K-12 Enrollment Application

K-12 Enrollment Application
This application form is for new students applying for admission into grades K-12. A $100 application fee is required, which covers application processing, transcript analysis, and new student testing. This fee is nonrefundable.
School Year*
Date of Application*

MonthDayYear
Child's Name*

First NameMiddle NameLast Name
Child's Birth Date*

MonthDayYear
Grade Applying for*

Kindergarten1st grade2nd grade3rd grade4th grade5th grade6th grade7th grade8th grade9th grade10th grade11th grade12th grade
Child's Sex*

MaleFemale
Parent/Guardian Information
Guardian 1's Name*

First NameLast Name
Guardian 1's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Guardian 1's Home Number

Area CodePhone Number
Guardian 1's Mobile Number

Area CodePhone Number
Guardian 1's E-mail
Guardian 1's Employer
Guardian 1's Occupation
What is Guardian 1's relationship to the child?*
Guardian 2's Name*

First NameLast Name
Guardian 2's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Guardian 2's Home Number

Area CodePhone Number
Guardian 2's Mobile Number

Area CodePhone Number
Guardian 2's E-mail
Guardian 2's Employer
Guardian 2's Occupation
What is Guardian 2's relationship to the child?
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Church Membership?*

YesNo
Name of Church
How frequently do you attend church services?*
Which factor(s) most influenced your decision to apply to Berean Academy's preschool?

Academic QualityChristian AtmosphereTuition ValueLocationSafe & Secure EnvironmentSchool Philosophy/Values
Please list each school the student has attended starting with the most recent.
Has the child ever been asked to repeat a grade?

YesNo
If yes, which grade(s)?
Has the child ever been suspended or asked not to return to a school?*

YesNo
If yes, please write an explanation.
State any chronic health, emotional, or physical problem(s) the child has.
Does the child have any learning diffiiculties?*

YesNo
Has child ever been tested or recommended to be tested for a learning disability or for ADD/ADHD?*

YesNo
Does the student require modifications to meet academic requirements?*

YesNo
Has the student ever participated in a special needs program (including gifted, resource, special ed.)?*

YesNo
Has the student ever had an individualized education plan (IEP)?*

YesNo
If you answered "yes" to any of the previous five questions, please explain.
Please name two references (non family members) for the child who can provide information relevant to his or her character.
Reference 1

First NameLast Name
Reference 1's Phone Number

Area CodePhone Number
Reference 1's Relationship to the Child
Reference 2

First NameLast Name
Reference 2's Phone Number

Area CodePhone Number
Reference 2's Relationship to the Child
In making this application, I understand that
1. Since the fees do not cover the actual cost of educating my child, we recognize that our participation is needed in prayer, service, and gifts in order to properly share in his/her training.
2. The school reserves the right to dismiss any student who does not respect its standard or cooperates in the educational process.
3. After acceptance, a place will be held for my child when te enrollment form and teh non-refundable registration fee have been submitted to the school by the date indicated on the acceptance letter.
4. It is hereby understood that the guardians will pay tuition for the amount stated by the school office. No refunds will be made for fees. Children transferring to another program and having attended one day or more of any month will owe the full month's tuition.
Statement of Cooperation
1. I pledge loyalty to the aims of the school and will bring any and all questions and criticisms directly to the administration so that they may be properly considered by those in authority.
2. We will read the Statement of Faith and the Philosophy of Education and are willing to have our child trained in accordance with them.
3. We will read the Student Handbook and will cooperate fully in seeing that the rules and regulations laid down there are met.
4. I give Berean Academy permission for my child to take part in all school activities, including sports and school-sponsored trips away from the school premises.
5. The teacher and administration are hereby given full discretion in the discipline of our child. This would include the issuing of suspensions and expulsion from the school program.
6. I agree to hold the school and its agents harmless for any 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 any injury or alleged injury to my child. Should legal action, for any reason, be taken against Berean Academy or any employee or agent thereof, on my child’s behalf and the school or its agent not be found at fault, I agree to pay any attorney fees, damages or other costs that Berean Academy or its agent should incur to defend itself against such action, and would immediately withdraw my child from school as soon as such action had begun.
7. This statement of cooperation will be in effect for as long as my children attend Berean Academy or Preschool.
8. The school reserves the right to dismiss any student who does not cooperate with the educational process. If a student is dismissed for any reason, the tuition will be prorated on a monthly basis for that period of time that the child is in school.
Notice of Non-Discrimination

Berean Academy admits all qualified applicants regardless of race, gender, color, or national and ethnic origin.
Confirmation/Submission

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature: Use your mouse to sign.
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Application Fee$100.00

Total $0.00
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