Application

Thank you for your interest in Heritage Christian Academy. Please find our online application below. Once you’ve successfully completed the application we will be in touch with you as soon as possible.

Name

First Name

Last Name

Preferred Name

Student Date of Birth

YYYY

Address

Line 1 - Home Address. Line 2 - Mailing address if different from Home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Gender

Grade You Are Applying For

Present School

Grades Attended

Address of Current School

Current School's Phone Number

(###)

###

####

Current School's Fax Number (for records request)

Former Schools (list in order beginning with most recent)

Has Applicant Ever Repeated a Grade?

If yes, explain

Yes

Explanation

Has Student Ever Been Suspended?

Only fill out if yes, and explain

Mother's Name

If Applicable

First Name

Last Name

Mother's Address

if Applicable

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Mother's Occupation and Employer

If Applicable

Lives with Student

Yes

Father's Name

If Applicable

First Name

Last Name

Father's Address

If Applicable

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Father's Occupation and Employer

If Applicable

Lives with Student

Yes

If parents are divorced, who has legal custody?

In the event of sole primary custody, the school requires copies of the custodial legal documents to be provided at the time of application.

Name of the local church you/your family attend:

Members?

Yes

Relationship

Phone

(###)

###

####

Name

First Name

Last Name

Relationship

Phone

(###)

###

####

Name

First Name

Last Name

Relationship

Phone

(###)

###

####

Allergies

Put none if not applicable

Daily Medications

Put none if not applicable

Special Conditions or Information

Siblings

List all names, ages, and school grades

Grandparents

List paternal (dad's) and maternal (mother's) grandparents. Include their names and addresses

Other Pertinent Information?

Other adults living in the home, etc.

Parent Questionaire

How did you hear about HCA?

Considering the goals for your student, why would you like your student to attend HCA?

Do you desire for your child to have a Christian education beyond this enrollment year?

(Y/N)

Has the student ever had modifications made in the classroom?

Has the student ever had psychological, behavioral, or academic testing to determine if he/she is gifted, has a learning disability, ADD, ADHD, behavioral, or emotional disorder?

If yes, please provide dates, test results, evaluations, IEP reports, etc. This information is not routinely part of the cumulative folders and must be requested by the parent/guardian form the resource teacher or school counselor.

Is the student presently taking any medication for medical or learning needs?

If yes, please provide kind of medication, dosage, and frequency. Please provide a copy of a medical evaluation, which must be within the last twelve months?

Does your child have any health problems?

Does your child have normal or corrected vision? Does your child have normal hearing?

Has the student ever been recommended for tutoring or remedial instruction?

If yes, please pro-vide dates and areas of remediation along with written evaluations

Has your child had disciplinary difficulty in his/her previous school?

We certify that the above answers are true and are made with no reservations:

By typing your name, you are submitting an electronic signature

Name

First Name

Last Name

Date

YYYY

Name

First Name

Last Name

Date

YYYY

Home and School Commitment

In making this application to Heritage Christian Academy I/We understand, accept and support the following:

A. We understand that HCA will teach and base its teachings on the understanding that the Bible is the inspired Word of God, that it is without error and is our guide for all facets of life.

B. We understand that our children will be taught that salvation and a relationship with God comes only through individual faith in the person and work of Jesus Christ. They will be instructed and encouraged to live for Christ in their thoughts, conversations and actions.

C. We understand that our child will be encouraged to participate regularly in Bible reading, study and prayer.

D. We understand the need for the home and school to work together toward a common goal of nurture and education.

E. We understand that HCA has full discretion in the discipline of my child within the bounds of the disci- pline policy as stated in the HCA handbook.

F. We authorize the use of emergency or professional medical treatment if our child is injured or becomes seriously ill during a time when we cannot be immediately reached.

Parent/Guardian initials

(F)

First Name

Last Name

G. We understand that HCA has full discretion in determining the proper grade level placement for our child, as determined by age and developmental screening or by diagnostic testing, and interviews.

H. We understand that HCA reserves the right to refuse any application at any time, if it is determined by the school administration that the applicant is not suited to the program offered in the school. HCA further reserves the right to dismiss any student whose academic performance or whose conduct does not meet the standards as set forth in the HCA handbook.

I. We agree to support the school, to the best of our ability, by making regular tuition payments, by faithful prayer of the kingdom work of the school, and in the offerings of practical help and resources to the school inasmuch as tuition fees do not cover the full cost of education.

J. We agree to support the spiritual, academic, and moral standards of HCA, as well as the dress code set forth in the policies found in the HCA Handbook.

K. We agree, should we take any legal action against HCA or any employee or agent thereof on our child’s be half, and the school or its agent not be found at fault, that we will pay any attorney fees, court fees, dam ages or other costs that HCA or its agents should incur to defend itself against such action.

My signature affirms: (A) I have read the above statements A through K and will accept and support them and (B) I understand that for my child’s application packet to be complete, it must include the following forms: (1) This Application for Enrollment (2) $75Application Fee

Parent or Guardian Signature

By typing your name you are submitting an electronic signature

First Name

Last Name

Parent or Guardian Signature

By typing your name you are submitting an electronic signature

First Name

Last Name

Heritage Christian Academy admits students of any race, color, nationality and ethnic origin to all 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 and ethnic origin in the administration of its education policies, admission policy, and other school-administered programs.

5th-8th Grade Questionaire and Commitment

To be completed by the student applying for grades 5-8 only

On a scale of 1-10(1 being the lowest) how excited are you about enrolling in HCA? Please explain.

What do you think are the most important differences between private Christian schools and public schools

Do you personally desire to come to HCA? Why or why not?

What questions, doubts, or fears do you have about coming to HCA?

Have you failed a subject? If so, which one? What is your hardest subject?

Do you plan to attend college?

What type of music do you enjoy?

Do you play a sport? If so, which one?

List the three most important things in your life and explain your choices.

Please use the space provided below to tell us something unique about yourself.

With my signature below, I certify that I have answered the above questions honestly and completely.

Student Signature

By typing your name you are submitting an electronic signature

First Name

Last Name

Date

YYYY