New Student Application | Christ Fellowship Academy

Thank you for choosing Christ Fellowship Academy, a ministry of Christ Fellowship, for your child(ren).
We are grateful for the opportunity to partner with you in educating your child.

Please use this for the current 2019-2020 school year.

Your New Student Application was successfully submitted. Please review your Admission Checklists per grade level: Preschool (K2-K4) Checklist and/or Kindergarten & Elementary ( K5-6th grade) Checklist

2019-2020 New Student Application

Student

Family

Medical

Background

Policies

Signature

Student First Name*

Student Last Name*

Birth Date*

Entering Grade Level*

School Year*

Gender*

Male

Female

T-Shirt Size*

Race*

Ethnicity*

Home Address*

City*

State*

Zip Code*

Country*

Mailing Address ( If Different From Above)

Mother / Guardian

First Name*

Last Name*

Cell Phone Number*

Other Contact Number*

Email*

Address*

City*

State*

Zip Code*

Country*

Occupation / Title*

Company Name*

Marital Status*

Father / Guardian

First Name*

Last Name*

Cell Phone Number*

Other Contact Number*

Email*

Address*

City*

State*

Zip Code*

Country*

Occupation / Title*

Company Name*

Marital Status*

Student Lives With*

Name of Church Family Attends ( N/A if not applicable)*

Names & Ages of Siblings

When did you tour Christ Fellowship Academy?*

Have you been awarded or will be awarded a Florida School Choice Scholarship?*

If so, which one? (Type None if not applicable)

( Please note: CF Academy only accepts the Step-up for Students or the Gardiner Scholarship)

Emergency Contacts

Parents will be contacted in the case of an emergency. It is the responsibility of the parents and/or guardians to keep the emergency contact information current and accurate. Changes to emergency contacts are done through the Headmaster Online or in writing at the CFA Office.

Name*

Phone Number*

Relationship to Student*

Name

Phone Number

Relationship to Student

Name

Phone Number

Relationship to Student

Pickup List

Changes to the pickup list are done through the Headmaster Online or in writing at the CFA Office.

Name*

Phone Number*

Relationship to Student*

Name

Phone Number

Relationship to Student

Name

Phone Number

Relationship to Student

Physician's Name

Physician's Phone Number*

Insurance Carrier*

Insurance Carrier Phone Number*

Policy Number*

List All Known Allergies (Type None if no allergies exist)**

Has your child's Pediatrician or Allergist prescribed an EPI-PEN for your child?*

Yes

If your child had been prescribed an EPI-PEN, CF Academy requires two EPI-PENS for each student (one with the teacher and one in the office). CF Academy Allergy Action Plan and Authorization for Medication forms must be completed and signed by your child's Pediatrician/Allergist as well as the parent/guardian.

List All Conditions (Asthma, Epilepsy, Etc.) ( Type None if no conditions exist)**

Check All That Apply*

Measles

Mumps

Chicken Pox

Whooping Cough

Flu

Meningitis

Convulsions

None

Any Evidence Of?*

Hearing Loss

Vision Difficulties

Speech Delays

None

Hospitalizations (Type None if not applicable)**

Operations (Type None if not applicable)**

List Any Other Conditions, Illnesses, or Concerns Not Covered Above (Type None if not applicable)**

Social and Physical Growth

Has your child received and/or been recommended for counseling?*

Has your child received and/or been recommended for psychological/educational testing?*

Has your child been diagnosed with any type of learning disability, Autism, ADHD, and/or other medical conditions?*

What problem does your child have that concerns you the most?*

What do you feel are his/her special abilities or capabilities?*

Has your child been disciplined in school? If yes, what disciplinary measures were used?*

Understanding Your Child

Why do you want your child to attend CF Academy?*

In what ways do you expect our program to help your child?*

School Background

Grade Last Attended?*

Entering Grade?*

List chronologically all schools attended, including preschool and kindergarten:

Date(s)*

Grade(s) Attended*

Name of School*

Date(s)

Grade(s) Attended

Name of School

Date(s)

Grade(s) Attended

Date(s)

Referral Information

How did you hear about CF Academy?*

Did someone recommend CF Academy to you? If yes, who?*

Placement Policy, Cooperation, and Technology

Read the Placement Policy Agreement

Read the Statement of Cooperation

Read the Acceptable Use of Technology

Read the Parent/Student Handbook

Placement Policy*

I agree and have read the Placement Policy

Statement of Cooperation*

I agree and have read the Statement of Cooperation

Acceptable Use of Technology*

I agree and have read the Acceptable Use of Technology

Parent/Student Handbook*

I agree and have read the Parent/Student Handbook

Terms and Conditions

Student Name*

Name of Person Responsible for Payment on Account*

Contact Email Address (Confirmation Email Will Be Sent Here)*

Address of Person Responsible for Payment*

Phone Number of Person Responsible for Payment*

I have read the Christ Fellowship Academy Statement of Faith, Philosophy of Education and Aspirations. I agree to have my child taught by these convictions. I have read the Parent-Student Handbook, Discipline Policies, Placement Policy, Dress Code Policies and Financial Policy. I agree with these policies, and expect my child to abide by them. If necessary, I agree that my child should and will be disciplined by CF Academy for non-conformance. I permit CF Academy Administration to discipline and counsel my child as necessary. I grant my permission for my child to attend and participate in school activities at CF Academy and to local points of interest or off-campus sites. I will cooperate with CF Academy to my fullest capability and support its Mission, Ministry, Goals, Programs, Administration, Faculty and Staff. I also understand that my child will not be placed in a classroom until all forms have been completed and submitted to the Admissions Department and all financial obligations are met.

Terms and Conditions*

I Agree and Have Read the Terms and Conditions

Required Signature

Certification of Application*

I certify that all information provided in this application is true and honest. I understand a student may be subject to admission denial if the information provided is false.

Student's Name*

Date*

Parent / Guardian Name*

Date*

Student Fees

Upon receiving an offer of admission, please submit the following within two weeks of acceptance: Registration and School Improvement Fees. The registration process is incomplete until all fees have been paid. The initial entrance fee payments, registration fee and school improvement fee, will need to be paid via cash or check only in our academy office. Once enrolled, additional payments including tuition may be paid online with your HeadMaster school account. Please access the appropriate tuition and fees schedule for more information:

2019/20 Tuition & Fees Schedule

Tuition and Fees Details*

I have read the tuition and fees details and agree to pay necessary fees and admissions costs.