North Valley Christian Academy NEW ENROLLMENT CHECKLIST

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1 NEW ENROLLMENT CHECKLIST Student Names (please print) Please return all completed forms and enrollment fees to the NVCA school office. Complete the enrollment Registration Form. Keep a copy for your records. Read and acknowledge the Parental Support and Commitment Form and the Financial Commitment Contract. NOTE: Signatures are required on pages 6, 8, 13, 16 and the blue Emergency Form Updated immunization records Birth certificate Blue Emergency Form (one per student) Extended Care Waiver (include all students) Private School Affidavit Ages 6-16 years old (Parent responsible for having notarized and mailing to address on form.) Payments: Include non-refundable Enrollment Fee. ENROLLMENT FEE: $300 per student (Preschool Grade 8) $150 per student (Online High School) Additional Items: Total Paid: $ Check # Credit Card Select a method of payment (A, B or C) on the Financial Commitment Contract (page 7) with appropriate signatures Extended Care - attach non-refundable registration fee if applicable (pg 2) Special Concerns Form (PS 12 th grade student) Schedule Entrance Exam (after March 15 th ) (Kindergarten - 8 th grade student) Non-refundable $50 Fee Prior School Administrator Form ( 1 st - 12 th grade student) Prior School Teacher Form ( 1 st - 12 th grade student) FOR OFFICE USE ONLY Paperwork Completed Yes Date No Date Information/Pages to follow: Received on: NVCA Office hours Monday Friday 8:00 a.m. 3:30 p.m N. 41 st Dr., Suite C101, Anthem, AZ ph: fax:

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4 NEW ENROLLMENT REGISTRATION FORM 1. Complete Applicant Information for each student. 2. Read and acknowledge the Parental Support and Commitment Contract and the Financial Commitment Contract. 3. Submit enrollment fee for each child. STUDENT #1: APPLICANT INFORMATION (Please print) Name Last First Middle Gender: Male Female Birth Date Church Attending RACE: (Circle one below) A Asian B Black H Hispanic O Other I American Indian or Alaskan Native W Caucasian Grade applying for: (K-12) Preschool Class applying for: (PS2 PS3 PK4 KB) Days: T Th MWF M-F A.M. P.M. (circle) (circle) STUDENT #2: APPLICANT INFORMATION (Please print) Name Last First Middle Gender: Male Female Birth Date Church Attending RACE: (Circle one below) A Asian B Black H Hispanic O Other I American Indian or Alaskan Native W Caucasian Grade applying for: (K-12) Preschool Class applying for: (PS2 PS3 PK4 KB) Days: T Th MWF M-F A.M. P.M. (circle) (circle) 3

5 PRIMARY HOUSEHOLD Student Resides: Full-Time Part-Time Parent 1 Name Relationship SSN Work Phone Cell Phone Parent 2 Name Relationship SSN Work Phone Cell Phone Send to (circle one) Parent 1 Parent 2 or Both Address City State Zip Home Phone Father's Occupation Father s Employer Mother's Occupation Mother s Employer Marital Status: Married Divorced Separated Single Widowed SECONDARY HOUSEHOLD Student Resides: Full-Time Part-Time Parent 1 Name Relationship SSN Work Phone Cell Phone Parent 2 Name Relationship SSN Work Phone Cell Phone Send to (circle one) Parent 1 Parent 2 or Both Address City State Zip Home Phone Father's Occupation Father s Employer Mother's Occupation Mother s Employer Marital Status: Married Divorced Separated Single 4

