STUDENT REGISTRATION APPLICATION FORM

AND PAYMENT AGREEMENT 2008-2009

PLEASE PRINT OR TYPE STUDENT INFORMATION:

Student's Information

Last Name______________________  First Name ______________________ Middle Name___________________

Student Nickname __________Current Age __ Last Grade___ Proposed New Grade ______

Date of Birth Month_________ Day ___________ Year ___________ Gender: Male _______ Female ________

Student Social Security No. ________-_____-__________   

School District in Which Student Resides                                                                                  

Student Place of Birth

City_____________________ State___________________ County ___________________

Estimated distance from campus:                      Actual later confirmed mileage from residence:            

Name of Local School District in which student will reside during the 2008-2009 school term:_____________________ 

Current Address of Student. If the Signer/Payer's Address is different from that of the student, kindly complete signer/payee

complete full residence and contact information on the appropriate section of this document.

House or Apt. No.________________________ Street Name___________________

City____________________ State ______  Zip Code__________ County of Residence of Student ___________________  

Home Telephone No.(     )__________________ Fax (      )_________________

Father's Information

Last Name________________First Name_______________Middle Name__________________

Social Security No. ________-_____-_________ Telephone Number (       )_________________

E-mail_________________________

Street Address ________________________________________________________________

City____________________State______Zip Code___________Country___________________

Work Telephone Number (      ) _________________Work Extension ____________

Work Email_____________________

Employed By (Name of Company/Business)___________________________________________

Position _______________________________ Dept. _________________________________

Lives with Child Y___ N ___ United States Citizen: Yes ___No.___Other Country? ____________

Mother's Information

Last Name________________First Name_______________Middle Name__________________

Social Security No. ________-_____-__________ Telephone Number (      )_________________

E-mail_____________________Street Address ________________________________

City____________________State______Zip Code___________Country____________________

Work Telephone No.(     ) _____________Work Extension ____________

Work E-mail_______________________

Employed By (Name of Company/Business)____________________________________________

Position _______________________________ Dept. __________________________________

Lives with Child Y___ N ___ United States Citizen: Yes ___No.___Other Country? __________

Emergency Contact # 1

Name of Individual to Call in an Emergency ____________________________________________

Telephone (      ) _______________ Relationship to Student_______________________________

Emergency Contact # 2

Name of Individual to Call in an Emergency _____________________________________________

Telephone (      ) ________________ Relationship to Student_______________________________

Physician to Call in Emergency

Telephone (     ) ________________

Faith Elementary and Middle School Student Registration Application

Male Guardian

Last Name________________First Name_______________Middle Name__________________

Social Security No. ________-_____-__________ Telephone Number (       )_________________

E-mail:________________________

Street Address _________________________________________________________________

City____________________State______Zip Code___________Country____________________

Work Telephone No.(       ) _____________Work Extension ____________

Work E-mail____________________

Employed By (Name of Company/Business)____________________________________________

Position _______________________________ Dept. __________________________________

Lives with Child Y___ N ___ United States Citizen: Yes ___No.___Other Country? ____________

Female Guardian

Last Name________________First Name_______________Middle Name__________________

Social Security No. ________-_____-__________ Telephone Number (      )_________________

E-mail ___________________Street Address __________________________________________

City____________________State______Zip Code___________County____________________

Name of School District in which you reside?                                                                          

Approximate Distance from school campus?           Exact Corrected Distance Later:                

Work Telephone No.(      ) _____________      Work Extension ____________

Work E-mail _____________________

Employed By (Name of Company/Business)________________________________________

Position _______________________________ Dept. __________________________________

Lives with Child Y__ N __ United States Citizen: Yes __No.__Other Country? _________

Church Affiliation if any                   ____________________________________                                                      

Name of Pastor _______________________ (Denomination if Applicable) __________

Telephone (      ) _______________ Church E-mail __________________

Name of Church________________________________________________

Street Address_____________________________________________

City___________________________State___________________Zip Code________

Telephone (      )_______________ Church Fax (      )__________________

Name of Church Clerk or Secretary____________________________

Telephone (      )_______________Fax (      ) ____________

Clerk E-Mail ______________________

Name of Last School Attended ____________________________________________

Name of Principal________________________________________________________

Street Address___________________________________________________________

City___________________________State____________Zip Code________________

School Telephone (      )_______________Former School Fax (      )_______________

