Text Box: Grade to Enter________            (K4 – 6th)

 OFFICE USE ONLY:

Date Rec'd ____/____/____
Registration fee: _________
Book Fees: _____________
Tuition: ________________

Text Box: For K4 (select one) AM       ______ PM       ______  

 Text Box: For  K5 (select one) AM       ______ PM       ______ ALL DAY _____  

                                                                         2008-2009  Enrollment Application

 

GRIFFIN CHRISTIAN ACADEMY

2000 W. McIntosh Rd.

Griffin, GA  30223

 

Student’s Name: ___________________________________________________________/_______________

    (last)                                                  (first)                             (middle)                              (name to be called)

 

Home Phone Number:_____________________ Date of  Birth: ____/____/______  Gender: ________

                                                                                                                  month    date     year                           M or F

 

Address: _________________________________________________________________________________

                        street                                                                 city                    state                  zip                   

 

Is this a new address? _______   County of Residence_______________ Race______________

 

Mailing Address (if different from above): _________________________________________________________________

 

E-MAIL ADDRESS (to be able to access online student information) _________________­­________________________

 

Student Lives With:    (Please check any that apply)

__Father                      __Stepfather                  __Parents are divorced         __Other  (relationship)

__Mother                   __Stepmother               __Parents are separated                  __________________________                                                                                                        

Father’s Name_______________________________

Mother’s Name______________________________

 

 

Home Address ______________________________

Home Address ______________________________

(if different from student)

(if different from student)

Telephone __________________________________

Telephone __________________________________

 

 

Cell or beeper _______________________________

Cell or beeper _______________________________

 

 

Father’s Employer ____________________________

Mother’s Employer ___________________________

 

 

Telephone __________________________________

Telephone __________________________________

 

PERSONS OTHER THAN PARENTS TO NOTIFY IN CASE OF EMERGENCY

 

Name _____________________________________Phone ____________________ Relationship _________________

 

Name _____________________________________Phone ____________________ Relationship _________________

 

Name _____________________________________Phone ____________________ Relationship _________________

 

Brother(s)/Sister(s) and Age(s): ________________________________________________________________________

 

What Church Do You Attend?  _______________________________________________________________________

 

Child’s Physician: ____________________________________________ Phone: _______________________________

 

List Any Medications Child Regularly Takes: ___________________________________________________________

Has this child ever failed a grade?     Yes ______ No ______ If Yes, What Grade(s)?_____________

Has this child ever been suspended from a school?  Yes _______ No _______

Has this child ever been expelled from a school?      Yes _______ No _______

(If Yes to either of the above, attach a written explanation of details.)

 

Please state briefly why you wish to enroll your child in GCA:  ________________________________

 

_______________________________________________________________________________________

 

If your child did not attend GCA last year, list the name and address of school attended:

______________________________________________________________________________________

 

Does the student have any special learning needs or diagnosed learning disabilities?   No   Yes   If so, has any

 

psycho-educational testing been done?    No   Yes   Please explain __________________________________

 

_____________________________________________________________________________________________

COVENANT

Do you believe in building a strong Christian Character program?  ______ Do you fully understand that the school reserves the right to use administrative correction when necessary? ______

 

“ I hereby pledge to pay my financial obligations to the school on the date due and understand that it will be necessary to withdraw my child if financial policies are not followed.”

 

“ I give permission for my child to take part in all school activities, including sports and school-sponsored trips away from the school premises and absolve the school and/or its employees from liability to me or my child because of any injury to my child at school or away from school during any school activity.”

 

“ I agree to uphold and support the high academic standards of the school by providing a place at home for my child to study and by giving my child encouragement in the completion of homework and other assignments.”

 

“ I appreciate the standards of the school and do not tolerate profanity, obscenity in word or action, dishonor to the Trinity and Word of God, disrespect to the personnel of the school.  I hereby agree to support all policies and regulations of the school in the applicant’s behalf and authorize the school to employ such discipline as it deems wise and expedient for the training of my child.  I have read the student handbook and agree to abide by it.” 

 

“ I understand the school reserves the right to dismiss any child who fails to comply with the established regulations

and disciplines, whose financial obligations remain unpaid, or any student whom the school administration deems necessary.”

 

“ I do hereby authorize medical care and will take responsibility for all expenses incurred in the same.”

WAIVER OF LIABILITY

The undersigned, who is (are) the parent(s)/guardian(s) of ________________________________________________________,

recognize that it is necessary on occasion to discipline students in the course of school training.  The undersigned would not want his/her child(ren) to attend Griffin Christian Academy if discipline was not enforced. Accordingly, for good and valuable consideration, the receipt and sufficiency whereof is acknowledged by the undersigned, the undersigned agree(s) to hold First Assembly of God of Griffin, Georgia, Inc., its Official Board, Trustees, Griffin Christian Academy and all teachers, employees, agents, members of the school and/or church harmless should the above referenced child be disciplined in the course of his/her training.

 

My signature certifies that the information given in this application is correct and true.  It further certifies that I agree to and abide by the covenant and the waiver.

Statement of Policy

Griffin Christian Academy admits students without regard to race, color, creed, sex, national or ethnic origins.  The school does not discriminate in the administration of its educational policies, admissions policies, athletics or other school administered programs. 

 

Father’s Signature: _____________________________________________ Date: _________________________

 

Mother’s Signature: _____________________________________________ Date: _______________________