race, color, national or ethnic origin in administration of its educational poli-cies, admission policies, athletic and other school administered programs. _____ School Transcripts / Copy of Last Report Card _____ Immunization Records 3231, K3-12th grade _____ Hearing, Dental, Vision Form 3300, K5-12th grade _____ Student Agreement Form 7th–12th grade

Source: http://www.praisetabernacle.info/school/application.pdf

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