Westwood Schools 255 Fuller Street P. O. Box 528 Camilla,GA 31730

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1 Westwood Schools 255 Fuller Street P. O. Box 528 Camilla,GA submits this application for admission to Westwood School for the year on behalf of the following student(s). Grade Grade Grade Grade I agree that if this application is accepted by the school, such acceptance will be subject to the following terms and conditions: 1. Tuition Kindergarten(K3, K4, K5) $3, Elementary (1 st 5 th ) $4, Jr. & Sr. High (6 th 12 th ) $4, Multiple Child Discount -For two children there is a $200 discount from the total bill. -For three children there is a $500 discount from the total bill. -For four or more children, the fourth child and any additional children will be exempt from tuition. However, the first three will be charged full tuition with no multiple child discounts. 2. Additional fees 1. Registration Fee $300-Current Families, $350-New Families 2. Building Fee $400 per family (Can be paid with the registration fee or included with tuition payments) 3. Technology Fee $50 per student (Can be paid with the registration fee or included with tuition payments) There is no refund of fees if a family decides not to send the student or students to the school after the deposit has been made for that day. Any tuition fees paid in advance will be pro-rated by the number of days enrolled. Students are not officially withdrawn until the parent or guardian has signed a withdrawal form. 3. Tuition Payment Options 1. Annual Due 8/1/14 2. Semi-Annual Due 8/1/14 and 1/2/ months 8/1/14 thru 5/1/15-Credit card, debit card, bank draft required months 6/1/14 thru 5/1/15-Credit card, debit card, bank draft required Credit Card, Debit Card and ACH tuition payments must be set up for the 1 st or 15 th each month. Registration is not complete without bank drafts/ach drafts/postdated checks. If a payment plan is not chosen at registration, a 10 month payment plan beginning August 1 st will automatically be set up. NOTICE: There will be a $35 charge for all returned checks and ACH drafts will be set up for automatic payment if you have a returned check.

2 4. Other Financial Obligations In addition to the above tuition and required fees, each family is responsible for raising $ during the year by the following means: (This amount must be raised by each family before January 31 st each year, or the amount must be paid in full before the student can register for the following school term.) 1. $ is to be raised through the use of grocery voucher program and/or the Scrip Program (February 1, 2014-January 31, 2015) 2. $ is to be raised through participation in one fundraising event payable and due by the date of the raffle. All families are expected to participate in the above unless they make arrangements at the time of registration to have the $ added into tuition. 5. Registration Procedures Payments of all debts must be current and all items listed below must be completed before a student is considered enrolled: a. 2014/2015 Westwood Contract (all) b. Payment of Registration Fee: $300 (current families) $350 (new families) c. Student Substance Abuse Policy/Parental Acknowledgement Form (grades 6-12) d. Form 3231-Current Shot Record (all) e. Form 3300-Hearing/Vision Screening (K4,and K5 only) f. Emergency Medical authorization Form (One for each student) g. Copy of Birth Certificate (K3, K4 and new students only) h. Updated Information Sheet: Parents/Grandparents(all) i. Bank Drafts, ACH Drafts or Post-dated Checks for tuition j. Must be tested by school within 2 weeks of registration to hold a place in a class. If not met, place may be forfeited. New students must take an entrance examination required by the school and have records and transcripts reviewed by Westwood s admission s committee before any of the above will be accepted. 6. Late Registration Places are reserved for presently enrolled students who register on or before February 28, Late Fee of $ will be applied under the following conditions and cannot be added into tuition payments. a) Registration forms and signed enrollment acceptance forms not completed by February 28, b) Any raffle money not paid from the school year. c) Any grocery voucher money not paid from the school year The late fee will be increased to $ if the above requirements are not completed by July 1 st, 2014 In addition to the above registration information, the following procedures apply: A. If at the end of this deadline, less than the maximum number of students have been accepted for enrollment in a particular grade, then further

