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APPLICATION PROCESS FOR K3, K4, & K5

We appreciate your interest in applying to Heritage Christian School. It is our desire to assist you in your endeavors toward academic excellence and educational advancement. We are a Christian school, and as

such, we are committed to Christian values and standards. We pray that we can be a blessing to your family. Please note that one packet must be filled out for each child.

STEP 1: APPLICATION Turn in the following to the Admissions Office: ______ Completed Student Application - Notary available in the school office.(signatures required) ______ Registration Fee ($275)*Early Registration Discounts my be available. ______ Parent's Pledge of Acceptance and Cooperation (signatures required) ______ Student's Pledge of Cooperation (signatures required) ______ Family Conference Questionnaire ______ Copy of previous year and most recent report cards (1st through 12th grade only) ______ Copy of most recent standardized test scores (1st through 12th grade only) ______ Copy of Birth Certificate.

**K3, K4, and K5 is a full day program.**

***K3 - Student must be 3 before September 1 to apply to the K3 Program.*** ***K4 - Student must be 4 before September 1 to apply to the K4 Program.*** ***K5 - Student must be 5 before September 1 to apply to the K5 Program.***

Heritage Christian School admits students of any race, color, and national or ethnic origin and guarantees all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not

discriminate on the basis of race, color, national or ethnic origin in administration of its educational policies, admission policies, or athletic and other administered programs.

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STEP 2: ADMISSIONS TESTING & NEW FAMILY CONFERENCE Please note that the Admissions Office must receive the paperwork from Step 1 before the testing and family conference is scheduled. ______ Assessment Testing - The Admissions Office administers entrance assessment to 1st through 12th grade applicants to assist in determining if Heritage Christian School can meet the academic needs of your child. We will do our best to offer a variety of testing dates that fit in to your schedule. The testing fee is $25 per student. ______ Student Reference Form(s)

For K3, K4, and Kindergarten - Parent Reference Form and Preschool Reference Form (if attended) For 1st through 6th grade - Current Teacher Reference Form For 7th through 12th grade - English Teacher and Math Teacher Reference Forms

______ New Family Conference - The purpose of the new family conference is to explain the mission and expectations of the school. K3, K4, K5 - New Family Conference in a general assembly is required. No Testing. 1st through 3rd - New Family Conference (individual family) and testing (individual) is required. 4th through 6th - New Family Conference (group) and testing (group) is required. 7th through 12th - New Family Conference is a mandatory meeting that takes place after all paperwork and testing has been completed and is for both parents and student(s). STEP 3: ADMISSIONS

The Administrative Staff will prayerfully consider your child's application. We will contact you within 2 business days of testing or family conference to confirm acceptance to Heritage Christian School.

Your student's name may be placed on a waiting list if there is no availability. We will notify you when a space

becomes available.

STEP 4: ENROLLMENT Upon acceptance to Heritage Christian School, the following information must be completed and received by the Admissions Office before your student is officially enrolled: _____ Supervisor's Interview and/or Testing Results for Enrollment _____ Immunization Record on HRS-680 form _____ Florida physical on HRS-3040 (the physical must be within 12 months of the first day of school)

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New Student Application Today's Date: __________________ Applying for: (Circle Grade): K3 K4 K5

Questionnaire How did you hear about HCS? ____________________________________________________

Has the student or any family member ever attended HCS before?________________________

If yes, who and what year(s) ______________________________________________________

Which factors most influenced you to apply to Heritage Christian School? (Please check all that apply) Christian Philosophy Concern about local schools Strength of extracurricular programs Academic reputation Desire to attend a private school Recommendations from current HCS families

Student Information Student's Full Name: Nickname :

Race: ______________ Date of Birth: Age: _____ SS#(Optional):

Place of Birth: Gender:

Student’s Cell Phone Number (if applicable):

Home Address: (Street)

(City) (State) (Zip Code)

Spiritual Information: Church Name:

Church Denomination:

Do you attend Church regularly? ________________ Is the student a Christian?

On what do you base your answer? Medical Information

Allergies: Has an Epi Pen been prescribed?