Name of Former School District__________________________________________

School District Fax (      ) _____________________

Transportation

Student will arrive at school by: Walk ___ Bicycle ___ Family Vehicle ____

Family Contracted Vehicle ____ Public Transport ___ School Vehicle ___

Last Name_______________First Name____________Middle Name ___________

U. S.Citizen: Yes ___No.___ Phone Number                                                  

E-mail Address __________________

Street Address ____________________________________

City                                  State           Zip Code             Country_____________

Work Telephone No.(      ) _____________Work Extension ____________

Work E-mail______________________________

Employed By (Name of  Company, ____________________________________ 

Position _______________________________ Dept. __________________________________

I am requesting and consenting for my child to be placed in the       Grade and Class. My child has the positive attributes which I believe will assist him or her in being a contributing member of his or her class ________________________________________ .  I believe you may appreciate knowing the following information about my child that may assist the school and  teachers in understanding and being effective in working with my child (ren).                                                                                                                                                        .     

Responsible Payer (s)

Important Note: I (We) understand and agree that as the signer (s) of this document, I  am or (we are) responsible for the advance, prompt and regular payment of installments for this account. I  or we understand that the cost for tuition which I (we) agree to pay for this student or these students is $3,500.00 per first child for the academic year, 3,150.00 for a second student from the same household, and $2,975.00 for a third student from the same household. My (Our) signature (s) to this document verifies that I (we jointly) accept that a double installment ($700.00) is due the school to secure the student's seat, prior to the seating of the student for the term. I (we jointly) accept that the remaining eight installments (i.e., $350.00 each) will be paid the school on the first business day of each month (Choice A) September 2008 - April, 2009, or (Choice B) October 2008 - May 2009.

I (we jointly) accept Choice A or Choice B. I am writing the letter designating my (our) acceptance of Plan of Choice in the blank that follows: Plan _______, I (we jointly) agree to add the $30.00 late payment fee to my (our) scheduled installment monthly whenever my (our) tuition installment is received by the school after the fifth (5th) calendar day of the month it is due. I agree that any/all late payment fees not paid to the school when due will be held as a debit to the end of the school term to be paid by me (us) prior to issuance of final documents for my (our) child (ren).

It is understood that no credit is extended for student lunch. It is also understood and accepted that Child Care Payments will be paid promptly after billing and not later than fifteen calendar days after issuance of the Statement for Payment by the school. It is anticipated and acceptable to me (us) that my (our) child (ren) will be dismissed from school for habitual non-payment or slow and irresponsible payment of my (our) child's (children') tuition account, or dropped from the Child Care Program for failure to pay timely.

Signature Section

My dated signature below indicates  my voluntary acceptance of this school's rules, standards, and requirements regarding student attendance, conduct, discipline, dress, and fundraising efforts.. Accordingly, I (we) pledge as sponsoring and supportive parent (s), to honor my (our) financial obligations and commitment as parent (s) or sponsor (s) and to timely pay and support the school in it's efforts to provide as safe, as excellent, and as relative as to grade placement and my child's abilities, a traditional basic, Christ-centered, and rigorous routine of education by the grace of God and in keeping with the school's resources, vision, mission, objectives, and philosophy.

By my signature below I am verifying that I am aware of school rules and policies for the student for which I am applying for acceptance for the 2008-2009 school term. I further verify that I am aware that a copy of current school policies and standards and is listed on the school's website: www.feschool.org. Further, by acceptance of my (our) child (ren)  as student (s), the school obligates itself to my (our) family to provide online on the school's official website, and /or issue a current copy of the Student Handbook no later than at Parent Orientation on August 21, 2008, or upon my request after the most recent  publication, and that my receipt of the publication will be confirmed by a signed and dated statement by myself, my spouse, or other connected and responsible individual to me. Should I (we) elect to avail myself (ourselves) of the electronic copy online, we will sign and date a release for the school. I (we) may elect to not accept or require the hardcopy of the publication. We understand that reference copies of the Student Handbook will be available for in-house parent and/or student use in each classroom,

the school office, and in the school library. Parents and students who enter the school later in the term will be given the same consideration, and the same signed release or receipt statements. The first day for student to report to school will be Monday, August 25, 2008.

Signature of Payer________________________________

DE Drivers License Number of Payee ______________________  

Signature of Payer _______________________________   

DE Drivers License Number of Payee _____________________

Drivers License Number: ______________________State______________

Date Signed by First Payer: _______________________________________

Date Signed by Second Payer: _______________________________________