3 applications for enrollment in that particular grade will be considered by the school with no preference to application for enrollment for students who are presently enrolled in the school for the term. Thereafter, when (and if) the enrollment in a particular grade reaches the maximum number of students based on additional accepted applications for enrollment in that particular grade will be considered by the school with no preference to applications for enrollment for students who are enrolled in the school for the school year. B.If, at the end of this deadline, the maximum number of students has not been accepted for enrollment in a particular grade, then further applications for enrollment in that particular grade may be considered and accepted by the school with no preference to applications for enrollment for students who are enrolled in the school for the school year. 7. Tuition, fines, fees and lunch balances must be paid current before a student can participate in extracurricular activities (including summer camps and practices). In the event a student s account becomes more than 60 days in arrears, they will immediately be removed from extracurricular activities until their account is brought current. 8. The applicant and the student(s) on whose behalf this application is made agree to abide by all the rules, regulations, and policies stated in the student handbook. 9. Students in grades 6 12 that are not participating in after school extracurricular activities should be picked up by 3:40 Monday Thursday and by 3:20 on Friday. Faculty/Staff are excused at these times and students that have not been picked up are left unsupervised. 10. The applicant and the student(s) on whose behalf this application is made agree to abide by all the rules and regulations promulgated by the Board of Trustees. 11. The Board of Trustees reserves the right to assess each family and/or student such additional amount(s) as shall be necessary in the judgment of the Board of Trustees to meet the expenses and/or requirements of the school. 12. Delinquent annual and semi-annual payments will accrue a penalty charge of $100 for every 10 days that the payment is late. When these bills are more than 30 days past due, it must be converted to monthly payments through ACH Drafts. 13. All students that attend Westwood in grades 6-12 will be required to submit to random drug testing. Parents will complete and return the Student Substance Abuse Policy parental acknowledgement form at the time of registration. 14. In order to keep all parties concerned properly informed, please list any additional names and addresses below the applicant s signature other than the applicant. 15. BEFORE THE STUDENT(S) CAN ATTEND CLASSES, HE/SHE MUST HAVE THE APPROPRIATE SHOT RECORDS ON FILE IN THE OFFICE: K-3-12 th Form 3231 (Need one original) If your child will be in after school daycare, regardless of the length of time or number of days, the school must have the appropriate shot records on file before the student can stay. I accept the foregoing terms and conditions and acknowledge that my total obligation hereunder is $. I tender the sum of and select alternative ( ) as the method of payment for the balance of my remaining obligation. Submitted, the day of 2014 Applicant s Signature (If someone else is paying a portion of the tuition/fees, they are required to complete and sign the following page) Accepted, this day of 2014 Camilla Schools, Inc. By

4 Please check box if information is different from last year s form. Emergency Medical Information (Must be filled out completely and notarized) Please Complete Separate Form for Each Child School Year Student s Name: Grade Home Address: Age: City: State: Zip: Home Phone: Male or Female: Race: Date of Birth: Date of last tetanus or DPT SocialSecurityNumber: (SSN required for Hope Scholarship purposes) Name of Resident Parent/Guardian: Father s Name: Address:City: State: Zip Cell Phone Number: Business Name& Phone:: Mother s Name: Address:City: State: Zip: Cell Phone Number: Business Name& Phone:: Persons to contact in emergency when parents cannot be reached Name: Phone: Relationship: Name: Phone: Relationship Family Physician: Phone( ) Medical Insurance Company: I.D. List all allergies or sensitivities to drugs, etc_ List any regular or prescribed medication the student is taking: Is there any reason that would prohibit the student to take part in physical education, athletics, or other classroom activity? If so describe briefly: (Written excuse from physician must be on file in the office to excuse a student from participation in P. E. classes) Check one:( ) Yes( )No, my child may be (may not be) given Tylenol at school for minor headaches during the school day. ( ) Yes( )No, my child may be (may not be) given Benadryl at school if any allergic reactions occurs In the event that I/we, the persons designated above, or our physician, cannot be reached first; or in the event of an emergency requiring immediate medical attention, I/we further hereby authorize Westwood, its faculty/staff, or agents to transport my/our child to a hospital. I/We further authorize the physicians at said hospital to carry out any and all medical procedures necessary. I also authorize the school to treat my child for any minor injuries or sickness that may arise during the day.(example: cuts, bruises, etc) I give my consent for the faculty of Westwood/or qualified medical personnel to act on my behalf In securing and administering necessary medical care and treatment for my child. Date: Student s Name: Signature of Parent/Guardian: Notary Signature: (Notary Seal) (This form must be notarized and is valid for one school year.)