What type of reaction does the student experience from this allergy?

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Please list any chronic/severe illnesses, injuries, surgeries, etc.:

What medications does the student currently take? Whether prescribed or over the counter.

In case of emergency, please list your hospital preference:

Prescribed or over the counter medication that needs to be administered to your child during school must be accompanied by a Medication Authorization Form completed by the Doctor. All medication must be within expiration dates. Please be advised that cough drops are considered over the counter medication. The school is unable to provide any medication to our students. Educational Information Day Care/ Preschool attended prior to Heritage Christian School: _________________________________

Has the student ever been dismissed from a previous school? __________________________

If yes, please explain: ________________________________________________________

Has the student ever experienced academic, behavior, emotional, or attention difficulties that resulted in discussion or referral for evaluation by a school official, psychologist, or other professional? If yes, please give details: ______________________________________________________________________________________________

______________________________________________________________________________________________

Is there any tuition or other fees outstanding at the previous school? ___________________ Student File/ Account Pass Code Each family will be able to create a pass code in order to make emergency adjustments to their account. These changes will include alternate pick ups, medical information, as well as inquiring about your student's grades, conduct, and account balance. These adjustments are temporary until received it in writing. This will not be a requirement, however, it is strongly recommended in case of emergency situations. If you choose not to create a pass code, all changes must be made in person during regular school office hours. There should only be one pass code selected for all students in your family. Please give this information only to people who are allowed to make changes to your account. Family Pass Code: _____________________________________________________________ (We recommend you select a pass code that is private and easily remembered) Pass Code Hint: _______________________________________________________________

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Parent Information Student’s biological parents: Married Separated Divorced Other

If separated or divorced, who has legal responsibility for school decisions? __________________

Please submit notarized copies of all court documents signed by a judge regarding custody & educational decisions. (Required for enrollment)

With whom the child lives:

Other home for student:

Will you or have you applied for Step up for Students? Yes No (Accepted on a limited basis)

(Please Circle One) Father / Step-Father / Other Name:___________________________________

Home Number: ____________________________

Cell Number: _____________________________

Employer: ________________________________

Occupation:_______________________________

Work Number: ____________________________

Email: ___________________________________

(Please Circle One) Mother / Step-Mother / Other Name:___________________________________

Home Number: ____________________________ Cell Number: _____________________________

Employer: ________________________________

Occupation:_______________________________

Work Number: ____________________________

Email: ___________________________________

(Please Circle One) Father / Step-Father

Name:___________________________________

Home Number: ____________________________

Cell Number: _____________________________

Employer: ________________________________

Occupation:_______________________________

Work Number: ____________________________

Email: ___________________________________

(Please Circle One) Mother / Step-Mother

Name:___________________________________

Home Number: ____________________________

Cell Number: _____________________________

Employer: ________________________________

Occupation:_______________________________

Work Number: ____________________________

Email: ___________________________________

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Emergency/Alternate Pick-up (Other than parents) **Please note all listed people must be 18 years or older** The school requires a picture for each pick up/drop off person. Please, send those headshots to headshots@heritageeagles.org.

Person's Name: Phone Number: Male Female

Relation to Child:

Does student(s) live with person? Yes No

Should they receive school e-mails? Yes No

Are they a Primary Contact? Yes No

Are they an Emergency Contact? Yes No

Does this person have student(s) who currently attend HCS? Yes No

If yes, who is the student(s):

Person's Name: Phone Number: Male Female

Relation to Child:

Does student(s) live with person? Yes No

Should they receive school e-mails? Yes No

Are they a Primary Contact? Yes No

Are they an Emergency Contact? Yes No

Does this person have student(s) who currently attend HCS? Yes No

If yes, who is the student(s):

Person's Name: Phone Number: Male Female

Relation to Child:

Does student(s) live with person? Yes No

Should they receive school e-mails? Yes No

Are they a Primary Contact? Yes No

Are they an Emergency Contact? Yes No

Does this person have student(s) who currently attend HCS? Yes No

If yes, who is the student(s):

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Parent's Pledge of Acceptance and Cooperation

