By His GraceChristianAcademy

9615 Shadowgrove Drive- Rancho Cucamonga, CA 91730

(818)404-1815

Let your light so shine before men that they may see your good works and glorify

your Father in heaven. Matt 5:16

REGISTRATION FORM

Last Name

MotherFather

Address

Home

City & ZipPhone()

Cell Phone ______Work Phone ______

Emergency Contact ______

HSLDA membership number ______Expiration date ______

PLEASE ATTACH A COPY OF THE CURRENT CARD

E-mail

Names of Children Date of Birth Age/Grade

Are You Born Again?

Mother Yes No When: ______Willing to pray for the school every day? Yes No

Father Yes No When: ______Willing to pray for the school every day? Yes No

Church currently attending: ______

Are you joining our PSP or just our support group (no record keeping)? PSP Support

Name & Address of your previous PSP if BHGCA is your new PSP:

______

______

Describe Your HomeSchool History: i.e. Always belonged to a PSP or filed your own affidavit, CHEA member, attend CHEA convention, use mostly Unit Studies, etc. ______

By His GraceChristianAcademy

9615 Shadowgrove Drive- Rancho Cucamonga, CA 91730 (818)404-1815

Let your light so shine before men that they may see your good works and glorify

your Father in heaven. Matt 5:16

Please list your qualification to teach your child:

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This is required to be on file by the State of California.

Family Name______

By His GraceChristianAcademy

9615 Shadowgrove Drive- Rancho Cucamonga, CA 91730(818)404-1815

Let your light so shine before men that they may see your good works and glorify

your Father in heaven. Matt 5:16

PSP PARENTAL AGREEMENT

Please read the following statements. If you are inAGREEMENT and WILL ABIDE by these policies, SIGN at the bottom and return with your registration fee.

1)We understand that the school cannot offer legal immunity and is only providing school services to assist parents in the schooling of their children.

2)We realize that although the school is keeping our children’s records, it is in no way responsible for their actual education.

3)We understand that since activities are parent driven, parents are expected to not onlyparticipate, but also take an active role in the school.

4)We understand that since the school is a volunteer organization, any adults involved with school functions or activities have not been fingerprinted or had a background check.

5)We understand that we are required to have a current, active membership with HSLDA.

6)We understand that our responsibilities as parents are as follows:

  1. Parents are required to keep the following records and report to the school
  2. Report Card for grades 7 – 12
  3. Record of Attendance
  4. Course of Study
  5. Health and Immunization Record or Waiver
  6. Statement of Teacher Qualifications are due upon entrance to the school
  7. Parents will provide and pay for their own curriculum
  8. Failure to turn in required paperwork by the date due will result in automatic termination from the school and forfeiture of our registration fee.

7)We have readthe school’s Statement of Faith and agree that this is not only the basis of the school, but also the standard of our home.

8)We understand that we are responsible for our student’s safety and conduct.

9)We understand that if we withdraw our student, we must notify the school immediately.

10)We understand that the services of the school are engaged by mutual consent and that either we or the school reserve the right to terminate any/all services at any time by written notification.

11)We understand that standardized testing is a requirement of By His Grace Christian Academy and that each student must participate inTerraNova in the Spring of 2015.

WE HAVE READ THE ABOVE POLICIES AND AGREE TO ABIDE WITH ALL THE ABOVE INFORMATION.

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Mother’s SignatureDate

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Father’s SignatureDate

By His GraceChristianAcademy

9615 Shadowgrove Drive- Rancho Cucamonga, CA 91730 (818)404-1815

Let your light so shine before men that they may see your good works and glorify

your Father in heaven. Matt 5:16

PSP REQUIREMENTS

1)The following forms are due by Aug 22, 2014:

  1. Completed Registration Form with paid registration fee
  2. Signed Parental Agreement
  3. Teacher Qualifications

2)The following forms are due by September 30, 2014:

  1. Health and Immunization Record or Waiver if not already on file with BHGCA.
  2. Course of Study

3)Due January 31, 2015

  1. Attendance Record
  2. Report Cards for grades 7 – 12
  3. Any information for the student’s cum file (e.g. examples of student’s work limited to two samples per subject)

4)DueMay 31, 2015

  1. Attendance Record
  2. Report Cards for grades 7 – 12
  3. Any information for the student’s cum file (e.g. examples of student’s work limited to two samples per subject)

I understand that failure to turn in required paperwork by the date due will result in automatic termination from the schooland forfeiture of our registration fee.

