APPLICATION 2021-2022

STUDENT APPLICATION
SCHOOL YEAR
KATY ADVENTIST CHRISTIAN SCHOOL
Grade applying for
Date of Application

Month Day Year
Date
Student Social Security
Name of student
Sex
2.Date of birth

Month Day Year
Date
Place of birth
Age
Document(s) submitted to Verify birthday for Child

Birth Certificate Hospital Statement Notarized Statement Passport or Visa
Student Living With

Father Mother Stepfather Stepmother Other
Home address
Street
PO BOX
City
State
Zip
Home Phone
Email address
example@example.com
Mother’s Cell Phone
Father’s Cell Phone

	Legal names Parents / Stepparents in #3	Denom. Affiliation	Church where Membership held	Languages used at home	Occupation	Business phone

Is this Student Sponsored By an Adventist Church Member

Yes No
Is this student a baptized member of the Adventist Church?

Yes No
If yes, indicate year baptized
Church where membership is Held
If student has other church affiliation, specify
6.School last attended

7. Other children in Family

	Name	Sex	Age	Living in home	School Attending
1
2
3

8. Has this student been previously identified as qualifying for a special education program?

Yes No
If yes, what kind?
When?
Where?
By Whom?
9. Does student have an unpaid account at another school?

Yes No
If so, state where
10. Person to whom financial statements are to be sent if different from that given in item #3.
NAME
ADDRESS
TELEPHONE
UNIFORMS:
I agree to abide by the uniform code as outlined in the KACS Handbook. To maintain color and quality consistency as well as cost effectiveness, uniforms need to be purchased at flynnohara.com/school/TX100 or Flynn O’Hara, 1022 Wirt Road Ste 322, Houston, TX 77055. Phone: 346-201-3490. They have a complete listing of required daily and dress uniforms. I will help my child abide by the uniform code listed above.

I understand they are expected to be in uniform daily and will be sent home to change if they come in inappropriate attire.
DATE

Month Day Year
Date
PARENT / GUARDIAN’S SIGNATURE

Clear
SPECIAL NEEDS:
I understand that Katy Adventist Christian School does not provide special needs services.
DATE

Month Day Year
Date
PARENT / GUARDIAN’S SIGNATURE

Clear
PHOTO STATEMENT:
From time to time we will take pictures of our children. We like to use these pictures in power point presentations in the area churches to show what is happening at our school. Occasionally we will put a photograph on a brochure or on our web site for advertising purposes. Names are never listed. By signing, you give permission for your child’s picture to be used in this way.
DATE

Month Day Year
Date
PARENT / GUARDIAN’S SIGNATURE

Clear
ELECTRONICS / CELL PHONES:
I understand that smart watches, cell phones, etc. are and regulations of KACS. I understand that these items will be confiscated if brought to school, and I will have to pay a fine to have them returned (see handbook). I also understand that disregarding any of the rules and regulations may result in my child being suspended / expelled. (Tablets / Computers may be allowed with permission from Principal.)

not allowed. I agree to make sure my child abides by the rules
DATE

Month Day Year
Date
PARENT / GUARDIAN’S SIGNATURE

Clear
PARENT CONTRACT:
I hereby agree to support school regulations and to help my child observe them, and to accept all financial educational obligations for this student. I understand that when an account becomes 45 days past due, financial arrangements must be made with the business office in order for the student to continue in school, plus a $25.00 late fee will be assessed each month for every month in arrears. If financial arrangements are not made, school policy requires that the student(s) withdraw until payment is made or an approved payment plan is arranged.
DATE

Month Day Year
Date
PARENT / GUARDIAN’S SIGNATURE

Clear
Should be Empty:

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STUDENT APPLICATION

KATY ADVENTIST CHRISTIAN SCHOOL

UNIFORMS:

SPECIAL NEEDS:

PHOTO STATEMENT:

ELECTRONICS / CELL PHONES:

PARENT CONTRACT: