Student InformationSchool Year: 20___/20___ Grade Applying For: ______

Date of Application: ______Social Security Number: ______

Name: ______(Name Preferred)______

Last First Middle

Address: ______

StreetCity,State Zip Code

Home Telephone Number: ______Birth Date: ______Age______( ) Boy ( ) Girl

Student Email: ______Beginning Date: ______

Family Information– *If Guardian, guardianship papers MUST be attached.

Father/*Guardian: ______Email: ______

Address: ______

Occupation: ______Employed by: ______

Home Phone: ______Cell/Mobile Phone: ______Work Phone: ______

Marital Status: ( ) Married ( ) Single ( ) Divorced ( ) Separated ( ) Widowed

Mother/*Guardian: ______ Email: ______

Address: ______

Occupation: ______Employed by: ______

Home Phone: ______Cell/Mobile Phone: ______Work Phone: ______

Marital Status: ( ) Married ( ) Single ( ) Divorced ( ) Separated ( ) Widowed

Student currently resides with ______

Church Affiliation: ______Pastor’s Name: ______

Which email should financial statements be mailed to: ______Father ______Mother

Please list chronologically all other children under 18 years of age living with the family:

NameAge and GradeSchool Attending

______

______

______

Activity Permission

I agree to allow ______to participate in all school activities, including school- sponsored trips away from school premises, and I absolve the school from liability to me or my child because of injury, death, or dismemberment to my child during a school-sponsored activity. I further authorize the school to secure any necessary emergency medical treatment for my child in the event of an injury at school, or on a school-sponsored trip away from the school premises, when parents cannot be contacted.

Signature of Parent or Guardian ______Date ______

PARENTAL CONSENT FORM

In making application for my child to attend ProvidenceChristianSchool, I agree to the following:

  1. We as parent(s) or guardian(s) of______, accepting God’s responsibility as stated in Proverbs 22:6, “Train up a child in the way he should go and when he is old he will not depart from it,” do affirm that Biblical training in our home will provide a secure haven of safety and loving care as indicated in the Word. ______(Initial)
  1. In full cooperation with ProvidenceChristianSchool, we will regularly participate and attend school sponsored meetings and activities. We will contribute at least 10 (ten) hours of our time in volunteering for fundraisers, booster club, parent volunteers, etc. during the school year. In lieu of the 10 (ten) hours, a monetary donation of fifty dollars ($50.) to school departments will suffice. ______(Initial)
  1. We pledge our loyalty to the goals and ideals of ProvidenceChristianSchool and will bring any concerns directly to the person involved so that they may be corrected in a Biblically appropriate manner. (Matthew 18:15-18) ______(Initial)
  1. We understand that this document is a legally-binding contract, and the parties to this agreement are Christians and believe the Bible commands us to make every effort to live at peace and to resolve any disputes with each other in private within the Christian community in conformity with the Biblical injunctions of I Corinthians 6:18; Matthew 5:23-24; and Matthew 18:15-20. Therefore, the parties agree that any disputes or claims shall be settled by Biblically-based mediation and/or arbitration, as completely outlined in the Student/Parent Handbook. ______(Initial)
  1. We pledge that if for any reason our child does not meet the academic requirements or cooperate with the disciplinary standards of Providence Christian School, we will withdraw him/her without delay and cooperate with the administration to make the withdrawal as quietly as possible, avoiding discussion with those not involved, so as to avert a spirit of dissension and division at either our child’s expense or the school’s. PCS reserves the right to dismiss, suspend, or otherwise discipline any student who does not adhere to the standards stated in the Parent-Student handbook.______(Initial)
  1. We understand that ProvidenceChristianSchool is a non-profit ministry operating on the principle of faith. Tuition and fees do not cover all operating costs, and we agree to support the school financially as God provides. We understand the school will require all students to make an effort to participate in school wide fundraisers. We further understand that families who fail to support or participate in fundraisers will be charged a fee based on the minimum requirement for each fundraiser. Additionally, we commit to perform services as needed and to uphold the school and its personnel consistently in family prayer. ______(Initial)
  1. We understand the purpose and goals of the school and support the spiritual and academic programs of the school. We further agree to support the school’s rules, regulations, and policies as stated in the Parent-Student handbook. ______(Initial)
  1. We understand this application cannot be considered without the registration fee and that, if our student is accepted, the registration fee will not be refunded. ______(Initial)
  1. We understand that, if we voluntarily withdraw our student from the school once classes have begun, we are responsible to pay the full tuition until the end of the semester.No records for any child will be released until the balance is paid in full. We also understand that if we are more than forty-five (45) days past due, our child(ren) will be immediately withdrawn until the account is paid in full and that no records for any child will be released. ______(Initial)

______

Father or Guardian SignatureMother or Guardian Signature

Student Affidavit

(Student signature required)

If accepted to attend Providence Christian School for the current or upcoming school year, I agree to abide by the rules and regulations as stated in the PCS Parent-Student handbook, treat peers and those in authority over me with respect, and strive to live a Godly life in all areas.

______

Student SignatureDate

ProvidenceChristianSchool, Savannah, Georgia

Emergency Information Form

(Please Print)

Student’s Name:______

Person(s) to Contact:

______

Name Relationship to Student

______

Home or Work Phone Number Cell Number

______

Name Relationship to Student

______

Home or Work Phone Number Cell Number

Please list any medical and/or allergy conditions of which we should be aware:

______

Prescription Medication

I, ______, parent/guardian of ______, authorize ProvidenceChristianSchool to administer the following medications to my child during the school day. I understand that ALL medications (including non-prescription/over the counter drugs) will be kept in a locked location and administered by a member of the ProvidenceChristianSchool staff according to my directions. I understand that medications need to be sent to the school in a prescription container that is clearly labeled with the child’s name and dosage. I will notify the school immediately of any changes in medication or instructions.

