Somerset Christian School

SOMERSETCHRISTIANSCHOOL

Admissions Application

A. NONDISCRIMINATION POLICY:SomersetChristianSchool admits students of any race, color, national, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. The school does not discriminate on the basis of race, color, national, and ethnic origin in administration of its education policies, admissions policies, and other school administered programs. However, in keeping with stated goals and objectives, SomersetChristianSchool reserves the right to use appropriate selection and dismissal criteria in order to best fulfill those goals and objectives.

B. GENERAL RECORD:

Student: ______

(Last name)(First name)(Middle name)

Application for Grade: ______Sex: ______Date of Birth: ______Age: ______

Month Day Year

Student Phone: ______SS#______

Area Number

Address: ______

City: ______State:______Zip Code: ______

Resides with: (circle one) Mother/Father Mother only Father only Guardian Father/Step Mother Mother/Step Father

Title: (circle one) Mr. & Mrs. Mrs. Ms. Mr. Dr. & Mrs. Rev. & Mrs.

Name of Parent/Guardian: ______

Ethnic Category: (circle one) Asian Caucasian Hispanic American Indian African American Oriental

Emergency Contact’s Name: ______Phone: ______

Mother’s Name: ______Phone: ______Cell Phone: ______

Employer’s Name: ______Phone: ______

Father’s Name: ______Phone: ______Cell Phone: ______

Employer’s Name: ______Phone: ______

Other School Age Children in Family:

Name ______Age ______Grade______School ______

Were you ever denied admission to a school? ______Why? ______

Were you ever suspended or expelled from school? ______When? ______Why? ______

______

Last school attended: ______

C. FINANCIAL RECORD

COMBINED INCOMERANGE:

______Less than 20,000______20,000 to 29,999______30,000 to 39,999______40,000 to 49,999

______50,000 to 59,999______60,000 +

Is there any reason why you would not be able to make your tuition payments? ______

D. CHILD’S SPIRITUAL RECORD

HomeChurch (Name) ______(Denomination)______

(Address) ______

Church Now Attending ______Phone ______

Senior Pastor ______Youth Pastor ______

Have you accepted Jesus Christ as your personal Lord and Savior? ______Year ______Have you been water baptized? ______

Are parents active member of a local church? ______

E. PARENT QUESTIONNAIRE: (attach additional sheets if necessary)

How did you find out about SomersetChristianSchool? ______

What do you see are your child’s greatest strengths? ______

What do you see are your child’s greatest needs?

Spiritual: ______

Behavioral: ______

Academic: ______

Social: ______

How do you see yourself being involved in the educational process of your child? ______

Please explain why you want your child to attend SOMERSETCHRISTIANSCHOOL. ______

______

F. STUDENT QUESTIONNAIRE: (Grades 5-12)

Have you used drugs, alcoholic beverages, or tobacco within the last 6 months? Yes______No ______

If yes, please explain: ______

______

What are your favorite subjects: ______

What subjects are the most difficult for you: ______

Why do you feel that you should be accepted as a student at SOMERSETCHRISTIANSCHOOL? ______

______

If you are accepted as a student at SOMERSETCHRISTIANSCHOOL, what type of student would you be? ______

______

What are some goals that you have for your life? ______

STATEMENT OF FAITH

The following truths are held in common agreements by the members of SomersetChristianSchool:

A.We believe the Bible to be the inspired and only infallible authoritative Word of God. (II Timothy 3:16)

B.We believe that there is one God, eternally existent in three persons: Father, Son, and Holy Spirit. (I John 5:4-6)

C.We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory. (I Corinthians 15:3;

I Peter 21-24; John 3:16; Thessalonians 4:18; Revelation 21:20)

D.We believe that for salvation of lost and sinful humanity, regeneration by theHoly Spirit is absolutely essential. (Romans 3:21-24; Galatians 4:4-7)

E.We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life. (Acts 1:8; Ephesians 5:18)

F.We believe in the resurrection of both the saved and lost; they that are saved unto the resurrection of life; and they that are lost unto the resurrection of damnation. (John 5:24, 28, 29)

My signature below affirms that I am a born-again believer, in agreement with and in full support of this Statement of Faith. Please sign below.

______

Signature of Parent/Guardian

STATEMENT OF AGREEMENT

In signing the Statement of Agreement and Financial commitment, I (we) agree to the following:

1.Student Placement: I request that the school reserve a seat for my student for the 2013-2014 school year, or the remainder of the year if the student enters during the year.

2.Effective Date of Contract: This contract shall be effective only upon my signature, receipt of this contract by the school, and acceptance by the school and is subject to the admissions policies of the school.

3.Tuition and Fees/Financial Policy: tuition and fees will be charged according to the tuition and fees adopted by the school for the applicable school year. By signing this contract, I agree to abide by the policies relating to the payment of such tuition and fees.

4.Tuition Assistance: Any tuition assistance given will be applied to my account on a monthly basis. I understand that it is my responsibility to pay the balance of my monthly tuition in accordance with item #3 above.

5.Rules and Regulations: I agree to comply with the school’s rules and regulations adopted by the school’s administration and Board of Directors. These rules include conduct and rules for academic requirements to be met by my student. I also agree that the school may dismiss, suspend, or discipline my student if these rules or requirements are not met, or for any reason deemed appropriate by the school.

6.Permission for Student’s Participation in Activities: I agree that my student may take part in any school-sponsored activity including, but not limited to, sports, trips, or events at any time. Any exception to my permission must be set out in writing and signed by myself and my child’s principal.

7.Permission for Transportation and Medical Care: I agree that the school has my permission at any time to allow faculty, staff members, or other persons authorized by the school, to transport my student on any school trip and/or event or to receive medical care. Any exception to my permission must be set out in writing and signed by myself and my child’s principal. I release the school and its employees and agents from any liability for any injury sustained by my child at school or in conjunction with any school activity unless caused by the gross negligence of the school.

8.I agree to comply with and be bound by all written policies of SomersetChristianSchool and the procedures as detailed in the parent/student handbook, and as any of these may be amended from time to time.

9.The person(s) responsible for payment of tuition ______

Home Phone ______Work Phone ______

Billing address ______

The parties of this agreement are Christians and believe the Bible commands them to make every effort to live at peace and to resolve disputes with each other in private of within the Christian Church. (See I Corinthians 6:1-8, Matthew 18:15-20). Therefore, the parties agree that any claim of dispute arising out of or related to this agreement shall be settled by biblically based mediation and, if necessary, arbitration in accordance with the Rules of Procedure for Christian Conciliation for the Association of Christian Conciliation Services. The parties agree that these methods shall be the sole remedy for any controversy or claim arising out of this agreement and expressly waive their right to file a lawsuit against one another in any civil court for such disputes, except to enforce a legally binding arbitration decision.

In signing this Statement of Agreement and Financial Commitment I agree, without mental reservation, that I am responsible for the payment of all tuition and fees for the student covered by this agreement.

______

Signature of father/guardianDate

______

Signature of mother/guardianDate

______

Signature of person responsible for paying tuition if other than above

In an effort to improve communication between the school and parents, we would like to include your email addresses in our files. The email addresses will be used by teachers and the school office to provide information to you. Please list any email address you want to receive information about your child.

Email address: ______