Jordan Christian Preparatory

Jordan Christian Preparatory

International Student Admission Application
Academic Information
All information is reported according to the Student and Exchange Visitor Information System (SEVIS) regulations and the U.S. Citizenship and Immigration Services in the Department of Homeland Security. Any falsification of information and/or signatures will result in denial of admission or dismissal. I understand that tuition and fees are non-refundable for a student whose I-20 SEVIS record has been terminated or cancelled as a result of falsified information. All information gathered is confidential and is for the sole purpose of admissions and enrollment at Jordan Christian Preparatory. I hereby release every person and institution from any and all liability including liability for defamation and/or invasion of privacy, resulting from and pertaining to information received regarding this application and waiving any right(s) I may otherwise have with regards to this information. Furthermore, my entry into the United States is for the sole purpose of pursuing a full course of study with the intent to graduate from Jordan Christian Preparatory.
Parent and Guardian Signature 1

Sign here
Date 1

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent and Guardian Signature 2

Sign here
Date 2

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent and Guardian Signature 3

Sign here
Date 3

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student Information
First Name
Last Name (Family Name)
English Name (If Chosen)
Requested Academic Semester
Requested Academic Year
Grade level applying for
Native Language
Gender
Current Age
Ethnic Origin (For reporting purposes only. This is optional and will not affect acceptance or placement decisions)
Home Address (Overseas)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Jordan Christian Preparatory of Auburndale, FL admits students of any race, color, national, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students of the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its education policies, admissions policies, scholarship programs, athletic and other school administered programs.
Student Information (continued)
Do you have any dietary restrictions?
If yes, please explain
Are you allergic to any animals?
Are you allergic to any medication(s)?
If yes, which medication(s)
Are you taking any medication(s)?
If yes, which medication(s)
Do you smoke?
If yes, please explain
Do you drink alcohol?
If yes, please explain
Have you ever been involved with illegal drugs?
If yes, please explain
Have you ever been arrested or involved in an illegal offense?
If yes, please explain
Does the student have any siblings?
Sibling Name

First NameLast Name
Sibling Gender
Sibling Age
Sibling Name

First NameLast Name
Sibling Gender
Sibling Age
Sibling Name

First NameLast Name
Sibling Age
Sibling Gender
Describe your family and your home
Explain what it means to be part of a family
Attestation: I confirm that the information provided is accurate and truthful to the best of my knowledge.
Parent/Guardian Signature

Sign here
Parent/Guardian Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Prospective Student Signature

Sign here
Prospective Student Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Choose no more than 10 activities in which you are involved or interested. Athletic eligibility is not guaranteed.
Do you play in a band or orchestra?
If yes, what instrument?
Do you participate in competitive sports?
If yes, which sport(s)?
Are you interested in playing competitive school sports?
If yes, which sport(s)?
What does it mean to display good sportsmanship?
Do you have any pets?
If yes, what are your pets?
What is your religious affiliation?
Are you active in your religion?
Do you attend church?
If yes, how often do you attend per week?
Academic Information
What are your reasons for wanting to study at a school in another country?
What are your academic goals as an international student?
What are your plans for college and career?
List any after school activities in which you are actively involved.
Have you ever repeated a grade?
If yes, which grade and why?
Have you ever been suspended?
If yes, which grade and why?
Do you have a diagnosed learning issue?
If yes, please explain?
Academic Information (continued)
Describe any academic or personal issue which has affected past performance or may affect future performance at school:
Describe yourself as a student:
Describe your favorite subject(s) in school and why:
Describe your most challenging subject(s) in school and why:
What are some examples of showing respect to teachers and fellow students?
List any special awards, honors, or achievements received in school:
Student Essay
Write an essay in the space provided discussing one of the topics provided below. Topics: * What are the greatest challenges you have faced? How did you resolve it? How did it affect you? * Explain an event or activity that has impacted you or created change in your life, and how you changed. * Of all your activities, which one is of greatest importance to you and why? * Describe a person of great influence in your life, why they are important, and how they changed you.
Family Information
The student currently lives overseas with
Father’s Name
Father’s Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Father’s Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Fathers Email
example@example.com
Fathers Occupation
Fathers Employer
Mother’s Name
Mother’s Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mother’s Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mothers Email
example@example.com
Mothers Occupation
Mothers Employer
Which address is the primary address to receive mail?
Sibling Information
Does the student have any siblings?
Sibling Name

First NameLast Name
Age
Gender
Sibling Name

First NameLast Name
Age
Gender
Sibling Name

First NameLast Name
Age
Gender
Describe your relationship with your parents/guardians.
Describe your family and your home.
Explain what it means to be part of a family.
I attest that all information supplied on this application is accurate and truthful to the best of my knowledge. I further agree to provide the required original documents, in addition to translated documents, which are both accurate and truthful.
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Additional Questions:
Has this student ever been expelled or suspended from school?
If so, explain
Has this student ever been arrested for a misdemeanor or felony?
If so, explain:
How did you hear about JCP?