5 CO-APPLICANT (If you are responsible for a portion of the tuition and/or fees of a Westwood student, this page must be completed and signed) Name: Address: City: State: Zip: Home Phone Number: Cell Phone Number: Business Name & Phone: NATURE OF THE OBLIGATIONS: How much have you agreed to pay? When are these payments to be made? Submitted, the day of, 2014 Co-Applicant Signature

6 Westwood Schools Enrollment Acceptance Form, submits the following and payment for (Parent or Legal Guardian) school year on behalf of the following students: STUDENT(S) GRADE TUITION $ Discount Sub Total Tuition Building Fee ($400 per family) Technology Fee ($50 per student) Raffle (if not participating, please add $350) Grocery/Scrip (if not participating, please add $216) Optional PTO Membership $10 Optional Donation toward new building project TOTAL OBLIGATION PAYMENT METHOD: Enclosed are the following completed items for the above student(s) enrollment Westwood contract..all grades 2 Payment of Registration Fee..all grades 3 Completed Drafts/Posted Dated Checks...Families paying monthly 4 Emergency Medical Authorization Form for each child.all grades 5 Updated information sheet: Parent/Grandparent all grades 6 Student Substance Abuse Policy/Parental Acknowledgement Form...6 th 12 th grades only 7 Form 3231 Current Shot Record if needed 8 Form Hearing/Vision Screening.. K4 & K5 only 9 Copy of Birth Certificate K3, K4 & new students 10 After FEBRUARY 28, 2014 Late Fee.all grades Until all of the above information has been completed, submitted & accepted by Westwood, registration in not complete and late fees may be incurred. ACCEPTED, this day of 2014 Camilla Schools, Inc. BY:

7 Parent/Grandparent Information Sheet Parents Name Address Phone Student Name(s) Grade Grade Grade Grade Grandparents Name Address Phone Grandparents Name Address Phone Grandparents Name Address Phone

8 Each year Westwood families will be required to participate in two Westwood PTO/Booster projects and Fall Festival. There will be opportunities to sign up for specific dates. This will be done on a first come, first serve basis. For those who do not take advantage of these opportunities, dates will be assigned. Westwood reserves the right to assess a fee of $ for each occurrence a family fails to work on an assigned project. Signed: Date:

9 Tuition Assistance Program Westwood School is a school for students who are truly interested in a top-quality college preparatory school experience. As a private school, tuition charges commensurate with the provision of such a program are necessary. In recognizing that some families may not be able to provide the full amount of tuition required, a tuition assistance program is available to qualified applicants. There are persons involved with the school and others in the community who support this program and make it available. Westwood School seeks to include students who have a desire to learn and actively participate during these important learning years. It is the intent of the school to make this opportunity available to students who are not in families that can readily pay the current tuition. Some of the guidelines of the tuition assistance program are: The granting of assistance will be based on the financial needs of the family. Students receiving assistance will be expected to perform satisfactorily in their studies. Families receiving financial assistance will be expected to keep adjusted payments up to date. The awarding of assistance should be confidential so that no stigma will be attached to the recipient nor will the recipient feel different from any other student. A Tuition Assistance Committee makes decisions on tuition assistance applications. All requested information must be provided by the family. Application for tuition assistance must be made annually and is renewable depending on the need of the family and the performance of the student. Application deadline will be April 15 for the presently enrolled families and June 1 for new families. Tuition assistance will generally be awarded according to availability of funds and space in the classroom. Persons wishing additional information on procedures for contributing to the Tuition Assistance Program or applying for tuition assistance should contact Carlton Gainous, Assistant Headmaster.

