Cedar Lake Christian Academy Application for Enrollment 2018-2019


EACH STUDENT MUST BE REGISTERED WITH A SEPARATE FORM.


Application Date *
Application Date
If your child is entering Kindergarten, he or she will be considered a new student.
What grade will your student be enrolling into?
Student's Birth Date *
Student's Birth Date
Please include street, city, state, zip code and county.
FATHER/GUARDIAN'S INFORMATION
Father's/Guardian's Name:
Father's/Guardian's Name:
Please include street, city, state, zip code and county.
Father's Cell Phone Number
Father's Cell Phone Number
Father's Employer Address
Father's Employer Address
Please list the physical address of current employer.
Father's Employer Phone:
Father's Employer Phone:
Father Lives with Student?
MOTHER/GUARDIAN'S INFORMATION
Mother's/Guardian's Name
Mother's/Guardian's Name
Please include street, city, state, zip code and county.
Mother's Cell Phone:
Mother's Cell Phone:
Mother's Employer Phone:
Mother's Employer Phone:
Mother Lives with Student? *
COMPLETE THIS REQUIRED SECTION:
If both parents listed above have legal custody, just type in "Both Parents Listed."
If both parents listed above are responsible for payment of fees, just type in "Both Parents Listed."
If none, type in "None."
MEDICAL & ACADEMIC INFORMATION:
If student is entering kindergarten, type in "Enrolling in Kindergarten."
Please include street, city, state, zip code and county.
If no, type in "No."
If no, type in "No."
If no, type in "No."
If no, type in "No."
If no, type in "No."
If no, type in "No."
If no, type in "No."
EMERGENCY PROCEDURE INFORMATION:
Permission to issue Tylenol: *
Doctor Office Phone: *
Doctor Office Phone:
SIGNATURE:
SIGNATURE:
Photo and Written Release (REQUIRED)
Does Cedar Lake Christian Academy or Preschool have your permission to use any image/video of your child made with others at school, field trips, sporting events, etc, or any written material that he/she may write about CLCA for promotional purposes (local media, newspaper, internet)? *
NEW STUDENT ONLY: Door Access Cards/Key Fobs Choices: Each family will be provided their choice of one of the following: Please mark your choice.
Additional Cards will be $5.00 each. Additional Fobs will be $10.00 each. Replacement Cards/Fobs will be $15.00 each.
Academy Before/Aftercare & Extra-Curricular Enrollment:
I wish to enroll my child in: (check all that apply) *
Before & Aftercare Fees are $3.50 per hour.
Fees Disclosure & Agreement
A $30 fee will be charged on all returned checks. Cash payments will be required if two (2) returned checks are received on any school account. • Registration and General Fees are non-refundable and non-transferable. I agree to pay all fees as described above. • Fees listed herein are not considered comprehensive. Throughout the school year additional fees may be required for such items as field trips, fundraisers, supplies, extra-curricular activities, lunches, before/aftercare, late charges, uniforms, etc. • Before/Aftercare Fees are incurred hourly and are due on a monthly basis. • Full-Day Academy students not picked-up by 3:15 PM will be placed in Aftercare and charged the appropriate fee. • Before/Aftercare hours are from 6:30 AM to 6:00 PM. Any student not picked-up by 6:00 PM will be charged a $15 Late Pick-up Fee, with an additional $15 added for every 15-minute period after 6:00 PM. If late pick-ups occur more than four (4) times during the year, services may be discontinued. • Monthly payments are due on the 5th of each month through Smart Tuition. I hereby understand and agree to the Fees and Policies stated herein. I agree to comply with this payment schedule and understand the consequences if I fail to adhere to the aforementioned policies. *
Fees Disclosure & Agreement: Registration Fees: Yearly New Academy $200.00 ($375.00 Family maximum) Returning Academy $175.00 ($325.00 Family maximum) General Fees: Textbooks & Materials $450.00 (includes classroom fee) Graduation Fee $35.00 for K5, $100.00 for HS Senior Computer Fee (6th-12th) $50.00 Tuition Fees: Yearly Monthly Academy (K5 – 5th) $4800.00. Academy (6th-12th) $5000.00. Before and after care fees: $3.50 per hour • 5% OFF Tuition for One-Time Payment • 20% OFF Tuition for children of full time Pastors or Chaplains • 10% OFF Tuition for families with 2 students enrolled for each child • 15% OFF Tuition for families with 3 or more students enrolled for each child • Military Discount: 10% for first child, additional 5% for an additional child (up to 15% per family) ** Only the single highest discount will be applied to the student’s account. The 5% one-time payment discount applies with any other discount. Payments are made online with Smart Tuition. *