HCA Admissions Application

Hosanna Christian Academy

8850 Goodwood Boulevard., Baton Rouge, LA 70806 225.926.4885 225.926.4104 (fax) www.hcablazers.org
Application for Admission
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Place of Birth
Gender

MaleFemale
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student resides with (fill in the blank: both parents, mother, father, or legal guardian)
Grade Level Entering
School Year
School Last Attended
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Occupation
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email Address
Parent/Guardian's Name - Secondary

First NameLast Name
Occupation
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email Address
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.
Student Questionnaire

Please complete all questions on this application. It is important to provide detailed explanations for all questions answered "Yes." If there is anything else you would need for us to know with regards to your child, please indicate it here:
Question 1: List ALL schools attended and grade; beginning with the most current first.
Question 2: Has student ever received any special honors that you would like for us to know about?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 3: Does the student have interests in fine arts (music, drama, choir, etc)?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 4: Has the student ever been a member of an athletic team or special club?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 5: Has student ever been diagnosed as gifted and/or talented?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 6: Has student ever been retained or repeated a grade?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 7: Does student suffer from any chronic illnesses (asthma, ulcer, seizures, diabetes, etc)?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 8: Does student have physical limitations (heart, hearing, vision, muscular, speech, nervous system, severe allergies, or other physical impairments)?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 9: Is student currently under a physician's care?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 10: Does student wear glasses or contact lenses?

YESNO
Question 11: Has student been tested for or diagnosed with ADD or ADHD and/or taking behavior modifying medication?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 12: Has student ever received tutoring or special academic student services (i.e. ESS, special education)

YESNO
Please explain below. Type "N/A" if not applicable.
Question 13: Has student ever been evaluated for learning difficulties?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 13: Has student received or been referred for counseling services?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 13: Has student ever had difficulty submitting to authority?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 14: Has student ever been suspended from school?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 15: Has student ever been expelled from school?

YESNO
Please explain below. Type "N/A" if not applicable.
Question 16: Has student ever been asked to withdraw from a school in lieu of being expelled or recommended for expulsion?

YESNO
Please explain below. Type "N/A" if not applicable.
Admissions Checklist: File Upload

ALL NEW KINDER-8th GRADE: 1. Copy of Birth Certificate 2. Copy of Social Security Card 3. Copy of Immunization/Medical Documents 4. Proof of Residency (utility bill, rental or mortgage, bill of sale, lease agreement) ENTERING 1st- 8th GRADE STUDENTS: 6. Copy of Recent Test Scores (Terra Nova, DIBELS, LEAP). 7. Copy of Report Card (most recent). 8. Copy of Attendance Records. 9. Copy of Discipline Records
Birth Certificate

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Social Security Card

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Immunization Record

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Proof of Residency

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Test Scores (entering 1st-8th only)

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Recent Report Card (enting 1st-8th grade)

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Attendance Record (entering 1st-8th grade)

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Discipline Record (entering 1st-8th grade)

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Acknowledgement/Signature
In signing this application, we acknowledge our commitment to the following:

1. Hosanna Christian Academy, henceforth known as HCA, is a Christian institution upholding Biblical Christian values. I understand my child will be taught the scriptures and attend Chapel.

2. We will support HCA in all matters as God leads and enables.

3. HCA students are expected to live a Christian lifestyle on and off campus, 24 hours per day, 7 days a week, 365 days per year, and may be disciplined, including expulsion, for inappropriate behavior outside of school.

4. The administration has the full responsibility of placing all students in the appropriate grade level.

5. Upon successful enrollment, I consent to the use of my child’s photograph, video, voice, or likeness for advertising or promotional purposes.

6. In the unlikely event of tragedy or trauma, HCA has permission to allow qualified counselors to assist my child.

7. If accepted into HCA, I commit to read and review the HCA Parent/Student Handbook with my child. Furthermore, I commit to supporting school officials in their enforcement of the policies and procedures set forth therein.

8. I agree that school administrators have full discretion in all school matters including the discipline of my child, as set forth in the HCA Parent/Student Handbook. This may include paddling, if deemed appropriate for the offense.

9.The school’s administration reserves the right to dismiss any student at any time whose conduct or academic effort fails to meet our high standard. HCA has sole authority to dismiss a student in whom we cannot accommodate. Positive parental involvement and support will influence final decisions.

10. When differences of opinion exist, I agree to first seek resolution with the person or persons with whom I disagree. If no resolution can be found, only then will I bring the difference of opinion to her/his supervisor. I understand that the school’s administration will not entertain conversations that attempt to subvert this biblically based process (Matt. 18: 15-17). Please see Chain of Command Chart in HCA Parent/Student Handbook.

11. I understand that the school is not obligated to provide special education and related services to my child, and I hereby waive any right my child may have to these services at this school, now and in the future.

12. I understand that my child will remain eligible for any Equitable Services available from the public school system pursuant to the Equitable Services provisions of IDEA at 34 CFR 300.130, et seq.

INTERVIEW. The school administration may require an interview for students entering grades 1st-5th. The school administration will conduct an interview with the student and family entering grades 6th-8th as part of the entry process.

REQUIREMENTS. It is important to complete all requirements before school starts. Failure to do so may delay the student from enrollment.
I agree to the terms and conditions as stated above, provided by the school. I also certify that all information in this form is true and accurate.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature

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