1. We, who have the responsibility to "train up a child in the way he should go," recognize that the standards for this training are set forth in God's Word, the Holy Bible. Knowing also that this training comes both by what children hear and what they see, we agree to support, both in our intent and by personal example, the Godly principles taught at Heritage Christian School. We realize it is our responsibility as parents to train our child spiritually and see the need as a family for regular attendance at a Bible preaching church. We also pledge to avoid obvious contradictions in our home to the Biblical principles stated on the Parent and Student Pledge. 2. We have made enough investigation to be satisfied with the curriculum, statement of faith, texts, equipment, methods, counseling, discipline, and motives of the school and do pledge to make Heritage Christian School our glad-hearted choice for our child. 3. We agree with the aims and ideals of the school and if we become dissatisfied with Heritage Christian School in any way we will resolve the matter with the person(s) involved, rather than spreading criticism and negativism. We pledge that if, for any reason, our child does not respond favorably to the school, we will not try to change the school, but will withdraw him/her quietly and without delay. We understand the school reserves the right to dismiss any student when either the parents/guardians or the student does not cooperate with the policies of the school as set forth in the Parent/Student Handbook and Pledge of Cooperation. 4. The teacher and administration are hereby given full discretion in the discipline of our child. Parents will normally be notified if anything as serious as suspension or expulsion seems appropriate. Behavior that requires staying after school will necessitate the parent providing transportation. Twenty-four hours notice will be given by the school in cases where a detention has been issued. 5. We understand that the school has the complete responsibility for placing our child in the proper grade level and class. 6. We hereby give our permission for our child to go on field trips scheduled by the school. Ample notice of field trips will be provided to the parents. 7. We understand that in the event of damage to school property by our child, we will make full restitution as indicated by an assessment by the administration. 8. I hereby grant permission to HCS to use my photograph(s), or the photograph(s) of my child, on the school’s website or in other official school printed publications without further consideration. I further acknowledge the right of HCS to edit, crop, or treat the photograph(s) at its discretion. I understand that should HCS choose to not use my photograph(s), or photograph(s) of my child, at this time, that it is not waiving its right to use the photograph(s) at some time in the future. I understand that should my child's photograph(s) be used on the HCS website that they will be available for download. I do hereby agree to indemnify, release and to hold HCS and its agents and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages that may arise from the dissemination of photograph(s) of my child, whether via the internet or in print, which I now have or which may arise in the future. 9. We understand that all students are accepted on a trial basis and by our signatures we are affirming our desire to cooperate fully with the administration of Heritage Christian School. 10. We understand that failure to cooperate with the faculty, staff, and administration or a violation of the Parent's Pledge, the Student's Pledge, or the Parent/Student Handbook including disclosing inaccurate information will be grounds for dismissal, up to and including immediate dismissal of student(s).

___________________________________________________________________ ____________________________ Father or Legal Guardian Signature Date ___________________________________________________________________ ____________________________ Mother or Legal Guardian Signature Date

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Parent Financial Agreement

I understand my financial responsibilities as follows:

The registration fee is due in full at registration. These fees are non-refundable once they have been paid, even if my child does not attend HCS.

Tuition may be paid annually by July 1st or in 10 monthly installments beginning July 1st. This first payment is non-refundable and non-transferable. If my child does not attend HCS or withdraws during the school year, I will be responsible for all fees and tuition accrued through the month in which I withdraw my child. There are no refunds other than payments made over and above the fees and tuition charged through the month of withdrawal.

Monthly payments are due to HCS by the first of each month. A late fee of $20 will be applied when accounts are not paid by the 10th of the month. If the 10th falls on a weekend, please pay the Friday before that weekend.

Books fees are due on Orientation Day. These fees are non-refundable. Report cards and other school records are issued only when accounts (including lunch

accounts) are paid in full. No students will be permitted to graduate until all tuition and any other fees are paid in full. A student and/or athlete my NOT participate in any sports or extra-curricular activities (including field trips and good conduct trips) if the school account is not current. A student will not be admitted to class if payments are one month past due. Student accounts must be paid in full before students return to classes following Christmas break and Spring break. Administration has the discretion to not permit a student to class due to an outstanding account balance.