Medication ______Dosage ______

Medication ______Dosage ______

Prescribing Physician ______Office Phone ______

Time medication should be administered ______

Parent/Guardian Signature ______Date ______

Over-the-Counter Medication

I, ______, give consent for my child, ______, to receive the following over-the-counter medications, as needed.

Check all that apply:

_____ Tylenol_____ Ibuprofen

_____ Do Not Give My Child Any Medication(s).

_____ Contact me (parent/guardian) before giving any medication(s).

DearChurch Minister,

The ______family has made application with ProvidenceChristianSchool for their student(s) ______. According to policies set by our Board as a covenant school, a minister’s recommendation must accompany their application. Providence strongly believes that a true Christian education begins at home and is nurtured through regular church attendance. Below is the Parent and Student Agreement that families must sign in our handbook.

Parent and Student Agreement

“Parent(s)/guardian(s) should be united in their belief that enrollment at PCS is the best training option for their child. At least one parent of students in grades Pre-k through 12 must have a clear testimony of personal faith in Jesus Christ as Savior. Parent(s)/guardian(s) should exhibit a desire for having their child taught from a biblical perspective.

As students become more mature, they are considered progressively more responsible for their attitude toward school. Students in the lower school must be willing to abide by the spirit of the family-school covenant. Students in grades 6-12 must agree to the specifics of the covenant as stated and personally sign the document. Further, students in grades 9-12 should exhibit a definite personal desire to be at PCS. The commitment to a positive attitude toward instruction from biblical perspectives should be made yearly at the point of re-enrollment by both parents and students.

It is expected that PCS students will consistently exhibit integrity-honesty and honor-in dealing with others including students, PCS faculty, and staff. Students will also consistently display a biblical attitude toward authority by a willing, cheerful, and immediate compliance with the expectations of all those placed in authoritative positions.

Students should treat all others as bearers of the Image of God; they shall respect others and their property. This means they will refrain from actions, languages, or attitudes that are destructive or detrimental to the school, its reputation, or its affiliates. Students will be accountable for their behavior whether or not they are under the direct supervision of school personnel. Actions that reflect upon the institution and reputation of PCS will be dealt with at school regardless of whether or not the student is on campus at the time, and regardless of whether or not the school is in session at the time of the incident. Students are expected to give appropriate effort to their academic endeavors and to any other responsibilities, they are given.

My student and I agree to abide by the PCS Student/Parent Handbook and the Code of Conduct. I will fully support the institution of ProvidenceChristianSchool, its staff, and faculty in their endeavors to provide a Christian environment in which to grow physically and spiritually.”

Church Minister Agreement

If you believe the applicant family will be an asset to ProvidenceChristianSchool and that the family will fully support our policies, please sign this recommendation on their behalf. If you would like more information about the school or would like to submit further remarks, please attach and return them to us. You may fax or mail this recommendation to us at the above address and phone numbers.

In His Service,______

Church Name

______

Paula CookDaytime Phone Number

PCS Head of School______

Minister’s Name (Print please)

______

Minister’s Signature

Providence Christian School

Schedule of Fees

2018-2019 School Year

  1. Registration Fee: Non-refundable, not pro-rated for returning student is $325.

New student fee is $425. $50 discount for registration paid by May 15th for following school year.

  1. Book Fee: $400 for K3 - 5th Grade: due by August 1st - not pro-rated.

$400 for 6th -12th Grade: due by August 1st - not pro-rated.

Book fee is used to cover the costs of textbooks, workbooks,tests, etc. The fee must be paid by August 1st in order to have textbooks prior to the first day of school.

  1. Testing fee will be $100.
  1. Tuition:(Seniors must use 10-month plan.)

Grades / Annual / 10 months / 12 months / FACTS
10 months with discount / FACTS
12 months with discount
6th – 12th / $5900.00 / $590 / 491.67 / $560.50 / $467.08
K - 5th / 5600.00 / 560 / 466.67 / 532.00 / 443.34
K3 - K4 / 5300.00 / 530 / 441.67 / 503.50 / 419.59
  • Discount for 2 or more children: 20% discount of youngest child’s tuition fee for second child, and each child thereafter.(No discounts apply to K3-K4).
  • Discount forfull year’s tuition paid in full in advance: 5% discount for tuition paid in full by August 1st. In the event of early withdrawal, the discount, which was given for payment in full by August 1st, will be forfeited based upon 10 months.
  • Payments through FACTSAutomatic Tuition Payment:Must begin in July (12 months) or August (10 months). Seniors must use 10-month plan.
  • Discount: 5% per month with completed FACTS form and paid one-time annual fee of $49.
  • Payments other than FACTS: Requires 10 or 12 post dated checks in advance.
  • $50 late fee for tuition payments not paid by the 15th of the month. Tuition payments are considered “due” on the first day of each month.
  1. Booster Fee:$50 fee per familyin order to support insurance and/or PCS athletic programs.
  1. Athletic Fee:$175 per athlete in grades 6 - 12 to support the athletic program, non-refundable. Issued uniforms and equipment must be returned in good condition upon completion of the season. Failure to do so will result in paying the replacement cost of the uniform(s).Fee must be paid prior to the FIRST practice of any sport.