Other
Agreement
Parent Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Medical Release
I give permission for Jordan Christian Preparatory to seek appropriate medical care for my child in the case I cannot be reached. This includes calling 911 or taking them to the hospital if necessary.

Should an emergency arise, it is understood that a conscientious effort will be made to locate, in order; all persons listed as emergency contacts on the registration form, before emergency action is taken.

I agree to provide a copy of my child’s shot records and health form to JCP.

I agree that any expenses of emergency treatment, care and transportation are my financial responsibility.
Medical Information
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Age
Taking any medications?
If yes, please list
Insurance Provider
Policy Number
Student Health Information

Please check if your child has or has had any of the following conditions:
Please select any health conditions that apply
Please explain allergies/sinus trouble
Please explain broken bones/fractures
Please explain sprains/dislocations
Please explain arthritis/bone and/or joint pain
Please explain neck injury
Please explain concussion/knocked out
Please explain emotional problems
Please explain spine injury
Please explain hearing trouble
Please explain kidney problems
Please explain mental health problems
Please explain operations/surgeries
Please explain other
***If you checked yes to any of the above-named conditions, please provide in more detail, by the condition, the date of the
occurrence and if there are any other pertinent information you feel JCP should be aware of.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dress Code:
Jordan Christian Preparatory is a uniform/dress code school. This responsibility ultimately rests on the parents and students. No student will be allowed on campus that is not in dress code.
School Uniform:
Tops: Polo style shirts or oxfords (any shade of blue, any shade of grey, white, and black only). Small designer logo on the top left of shirt is fine. Must be tucked in and appropriately buttoned.

Not permitted: Shirts without collars, shirts designed to show skin in the belly or chest area & shirts promoting violence, gangs, drinking/drugs.

Bottoms: Dress slacks, skirts/skorts and shorts. Any shade of khaki/beige, black and navy blue. Cargo uniform style shorts and uniform style joggers are permitted.

Not permitted: Jeans, leggings/jeggings or athletic apparel (unless its school approved athletic apparel). All belt loops must have a belt. Must be worn around natural waistline. Sagging or any form of underwear exposure will be in violation of school conduct.
Shoes:
Fully covered sneakers only (no crocs, slides or bedroom slippers).
Outware:
No hats, headcovers (bandanas, du-rags, winter headband, scarves, bonnets). All sweaters & sweatshirts/hoodies/jackets must still have school approved shirt underneath. No hoodies will be permitted to wear in class.
Zero Tolerance for the following:
- Dresses, shorts, and skirts shorter than two inches above the knee.

- Low-cut neckline, spaghetti straps, beach dresses, tank tops, excessively form-fitting clothing, or outfits with bare midriffs
(skin must not show around the midriff when the student is standing, sitting, bending over, or raising their arms above their
heads.)

- Shorts shorter than two inches above the knee or tight shorts (Spandex, biking, etc.)

- Items with suggestive lettering, pictures, symbols, names of rock groups or abusive language written on them.

- Flip-flops, clogs, or open-backed shoes (slides) (for safety reasons).

- Pants or shirts with excessive patches or holes. Pant cuffs that are frayed or slit.

- Wallet chains for girls or boys.

- Sweatpants (fleece). Team sweats can be worn on game days and on P.E. days.

- Oversized/baggy look.
Annual Tuition & Fees for International Students
Tuition – (6 th -12 th grade) - $24,000.00
Curriculum (6 th -12 th grade) - $500.00
Technology Fee/Other - $500.00
Testing Fee - $100.00

I understand that payments are due on the 1 st of each month or the first business day and if not received in the school office by the 5th of each month, there will be a late fee of $35.00 accessed. If the tuition payment is not received by the last business day of the month, your child will not be able to return to school until the tuition payment and late fee have been paid.

The total for Tuition & Fees is $25,100.00 for 6th – 12th grade per year, which can be broken down in 10 payments starting with the 1st payment due by the 1st of August and the last payment due on May 1st . All curriculum/ technology/ testing fees must be paid with the 1st payment (total is $3,500.00).
How will you pay for your child's tuition?
Parent Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Pick-up Permission & Emergency Contact:
Please note: Only those persons listed on this form are granted permission to pick-up your student from Jordan Christian Preparatory. Any alterations for this list must be made, dated and initialed by the Parent/Guardian.