If any check is returned for "Insufficient Funds" or other reasons, a fee of $20 is charged to the account. If two checks are returned by the bank, the account will be placed on a "cash only" basis.

I will be responsible for any lab fee, after-school care, uniforms, fines, field trips, yearbooks, lunches, activity fees, athletic fees, and other miscellaneous fees.

Payments may be made with cash, check, or debit card. (No credit cards accepted) I agree to pay all of our financial obligations to Heritage Christian School on or before

the due date. If I am ever unable to do so, I will notify the School Office immediately. I agree to abide by the terms and conditions herein outlined.

___________________________________________________________ ______________ Father or Legal Guardian Signature Date

___________________________________________________________ _____________ Mother or Legal Guardian Signature Date

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Student Pledge of Cooperation

Each student must agree to honor the standards of Heritage Christian School and understand that it is a privilege to attend. As a student of Heritage Christian School, therefore, I pledge to: 1. Love God Wholeheartedly - (Mark 12:30) 2. Serve Others Joyfully - (Philippians 2:3-4) 3. Obey Authority - (Hebrews 13:17) 4. Work Diligently - (Colossians 3:23) 5. Cooperate respectfully and obey willingly those in authority and comply with the policies and procedures outlined by the Parent/Student Handbook. - (Hebrews 13:17) 6. Strive for excellence as a student. - (Philippians 1:10; Proverbs 18:9) 7. Refrain from television, movies, music, and other media, which emphasize immorality, the drug culture, or rebellion against authority. - (Philippians 4:8) 8. Abstain from the use or possession of alcoholic drinks, tobacco or drugs. (Revelation 21:8; Corinthians 6:19, 20) 9. Abstain from immoral actions including profanity, sexual immorality, occultist practices, etc. (1 Thessalonians 4:3-7; Ephesians 5:3-5) 10. Avoid the appearance of evil. (1Thessalonians 5:22; Proverbs 22:1) 11. Wear modest apparel and comply with the dress code that has been set by HCS. (1 Timothy 2:9; Deuteronomy 22:5; Proverbs 7:10) 12. Endeavor to refrain from gossip, grumbling and complaining. (Philippians 2:13; Proverbs 26:20) 13. Comply with the discipline policies. 14. I understand that I can be held accountable by the school for any negative behavior both on and off campus at any time during the year. If the school determines the inappropriate behavior impacts my reputation, the school's reputation and or other HCS students or families in a negative manner, suspension or expulsion may result.

Attendance at Heritage Christian School is a great privilege. And, like all privileges, it comes with certain responsibilities. I personally agree to uphold each of the above statements and state that I want to attend

HCS and have not been made to do so against my will.

____________________________________________________ _________________________ ___________ 4th-12th Grade Student Signature Grade Entering Date

Understanding that God gives the parents responsibility for training their children, I/we agree to work with Heritage Christian School personnel to hold this student accountable for the above agreement of conduct. __________________________________________________________________ _________________________ Father or Legal Guardian Signature Date __________________________________________________________________ _________________________ Mother or Legal Guardian Signature Date

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We understand all of the application documents and have disclosed all information accurately. We agree to cooperate fully with faculty and staff of Heritage Christian School and to abide by the Parent’s Pledge, Financial Agreement, Student Pledge, and the Parent/Student Handbook. If we become dissatisfied with HCS, we will follow the procedures set up in the Parent’s Pledge. We also understand that administration has full discretion to make any changes to policies during the school year.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED DURING SCHOOL ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold Heritage Christian School and its agents and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities.

Completion of this application does not guarantee enrollment. The administration evaluates each applicant and decisions are made based on the

ability of Heritage Christian School to meet the needs of each child.