10 Authorization Agreement for Automated Payments Company: Camilla Schools, Inc. Customer: I/we hereby authorize Camilla Schools, Inc., hereinafter called COMPANY, to initiate debit entries to my/our checking savings account (select one) indicated below and the depository named below, hereinafter called DEPOSITORY, to debit same to such account. Depository Name: Branch: City: State: Zip: Transit/ABA Number: Account Number: If applicable: Set amount: $ or Range: $ to $ Start Date End Date This authority is to remain in full force and effect until COMPANY and DEPOSITORY has received written notification from me/either of us of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. Name: Signature: Contact Phone Number: Date: If Joint Account: 2 nd Name: Signature: Contact Phone Number: Date: *Please attach a voided check to be used to verify routing transit and account number information.

11 Camilla Schools, inc. D/B/A Westwood Schools Student Substance Abuse Policy Parental Acknowledgment Form I/We the undersigned parent(s) or legal guardian(s) of hereby acknowledge that Camilla Schools, Inc. d/b/a Westwood Schools ( Westwood ) Substance Abuse Policy has been reviewed and explained to me/us and that I/we have received a copy of Westwood s written policy statement. We further acknowledge the following: 1. That I/we have been notified that the unlawful manufacture, distribution, dispensation, possession or use of alcohol, drugs or other controlled substances is prohibited on Westwood s property or during any school sponsored activities, and that violation of these prohibitions will subject my/our child to rehabilitation referral and/or discipline up to and including expulsion. 2. That as a condition of continued enrollment, my/our child will abide by Westwood s Substance Abuse Policy, including the provision for random testing of all students. It is agreed and understood that if my/our child fails the drug and/or alcohol test by testing positive, he/she will be referred to a rehabilitation or substance abuse assistance program at my/our own expense, and/or disciplined in accordance with Westwood s policy up to and including expulsion. Any refusal to be referred to rehabilitation will result in immediate expulsion. I/We further acknowledge and agree that if my/our child fails a second or follow-up drug and/or alcohol test he/she will be subject to immediate expulsion without the possibility of reinstatement. Also, it is agreed that if my/our child is convicted of a violation of a criminal drug statute, I/we will notify Westwood within five (5) days of conviction. 3. That I/we acknowledge and consent freely and voluntarily to Westwood s right to conduct unannounced searches for illegal drugs and alcohol on Westwood property, in all facilities and vehicles on school property. It is understood that Westwood has the right to inspect lockers, desks, work areas, vehicles, and other containers and objects on Westwood s property that might conceal illegal drugs and alcohol. I/We further acknowledge and consent freely and voluntarily to reasonable searches of my/our child s person and his/her personal property. It is understood that failure to cooperate fully with Westwood in this regard will result in disciplinary action up to and including possible expulsion. I/We the undersigned parent(s) or legal guardian(s) understand and agree to the above terms and conditions of attendance at Westwood. Student Name Social Security Number Parent/Legal Guardian Signature Parent/Legal Guardian Signature Date Westwood Witness Date

12 GOAL Scholarship Criteria 1. The maximum amount of tuition assistance available per student will be 50% of tuition only. This does not include other required fees. 2. All students in grades that are eligible for tuition assistance will be tested. 3. All applicants must be determined eligible for admittance (regarding academics, discipline, attendance and drug screening) by the Westwood Acceptance Committee before they are allowed to apply for any financial assistance. 4. After initial acceptance, the Westwood Financial Assistance Committee, which consists of five Westwood supporters (who do not currently have children enrolled in Westwood), will determine eligibility for financial assistance. These committee members serve 2 year terms. 5. Students are eligible for only one form of assistance. 6. Drug screening is a part of the application process. 7. Each year the Westwood Acceptance Committee will review the number of students in each class and determine which grades have scholarship opportunities that will not require additional staffing. Priority will be given to these grades so Westwood can enjoy the benefits of adding students without incurring additional expenses when and where possible. Our current target enrollment is 450 (30 students per grade). 8. If a class is reaching capacity, full paying students will receive priority over scholarship students. 9. The registration fee of $300 (for current families)/$350 (for new families) has to be submitted with the scholarship application. The registration fee is refundable when: 1) No scholarship funds are available, or 2) Applicant is determined to be ineligible for assistance. The registration fee is not refundable when the applicant is approved for scholarship but chooses not to enroll. 10. Applicants are required to be enrolled in public school a minimum of 1 year before they are eligible to return to Westwood and apply for scholarship funds. (This rule does not apply to students entering K4 or K5.)