The persons listed below have my permission to pick-up my student from Jordan Christian Preparatory and/or be contacted in the event that there is an emergency, and the parent/guardian is unable to be reached.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photography/Video Agreement:
I understand that a photographer or videographer from Jordan Christian Preparatory may take pictures with my student (listed below) in it, either individually or in a group.

I further understand that these pictures, whether in print or online, may be used in future brochures, videos, or other publications of Jordan Christian Preparatory.
Student Name

First NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Binding Arbitration Agreement:
SECTION 1 - SUBMISSION TO ARBITRATION
Believing that lawsuits between believers are prohibited by Scripture, all who place their children in Jordan Christian Preparatory agree to submit to binding arbitration any matters which cannot otherwise be resolved, and expressly waive any and all rights in law and equity to bringing any civil disagreement before a court of law, except that judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction thereof.

SECTION 2 - NOTICE OF ARBITRATION
In the event of any dispute, claim, question, or disagreement arising out of or relating to this school handbook or other school matter, the parties shall use their best efforts to settle such disputes, claims, questions, or disagreement as befits Christians. To this effect, they shall consult and negotiate with each other in good faith and, recognizing their mutual interests not to disgrace the name of Christ, seek to reach a just and equitable solution. If they do not reach such solution within a period of sixty (60) days, then upon notice by either party to the other, disputes, claims, questions, or differences shall be finally settled by arbitration as described in section 1, above, and such Procedures for Arbitration as are adopted pursuant to Section 3, below.

SECTION 3 - LIMITATIONS ON ARBITRATION DECISIONS
The Procedures for Arbitration shall be as adopted by Jordan Christian Preparatory.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature (Accepted by Michael Guastella – Headmaster/President)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Transportation Waiver Release:
I, the undersigned, give my consent for my child First Name Last Name to be transported to and from school, as well as all field trips and other school related functions such as sports activities and other school related events, by Jordan Christian Preparatory school vans/bus and will assume all liability for their participation in this activity/event and any injury that may result during transport to and from the activity/event. Please note, transportation to and from school is given on a first-come first-serve basis, with priority given to returning families first. Spots are not guaranteed.
Further, by signing below:
1. I will not hold Jordan Christian Preparatory, its officers, agents, employees, assigns or anyone acting on its behalf, responsible or liable for injury occurring to the named person in the course of such activities or such travel.

2. I hereby accept financial responsibility for personal items lost by the person identified herein.

3. I authorize Jordan Christian Preparatory to transport and to obtain, through a physician of its own choice, any emergency medical care that may become reasonably necessary for the person in the course of such activities/events or such travel and agree to accept the cost of transportation and/or treatment by medical personnel or facility.

4. I accept full responsibility and hereby grant permission for my child to travel on the school vans/bus.

5. I understand that the privilege of riding the bus will be revoked if my child is misbehaving and not following the rules set forth by the driver.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of parent/guardian
Name

First NameLast Name
Relationship
Admission
All applicants for admission to Jordan Christian Preparatory must obtain an application for admission. Initial acceptance of new students is probationary for the first 9 weeks. JCP reserves the right to establish and maintain its own standards for student conduct and dress. Students are expected to make acceptable progress both spiritually and academically, to abide by the school rules and guidelines, and to conduct themselves in a manner consistent with the policies and practices as established by the administration. Jordan Christian Preparatory makes no distinction in the admission of students based upon race, gender, nationality, or ethnic culture. As a private Christian institution, admission to JCP is a privilege rather than a right. This privilege may be forfeited, and enrollment terminated should a student, new or returning, fail to meet his or her responsibilities as a student at Jordan Christian Preparatory.

By signing these documents, I am stating that I have read and do understand the rules and guidelines set forth in the parent/student
handbook.

This document must be signed by students in 6 th grade and above.
Signature of parent/guardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of parent/guardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of Prospective Student
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Jordan Christian Preparatory

Academic Information

Student Information

Student Information (continued)

Academic Information

Academic Information (continued)

Student Essay

Family Information

Additional Questions:

Medical Release

Medical Information

Student Health Information

Dress Code:

School Uniform:

Shoes:

Outware:

Zero Tolerance for the following:

Annual Tuition & Fees for International Students

Pick-up Permission & Emergency Contact:

Photography/Video Agreement:

Binding Arbitration Agreement:

Transportation Waiver Release:

Admission