_________________________________________ _____________ Father or Legal Guardian Signature Date _______________________________________________ _______________ Mother or Legal Guardian Signature Date

Please note: Notary is available in the school office at no charge. Only one parent must be present for

notarization. STATE OF FLORIDA COUNTY OF __________________ The foregoing instrument was acknowledged before me this _______ day of _____________, 20___, by ____________________________________. _____________________________________________ Notary Signature _____________________________________________ Name of Notary (Notary Seal) Personally Known _________ or Produced Identification _________ Type of Identification Produced __________________________________________________________

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Parent Reference Form

Name of Student _______________________________________ Date _____________ (Please Print) First Name Last Name The above student is a candidate for admission to Heritage Christian School. We would appreciate your

observations about the areas listed below. (Please circle the Developmentally Average Below Average Not Observed/ appropriate number) Above Average No Interest Shown 1. Expresses interest in 4 3 2 1 coming to school 2. Finds constructive 4 3 2 1 things to do on his/her own 3. Stays on task without 4 3 2 1 direction for 10 - 15 minutes 4. Responds well to correction 4 3 2 1 5. Adjusts to new situations 4 3 2 1 without undue fear 6. Expresses him/herself in 4 3 2 1 complete sentences 7. Listens without interrupting 4 3 2 1 8. Has trouble controlling 4 3 2 1 his/her temper 9. Uses crayons beyond 4 3 2 1 scribbling 10. Chooses to look at books 4 3 2 1 11. Remembers a song or 4 3 2 1 TV commercial 12. Listens to a complete story 4 3 2 1 13. Cries easily or 4 3 2 1 uncontrollably 14. Has urinary/bowel control 4 3 2 1 15. Separates from parent well 4 3 2 1

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Parent Reference Form

Continued

(Please circle the Developmentally Average Below Average Not Observed/ appropriate number) Above Average No Interest Shown 16 Displays self control 4 3 2 1 17.Talks with other children 4 3 2 1 18. Pronounces words clearly 4 3 2 1 19. Speaks in sentences 4 3 2 1 20. Recognizes own name 4 3 2 1 21. Uses "baby talk" 4 3 2 1

22. Shows interest in books 4 3 2 1 23. Listens to a complete story 4 3 2 1 24. Makes friends easily 4 3 2 1 25. Dresses him/herself 4 3 2 1 25. Uses the bathroom alone 4 3 2 1 26. Washes hands and face 4 3 2 1 27. Prefers playing with others 4 3 2 1 28. Prefers playing alone 4 3 2 1 Please place an "X" by those activities your child can perform independently: (Your child is not expected to have all items mastered before entering kindergarten)

_____Button _____Uses scissors _____Pick up toys _____Zip jacket alone _____Jump with feet together _____Catch a ball _____Buckle a belt alone _____Hop on one foot _____Ride a bike

Additional Information: Write four adjectives that describe your child. For example - fun loving, laid back, organized, or likes to be in charge. ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________

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Parent Reference Form

Continued My child needs (Check one): _____A moderate amount of structure _____Lots of structure To what degree do you feel your child is ready to successfully start K-4 or kindergarten? _____Very Ready _____Ready _____Not Ready _____Not Certain What evidence did you use to determine your child's readiness? ____________________________________________________________________________________________________________ ________________________________________________________________ Has your child attended a Pre-School program? _____Yes _____No If yes, please complete the following information: School Name __________________________________________________________________________ ______________________________________________________________________________________ Street Address City State Zip Any additional information that you wish for us to know regarding your child: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________

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FAMILY CONFERENCE QUESTIONNAIRE

Parents' Names ____________________________________________Date_______________ Students' Names and Grades: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ What led to your decision to apply to Heritage Christian School? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Have you heard anything about Heritage Christian School that concerns you? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ What specific concerns do you have about your child's present school? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ How do you feel Heritage Christian School can meet the needs of your child? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ If there was an issue with your child and his teacher or staff member, how would you try to resolve the issue? _____________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ What are your expectations of the school-home and the parent-teacher partner relationship? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Please list the three greatest influences that shape your child's values. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Are you willing to read communications from the school, respect deadlines for returning forms, etc.? _________________________________________________________________________ Understanding that tuition alone doesn't cover the cost of education at Heritage Christian School, will you support fund raising efforts of the school? _____________________________________