Child's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Father's Name *

First Name

Last Name

Father's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father's Home Phone *

(###)

###

####

Father's Work Phone *

(###)

###

####

Father's Cell Phone *

(###)

###

####

Father's Occupation Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Name *

First Name

Last Name

Mother's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Home Phone *

(###)

###

####

Mother's Work Phone *

(###)

###

####

Mother's Cell Phone *

(###)

###

####

Mother's Occupation Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Emergency Contact #2

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Emergency Contact #3

First Name

Last Name

Emergency Contact Number

(###)

###

####

Grades Attended *

Check All that Apply

None

K

1st

2nd

3rd

4th

5th

6th

7th

8th

9th

10th

11th

12th

Grades Attended

Check All that Apply

None

K

1st

2nd

3rd

4th

5th

6th

7th

8th

9th

10th

11th

12th

Grades Attended

None

K

1st

2nd

3rd

4th

5th

6th

7th

8th

9th

10th

11th

12th

Has your child ever been enrolled or recommended for any of the following special classes? *

Gifted

Learning Disability

Speech Therapy

Physically Challenged

None of the above

Other

We understand and consent the Academy's philosophy of teaching the Bible, and sharing Jesus with all students as a part of everyday school activities. *

Yes

We agree to support the standards of the school in every area of philosophy, policies and rules to include: spiritual, academic, behavioral, dress, moral, and disciplinary issues. *

Yes

We agree to attend at least two services at Calvary Chapel of San Antonio per month. Eligible services include Sunday morning, Wednesday evening and Friday evening *

Yes

We agree to help assume responsibility for our child's education through supervising homework and reviewing/signing daily folders. *

Yes

We agree to allow Academy personnel to administer corporal punishment (spanking) to our child when necessary. Parents will be contacted when this occurs. *

Yes

We understand that if our child continues a pattern of willful disobedience he/she will be disenrolled from Calvary Chapel Christian Academy. *

Yes

In the event our child becomes ill or injured while under school supervision, we give consent for the school authorities to take the following steps: *

1) Contact a Parent of the child and follow his/her instructions. 2) Contact the child's physician and follow his/her instructions in the event neither parent can be reached. 3) Use their own discretion to contact a properly licensed healthcare provider and follow his/her instructions if the child's physician cannot be reached.

Yes

If, in the opinion of a properly licensed healthcare provider, our child needs medical or surgical services which require our consent before supplied and we cannot be reached, we hereby authorize, appoint, and empower the school principal, or his designee, to furnish such written or oral authorization as may be required on our behalf. Further, we release the principal, his designee, Calvary Chapel Christian Academy, and Calvary Chapel of San Antonio from any liability that might arise from the giving of such authorization.. *

Yes

We understand that Calvary Chapel Christian Academy reserves the right to refuse any application or dismiss any child at any time for unacceptable work or conduct or any other reason it deems necessary in accordance with its policies and procedures. Failure of the parent to abide by the terms of this contract will result in student dismissal from the Academy. *

Yes

Date *

Provide the date that this agreement was signed

MM

DD

YYYY

Date

Provide the date that this agreement was signed

MM

DD

YYYY