STUDENT ENROLLMENT APPLICATIONSTUDENT INFORMATIONName__________________________________________ Age _____ Sex _____ Birthdate ___________

Address _____________________________________________________________________________

City/State/Zip ________________________________________________________________________

Home Phone _______________________ Email: _____________________________________________

FAMILY INFORMATIONLegal Rights (Check as Apply): Parents _____ Guardian ____ Foster Care ____ Other _______________

Father’s Name _______________________________________ (Full Custody ____ Shared Custody ____)

Employment _________________________________________ Work Phone: _____________________

Cell Phone: __________________________________________

Mother’s Name ______________________________________ (Full Custody ____ Shared Custody ____)

Employment _________________________________________ Work Phone: _____________________

Cell Phone: __________________________________________

Emergency Contact Person: Name ________________________________________________________

Address (City, State, Zip): ________________________________________________________________

RELIGIOUS INFORMATIONChurch Membership Affiliation: __________________________________________________________

Address (City State, Zip): ________________________________________________________________

Pastor’s Name: __________________________________ Church Phone: _________________________

Has Father made a profession of faith in Christ (circle one): Yes or No

Has Mother made a profession of faith in Christ (circle one): Yes or No

Has Student ever made a profession of faith in Christ (circle one): Yes or No

MEDICAL INFORMATIONFamily Physician: ____________________________________ Phone: ____________________________

Does Student have any physical disabilities or allergies: ________________________________________

_____________________________________________________________________________________

Attach Immunization record; Student’s immunizations must be up-to-date prior to student being allowed to attend classes at Bethel Christian Academy. _______________(Initial Here)

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GENERAL INFORMATIONApplication must be filled out completely before it can be processed. Registration fee must be paid at time application is submitted. Registration is non-refundable; if student application is denied, registration fee will be returned with denial letter. An interview with the parents and student are required for all new applicants before final acceptance.

By signing below, the signees agree to the terms as stated below:

Signees pledge to pay financial obligations to the school on the date due and understand that it may be necessary to disenroll student if payment arrangement are not strictly adhered to; which as a result lead to accounts becoming past due.

Signees understand that accounts are contracted based on a “full year amount.” Pro-rating contract rates are at the discretion of the Bethel Christian Academy and are not automatically awarded. By signing this application, signees agree to be responsible for the “full year amount” at the time of signing this application. Scholarships are available, however they are based on criteria set by those awarding them and are not guaranteed to any student. Signees are responsible for all fees associated with student’s account.

Signees give permission for student to take part in all school activities, including sports and school-sponsored field trips away from the school premises, and absolve the school from liability to signees or student because of injury which may occur at school or during school activities.

Signees agree to uphold and support the high academic standards of the Bethel Christian Academy, by providing a place at home for students to study and complete homework and all assignments of which the student is responsible for completing on their own.

Signees acknowledge appreciation of the standards of Bethel Christian Academy and will not tolerate profanity, obscenity in word or action, dishonor to the God and the Word of God, or disrespect to the personnel of Bethel Christian Academy.

Signees agree to support all regulations of Bethel Christian Academy in the student’s behalf and authorize Bethel Christian Academy to employ discipline as it deems wise and expedient for the training of the student.

Signees acknowledge that Bethel Christian Academy reserves the right to dismiss any student who fails to comply with the established regulations and discipline or whose financial obligation remains unpaid. Understanding that if necessary, Bethel Christian Academy will exact every legal means available to recover all payments due; student records will not be released until account balances are paid in full.

Signees acknowledge having read the Student Handbook, agree to complete Parent Orientation PACEs, and understand the terms stated on this application and agree thereto.

_____________________________________ ______________________________________Signature of Father Date Signature of Mother Date

Received by: _______________________________________________

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