13 Authorization Agreement for Charge Card Payments I (We) authorize Camilla Schools, Inc. to initiate debit entries to my VISA/Mastercard (choose one) Card number Expiration date 3 digit verification code Set Amount $ Choose the 1 st or 15 th as your payment date Start Date End Date Printed Name: Signature: Date: Contact Phone Number: Please attach a copy of front and back of your card

14 Westwood After School Care 1. After school care is available for students in grades K3 5 th grade. 2. Snacks are provided for children who stay after 3: Charges are only for days in attendance and are as follows: 2:30 3:00 $3.00 per day 3:00 5:00 $5.00 per day Past 5:00 $6.00 per day 4. A late charge of $5.00 per 15 minutes is added for students picked up after 5:20. Bills are mailed on the first of each month and are due by the 10 th each month.

15 Westwood Schools Acceptable Use Policy Each student in grades 5 12 must have this form signed and turned in. Students not returning the policy with parent signatures and theirs will have their USERID suspended and will not be allowed access to the school network. Purpose Passwords The primary purpose of the campus computer network is educational. The network serves as a resource for enriching teaching and learning objectives at Westwood Schools. Approved uses of the computer network are intended to enhance the established curriculum. Users are responsible for ensuring that their activities conform to Westwood Schools standards as an institution of Christian education.. The network is not for any private, commercial or business, or political use. If a password is assigned to a student or staff, that password should remain secure. Passwords should not be shared or transferred. All users of the network will be held accountable for their use of the computer, including any use of a computer or software by someone using their password. Disciplinary Action 1. suspended use from equipment or the system, 2. restricted access to equipment or the system, 3. financial restitution, 4. and/or other appropriate disciplinary measures Privilege All use of the computer network is a privilege and not a right. All users assume responsibility--personal, legal, financial, and otherwise--for their actions while using the computer network and while accessing Internet content over the school network. Inappropriate use can result in cancellation or restriction of access privileges, in addition to disciplinary or possible legal action. Prohibited Activities Involvement in any activity prohibited by law Transfer or storage of large files without permission Attempting to establish a commercial venture on the network Involvement with online games or gambling Storing and/or transferring obscene, pornographic, or sexually explicit materials Transferring chain type letters Sharing passwords Accessing any area of the school network without permission Interfering with normal and proper network operations Interfering with normal and proper Internet access/operations Refusal to grant access to files or directories used during school hours, regardless of their actual location (this includes personal accounts, if used at school during school hours) Accessing computer files of other students or staff

16 Copying protected software without authorization or permission Loading software of any kind without approval and permission Conduct on the Internet or over the network that is harmful, harassing, or otherwise offensive to others. Abuse or damage to computer equipment or software, especially if due to direct violation of these rules Using the network or Internet access for personal or entertainment purposes without approval or permission Downloading any file for any reason without specific approval from the system administrator or teaching personnel Any use of outside resources, such as collegeboard.com, that do not conform to the Acceptable Use Policy or rules of that website or projects such as flatclassroom.net that do not conform to the rules of that project. Violators are subject to penalties both at Westwood Schools and at the outside resource. Students may not share their full name in public spaces without specific parental permission. Students may not upload photos of an explicit or inappropriate nature to any website and may not identify individuals in any photos by their full name. Students must remove any material deemed objectionable by the teacher promptly. Professional Liability The system administrator and teaching staff at the school are not responsible for the actions or activities of students while using the computer network. While students will be supervised while using the network, it is impossible for the system administrator or teaching personnel to control or supervise the activities of every student in the lab at all times. Policy Changes Interpretation, application, and modification of this Acceptable Use Policy are within the sole authority and discretion of Westwood Schools. Any questions or issues concerning these policies and regulations should be directed to the system administrator at the school office. I have read and understand the acceptable use policies of Westwood Schools. Student Signature Date I have reviewed these acceptable use policies and reviewed them with my child and understand and support these policies. Parent Date Note: This policy must be signed and returned during the first two weeks of school or network access privileges will be revoked.