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Student Enrollment Application

The Furnace

Crossroads Christian Education

Student Enrollment Application

Applicant Information

Student’s Full Name:

Date of Birth:

SSN:

Home Phone:

Home Address:

City:

State:

ZIP Code:

Gender: (Please circle)    Male    or    Female

Race:

Grade Level:

Parent (Guardian) Information

Father’s Full Name:

Father’s Cell Phone:

Father’s Work Phone:

Email:

Father’s Driver’s License #:                                                                 

Mother’s Full Name:

Mother’s Cell Phone:

Mother’s Work Phone:

Email:

Mother’s Driver’s License #:                                                                 

       
 

 

Emergency Contacts with permission to pick up student

Name:

Relation:

Address:

Phone:

Name:

Relation:

Address:

Phone:

Name:

Relation:

Address:

Phone:

Name:

Relation:

Address:

Phone:

     
 

 

Student Medical Information

Physician:

Phone:

Preferred Hospital:

Healthcare Provider:

Insurance Number:

Provider Phone:

Does the student suffer from any medical condition, chronic illnesses, or special needs? (Please circle)        Yes   or   No 

If yes, please describe:

List any allergies the student may have:

 

List any medication the student will be taking throughout the year:

 

Does the student have any condition that may require frequent restroom breaks? (Please circle)        Yes   or   No

If yes, please state the condition:

       
 

If your child is seriously injured or sick and school personnel are unable to reach parents/guardians, the final decision for action taken will be the judgement of school authorities.  The parents/guardians give their authority to school personnel to take such action in treating their son/daughter.  This includes transporting an injured or sick child to the emergency room of a local hospital if so determined.

Tuition and Fees Terms

A $100 Non-Refundable Registration Fee is Due at that time of Application for Enrollment.

A $100 Technology Fee is Due the First Month of Enrollment.

Tuition Totals: KG-6th Grade Annual Tuition is $4,500.  The monthly tuition is $450 based on a ten-month payment plan.  7th-12th Grade Annual Tuition is $6,000.  The monthly tuition is $600 based on a ten-month payment plan.  The monthly tuition payment is due on the first Monday of every month for the entire school year.  A $25 Late Fee will be assessed to the parent on the 10th day of the month if the payment is not paid in full.  An additional $25 Late Fee will be assessed to the parent on the 20th day of the month if the payment is not paid in full.  Tuition and Late Fees not paid by the last day of the month may result in Exclusion of the Student participating in classes.  Academic records will be withheld until all tuitions and fees are paid in full.

I have read and agree with the Tuition and Fees Terms.            __________  Initials     __________  Initials

 

 

Permission to use student image

In the event that a staff member takes a picture of my student, the group, or the class, I give permission for my child’s image to be used.  Uses of the images may include but are not limited to pamphlets, brochures, flyers, bulletin boards, school website, school videos, social media, DVDs, or other publications that support The Furnace. 

I have read and agree to give Permission for My Student’s Image to be used. ________  Initials    ________  Initials

 

 

After care

Students enrolled with The Furnace are automatically eligible to utilize After Care when needed.  Parents must follow the terms, fees, and procedures outlined for After Care in the Student Handbook. 

I have read and agree to After Care as outlined in the Student Handbook.   ________  Initials      ________  Initials

 

 

Parent Statement of Faith

Father’s Church Membership:

Are you in good standing with the church?   Yes   or    No

Pastor’s Name:

Pastor’s Phone:

Please write a summary of your testimony:

Mother’s Church Membership:

Are you in good standing with the church?   Yes   or    No

Pastor’s Name:

Pastor’s Phone:

Please write a summary of your testimony:

Student Statement of Faith

Student’s Church Membership:

Are you in good standing with the church?   Yes   or    No

Pastor’s Name:

Pastor’s Phone:

Have you accepted Jesus Christ as your personal Lord and Savior?

            Yes     or      No

If yes, please write a summary of your testimony.

If no, please identify and describe why. (ex. Age, understanding, newness to Biblical truth, etc)

       
 

 

 

As the Parent/Guardian of the student wishing to be enrolled, I have read and understand the Spiritual, Academic, Parental, and Financial responsibilities that are associated with enrollment into The Furnace, and would like to move forward in the Registration process.

I understand that this contract and enrollment will not be considered until the Registration Fee is paid in full.

 

 

______________________________________________                        ____________________

 

Signature of Parent/Guardian Financially Responsible                                                                             

 

Signature of Parent/Guardian                                                                                                                             

Date Registration Fee Paid:                                                         Signature of School Administrator

 

                                                                                    

                                                                                    

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