Student Application Form

Permission to Administer Medication

This form must be completed on an annual basis.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
In order for school personnel to administer any prescription or over the counter medication on a routine basis, WE MUST HAVE THIS FORM COMPLETED AND SIGNED BY THE STUDENT'S PARENT/ GUARDIAN OR PHYSICIAN. ONLY MEDICATIONS IN THE ORIGINAL CONTAINER WITH CLEAR INSTRUCTIONS WILL BE ADMINISTERED TO STUDENTS. All medication will be kept locked with school personnel unless a doctor authorizes them to carry a medication at all times.
Does your child routinely take any prescription or over the counter medication? (If yes, you will be asked to list them in the next section.)*

YesNo

Please list all current medications below.

	MEDICATION	Dosage	Time of Day	Purpose	Duration
1
2
3
4
5

Please list any potential side effects or reactions that your child may have to these medications.
Does the student need to carry any of these medications on their person at all times?

YesNo
If YES, please list doctor's name and phone number.

PrefixFirst NameLast Name
Phone Number
I hereby request that personnel from Oakdale Christian Academy to give the above medication to:
Student Name
I understand that:

Ongoing medications must be monitored by the student's own primary care physician.A new PERMISSION TO ADMINISTER MEDICATION form must be submitted with any change in medication.It is the parents responsibility to keep track of when the prescriptions are in need to be refilled, and to make sure they are mailed to the school as soon as possible. Please send health services an email confirmation, that they have been sent.
Type Your Name

First NameLast Name
Signature

Clear
Date and Time
I give permission for Oakdale staff to administer over the counter medication at their discretion - to address occasional symptoms such as headaches, cough, congestion, sore throat, upset stomach, and other minor injuries or illnesses - to my child:*
Student Name
Type Your Name*

First NameLast Name
Signature*

Clear
Date and Time*

Permission for Medical Treatment
Student's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Student's SSN
Parent/ Guardian responsible for medical treatment decisions:*

First NameLast Name
Date of Birth*

MonthDayYear
Parent's SSN*
Parent's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Phone Number*
Alternate Phone Number
Emergency Contact (not parent/ guardian)

First NameLast Name
Contact's Phone Number
Does the student have health insurance?*

YesNo
Name of Insurance Company
Insurance Co. Phone Number
Policy Number
Group Number
Name of Insured

First NameLast Name
Is prior approval required for treatment?

YesNo
Is there a certain doctor or clinic in Jackson, KY that accepts your insurance? If so, please list:
Doctor/Clinic Name
Please attach a scan of applicant's insurance card (front and back):

Cancelof
Consent to Medical Treatment
I, the undersigned parent/ guardian of applicant, a minor, give my consent for Oakdale Christian Academy staff to secure medical services, including diagnosis and treatment in case of illness or injury. I agree to assume all financial responsibility for such services.*
Initial Here
I also give my consent for any x-ray examination, anesthetic, medical or surgical diagnosis and/ or treatment, and hospital care to be rendered to my child under the supervision and on the advice of a licensed medical professional; and for anesthetic, dental or surgical diagnosis and/ or treatment, and hospital care to be rendered to my child by a licensed dentist.*
Initial Here
I give the consent for the exchange of pertinent medical/ dental/ surgical information between Oakdale Christian Academy and any medical personnel involved in the care and treatment of my child, and give permission for Oakdale Christian Academy to obtain copies of medical records when they are pertinent to the continuing care of my child.*
Initial Here
It is understood that consent is given in advance of any specific diagnosis or treatment. It is given to encourage Oakdale Christian Academy and the attending physician or dentist to exercise their best judgment concerning diagnosis and treatment.*
Initial Here
I authorize Oakdale Christian Academy power of consent in all matters related to keeping immunizations up to date, including signing for any required immunizations.*
Initial Here
I understand that this consent shall remain in effect as long as my child is a student at Oakdale Christian Academy.*
Initial Here
Student's Name*

First NameLast Name
Parent's Name*

First NameLast Name
Parent's Signature*

Clear
Date and Time*

Parent/ Guardian Consent and Agreement

Please carefully review each section.
Student Name*

First NameLast Name
INTERNET USE: I understand that the use of the internet may be required for some class assignments and give my consent for the student I am enrolling to use the internet as an academic resource. Beyond its role as an academic resource, the internet is utilized as an earned privilege for communication with family and friends. Please indicate your consent for the enrolling student by checking the appropriate box below:*

I grant permission for the student I am enrolling to use the internet for non-academic purposes such as communication (ie. email, social media, etc)I DO NOT grant permission for the student I am enrolling to use the internet for non-academic purposes such as communication.
PUBLICITY: I understand that the funding for Oakdale Christian Academy and financial aid is made available because of the generosity of supporters who consider the mission of Oakdale to be important, and I give my consent for Oakdale to use photography and video of school activities that include the student I am enrolling in promotional material. The student may also participate in speaking and providing public statements or letters of thanks as part of Oakdale Christian Academy's public relations.
Initial Here
RECREATION/ TRIPS/ TRANSPORTATION: I agree that extracurricular activities are a vital part of a well-rounded boarding school program. I give my consent for my child to participate in sports and recreational activities sponsored by Oakdale Christian Academy and absolve the school from any liability should injury occur. I understand that some of the outdoor recreational activities may include hiking, canoeing, camping, rock climbing, rappelling and caving. I understand that safety precautions will be taken and that such activities will be supervised by staff with experience in these activities. I give my permission for my student to participate in off campus overnight activities as arranged and supervised by Oakdale Christian Academy. *
Initial Here
BEHAVIOR POLICIES: I have read and understood the parent- -student handbook. I will support the policies of the school as expressed in the handbook and will encourage my child to live up to the behavioral expectations of the school. *
Initial Here
PERSONAL ELECTRONICS POLICY: I recognize that the use of electronic equipment (cell phones, laptop computers, digital cameras, translators, digital music devices, etc) in violation of the electronic equipment policy, as stated in the student handbook, will result in the permanent loss of the equipment. In sending any electronic equipment with the enrolling student, I acknowledge that I am trusting their judgment in the use of these items, and understand that misuse may result in confiscation and permanent loss. *
Initial Here
Parent's/ Guardian's Name:*

First NameLast Name
Parent's/ Guardian's Signature*

Clear
Other Parent's/ Guardian's Name (if applicable):

First NameLast Name
Other Parent's/ Guardian's Signature (if applicable):

Clear
Date and Time
You will be redirected to PayPal to complete your submission by paying the appropriate non-refundable re-enrollment fee. Click below to proceed.

***Also please be aware that there is a partial tuition down payment in order to secure your child a spot.***
Re-Enrollment Fee*
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Re-Enrollment Fee for Fall 2025-26 School Year
$100.00

Re-Enrollment Fee for BOTH Summer LEAD 2025 and Fall 2025-26
$200.00

Total

$0.00
Should be Empty:

2025-2026 Re-Enrollment

Statement of Financial Responsibility

Health History

Permission to Administer Medication

Permission for Medical Treatment

Parent/ Guardian Consent and Agreement