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Parent’s SignatureDate

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Parent’s SignatureDate

By His GraceChristianAcademy

9615 Shadowgrove Drive- Rancho Cucamonga, CA 91730(818)404-1815

Let your light so shine before men that they may see your good works and glorify

your Father in heaven. Matt 5:16

EXPLANATION OF FEES

PSP (Records Only) Membership $175 per family per year if completed registration is received by 8/22/14 – Includes full record keeping services as well as a transcript for all high school level classes. Includes full access to our email list and field trips, if any.Our school also provides services such as signatures for work permits, auto insurance and other documentation that requires an official school seal. REGISTRATION FEES INCREASE TO: $200 from 8/23/14-9/30/14; $225 after 10/1/14

ALL FEES ARE DUE AND PAYABLE WITH YOUR REGISTRATION PACKETS.

LATE FEE OF $25.00 WILL BE CHARGED FOR ALL PAPERWORK NOT RECEIVED BY DATES LISTED IN REGISTRATION PACKET.

NOTICE OF NONDISCRIMINATORY POLICY AS TO STUDENTS

The By His Grace Christian Academy, Inc. admits students of any race, color, national and ethnic origin to all the rights , privileges, programs, and activities generally accorded or made color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school -administered programs.

BY HIS GRACE CHRISTIAN ACADEMY, INC. PRIVACY POLICY

BY HIS GRACE CHRISTIAN ACADEMY, INC. takes your privacy seriously. Please read the following to learn more about our privacy policy.

What This Privacy Policy Covers: This policy covers how BY HIS GRACE CHRISTIAN ACADEMY, INC. treats personal information that BY HIS GRACE CHRISTIAN ACADEMY, INC. collects and receives. Personal information is information about you that is personally identifiable like your name, address, email address, or phone number, and that is not otherwise publicly available.

General: BY HIS GRACE CHRISTIAN ACADEMY, INC. collects personal information when you register with BY HIS GRACE CHRISTIAN ACADEMY, INC. When you register we ask for information such as your name, email address, birth date, gender, ZIP code, etc. When you register with BY HIS GRACE CHRISTIAN ACADEMY, INC., you are not anonymous to us.

BY HIS GRACE CHRISTIAN ACADEMY, INC. does not rent, sell, or share personal information about you with other people except when we have your permission.

We respond to subpoenas, court orders, or legal process, or to establish or exercise our legal rights or defend against legal claims. We believe it is necessary to share information in order to investigate, prevent, or take action regarding illegal activities, suspected fraud, situations involving potential threats to the physical safety of any person, or as otherwise required by law.

Confidentiality and Security: We limit access to personal information about you to only those people within BY HIS GRACE CHRISTIAN ACADEMY, INC. who we believe reasonably need to come into contact with that information to provide products or services to you or in order to do their jobs.

Changes to this Privacy Policy: BY HIS GRACE CHRISTIAN ACADEMY, INC. may update this policy. We will notify you about significant changes in the way we treat personal information by sending a notice to the primary address specified in your file or by placing a prominent notice on our site.

Effective Date: January 1, 2006

By His GraceChristianAcademy

9615 Shadowgrove Drive- Rancho Cucamonga, CA 91730 (818)404-1815

Let your light so shine before men that they may see your good works and glorify

your Father in heaven. Matt 5:16

Participant Hold Harmless Agreement

PLEASE READ THIS RELEASE, IT CONTAINS IMPORTANT LIMITATIONS OF LEGAL LIABILITY.

I/We, ______, hereby for myself/ourselves, my/our heirs, executors, and administrators, do hereby waive, release, discharge and hold harmless, By His Grace Christian Academy, all their owners, Board of Directors, officers, shareholders, and all individual members thereof, and all other persons and/or organizations in any way connected with the events, property, classes, instruction, or any other activity described herein, their representatives, heirs, executors, administrators and assignees from any and all right, claim, or liability for claims of any kind or nature that I/We might have as a result of, or arising from our participation in the activities of this Independent Study Program/Support Group. Further, we do hereby acknowledge that this release will extend to any accidents, damages, or claims arising from my participation, caused by my own act(s), or the act(s) of anyone within or outside of my control. This extends to every kind of nature whatsoever, whether known or unknown, and expressly waive any benefits i/we may have under Section 1542 of the California Civil Code relating to the release of unknown claims.

Father’s Signature______Date______

Mother’s Signature______Date______