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Risen Christ Christian Academy

Application for Enrollment

Application for Enrollment
Child's Name*
First Last
Birth Date*
Date Format: MM slash DD slash YYYY
Gender*
Social Security Number*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Parent/Guardian #1 Name*
First Last
Relationship with child*
Phone*
Address*
Same as child's address

Street Address City State / Province / Region ZIP / Postal Code
Occupation/Title*
Company*
Parent Email*
Church Membership*
Parent/Guardian #2 Name
First Last
Relationship with child
Date of Birth
Date Format: MM slash DD slash YYYY
Phone
Address
Same as child's address

Street Address City State / Province / Region ZIP / Postal Code
Occupation/Title
Company
Parent Email
Church Membership
With whom does the student live?
Allow photos in all school publications?*
- Yes
- No
Allow photos in all public publications?*
- Yes
- No
Sibling Information
Name Gender Birthday
How did you hear about Risen Christ Christian Academy?*
Who can we thank for referring you to our school?
Persons permitted to pickup student
Other than parents/guardians listed above. Please include name and their relation.
Name Relationship to child Phone
Childcare & Education Information
What grade is your child registering for?*
Has your child been in childcare before?
- Yes
- No
School Name
How long?
School Address
Street Address City State / Province / Region ZIP / Postal Code
School Phone
Principal
Reason for leaving
Has your child ever been involved in a remedial class?*
- Yes
- No
Subject*
Has your child ever been involved with a tutor?*
- Yes
- No
Subject*
Has your child ever been involved in an advanced class?*
- Yes
- No
Subject*
Has your child ever experienced any discipline/conduct problems in relation to school suspensions, school expulsions, grade retention, promotions, etc.?*
- Yes
- No
If yes, please explain*
Does your child have any special visual, hearing, motor, or other type physiological or psychological difficulty of which we should be aware to most effectively educate your child?*
- Yes
- No
If yes, please explain*
Does your child have any specific allergies?*
- Yes
- No
If yes, please list*
Is your child on any special medication?*
- Yes
- No
If yes, please list*
Is there any specific difficulty your child is experiencing at school?*
- Yes
- No
If yes, please explain*
Financial Agreement
Tuition Amount*
- $5940 (Kindergarten)
- $5940 (Grades 1 - 4)
- $5940 (Grades 5 - 8)
- $5940 (Grades 9 - 12)
NOTE: In addition to the above tuition, a non-refundable Registration/Technology Fee of $200 for each student is due at the time of enrollment.
Registration/Technology Fee
Registration/Technology Fee
Price: $200.00
Processing fee
Price: $7.00
Payment Plan Preferred*
- One payment in full at enrollment
- Two (2) equal payments, one due at enrollment and by January 10
- Ten (10) equal payments by the 5th of each month Aug - May
- Twelve (12) equal payments by the 5th of each month July - June
Payment Method Preferred*
- Personal check
- Debit (ACH) Card automatic payment
- Credit Card automatic payment
NOTE: For security purposes, if your payment preference is a Debit (ACH) or Credit card, please complete the Debit/Credit Payment Application form on the Registration page and bring or mail it to the school office. Please note that your application is not complete until the signed form is received.
International student?*
- Yes
- No
For International Students
Local Address*
Street Address City State / Province / Region ZIP / Postal Code
Country of Birth*
Passport Number*
Guardian Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Guardian Phone*
Check the box beside the statement:*
- The above information is true and factual to the best of my/our knowledge. I/we understand that misrepresentation of the student’s past record may be considered grounds for dismissal. I/we give permission for administrative officials of Risen Christ Christian Academy to contact previous schools to verify the above and to discuss the student’s academic, disciplinary and attendance record. I/we hereby obligate myself/ourselves to meet the charges for tuition and fees when due. In consideration for the enrollment of my/our son/daughter to Risen Christ Christian Academy, I/we agree to pay the published tuition for his/her enrollment as a condition precedent to the school’s release of my /our son’s/daughter’s grades each semester. I/we further understand that my/our failure to meet the tuition obligation may mean termination of my/our child’s enrollment at Risen Christ Christian Academy. By signing this application I (we) agree to the financial obligations and understand that all families are required to participate in some of the selected family fund raising activities. By submitting this application I agree to the stated financial policies.
Parent Signature*
Date*
Date Format: MM slash DD slash YYYY
Payment Section
Total
$0.00
Credit Card

Card Details

Cardholder Name
Option
Product Name
Price: $0.00 Quantity:
Total
$0.00
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