6 NEW ENROLLMENT STATEMENT OF FAITH Statement of Faith 1. We believe the Bible to be the one inspired, infallible, authoritative Word of God. (2 Timothy 3:16 17, 2 Peter 1:20 21, John 20:31, Matthew 25:35) 2. We believe that there is one God, eternally existent in three Persons: Father, Son, and Holy Spirit. (Deuteronomy 6:4, Mark 12:29, Matthew 28:19, 2 Corinthians 13:14) 3. We believe in the deity of our Lord Jesus Christ, His virgin birth, His sinless life, His miracles, His vicarious and atoning death through His shed blood, His bodily resurrection, His ascension to the right hand of the Father and His personal return in power and glory. (Matthew 1:20 21, John 10:30 38, Matthew 26:28, Hebrews 9:14, 1 Peter 3:22, Philippians 2:9, Revelation 19:11 12) 4. We believe that regeneration by the Holy Spirit is absolutely necessary for salvation of the lost and sinful man. (Romans 8:11, 1 Peter 3:18, Romans 10:9 13, 1 John 1:9) 5. We believe the Lord Jesus Christ died for men s sins according to the Scriptures, and all who believe in Him have the forgiveness of sins through His blood. (1 Cor. 15:3, Eph. 1:7) We believe an individual becomes a child of God by being born of the Holy Spirit by the word of God through a personal faith in Jesus Christ. (John 1:12 13, 1 Cor. 3:16) 6. We believe in the present ministry of the Holy Spirit, by whose indwelling the Christian is enabled to live a godly life. (Romans 8:16, Galatians 4:6, 1 John 3:24, 1 Corinthians 3:16) 7. We believe in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation. (Hebrews 9:27, 2 Peter 2:9, Revelation 20:12, Psalm 96:13) 8. We believe that heaven and hell are definite places. (Luke 11:12, Acts 7:49, John 14:2 4, Hebrews 11:10) 9. We believe in the spiritual unity of believers in our Lord Jesus Christ. (John 14:23, Ephesians 5:30, 2 Corinthians 11:2, Deuteronomy 14:2) North Valley Christian Academy does not discriminate in regard to race, creed, color, handicap, familial status or national origin. 5

7 PARENTAL SUPPORT AND COMMITMENT FORM North Valley Christian Academy is a partnership between parents and the school. The opportunity for families to choose an education at NVCA requires parental understanding of the commitment to the various policies and procedures necessary for the efficient operation of NVCA. These are listed below in the form of statements of support and commitment. 1. We recognize that our child s education needs strong, positive parental support. Therefore, we will support all school policies and procedures and the authority of the board, administration, faculty and staff. Additionally, we agree to pray for the students, volunteer our time, and attend events and activities throughout the year. ( Remind them to be subject to rulers and authorities... Titus 3:1-2) 2. We agree that if a conflict arises between our child/family and others in the NVCA family (students, parents, faculty, staff, or administrator), we will address the concern directly with that person alone. This policy of conflict resolution is based on the biblical principle found in Matthew 18: If your brother sins against you, go and show him his fault, just between the two of you. 3. We agree that NVCA has full discretion for the grade placement and teacher assignment of our child. 4. We agree to cooperate with the school to ensure our child s daily attire meets the Dress Code. 5. We are aware of the rules of North Valley Christian Academy and will actively support NVCA in the administration of those rules. 6. We grant permission for our child to attend all school-sponsored trips and activities throughout the school year unless we request, in writing, non-participation in an event. 7. We understand that our child s likeness may be photographed or videotaped by the school in the course of school activities. We hereby give consent for the school to use our child s likeness in promotional and/or advertising materials, including the use of video and still photos on the school s website. We understand that to withhold consent, we must provide a written statement, signed and dated, to the school. 8. We give authority to the administrative designee to render care of first aid in case of illness or injury. 9. Due to sensitivities NVCA is a peanut/nut sensitive campus. NO peanut or nut containing products are allowed. 10. We understand that if at any time the school determines, in its sole discretion, that our actions do not support the school, its values, the ministry, or reflect a lack of cooperation and commitment to the home and school working together, the school has the right to request the withdrawal of our child. 11. We have read the NVCA Statement of Faith (page 5) and understand that these biblical tenets will be taught and applied throughout the school program. We have read all of the policy provisions listed on this Parental Support and Commitment Form. The signatures below indicate our understanding of these policies. Father/Guardian Signature Mother/Guardian Signature Date Date Please Print Student Name(s): 6

8 FINANCIAL COMMITMENT CONTRACT TERMS AND CONDITIONS This Contract is subject to the following terms and conditions: 1. Enrollment of any student may be terminated for any reason at the administration s sole discretion, when it is determined that dismissal is in the best interest of the student and/or NVCA. 2. NVCA will exclude any student when the tuition account for said student is in arrears of 45 days, unless specific financial arrangements have been made with the Business Manager and approved by the school board of trustees. 3. If the parent(s) or guardian(s) does not pay the financial obligation in full, resulting in a contractual delinquency, NVCA may refer the matter to an appropriate third-party representative for collection. Any fees incurred will be added to the outstanding financial obligation. 4. I (We), as the parents(s) or guardian(s) of the student, agree and acknowledge that tuition and extended care fees shall be paid through FACTS Tuition Management. 5. No student transcripts or records will be released until the account is paid in full. PLAN A PLAN B PLAN C Annual Payment (5% discount) Due July 5, 2015 $ Semester Payment (3% discount) July 5, 2015 $ Dec. 5, 2015 $ Monthly Payments: 11 months for K-8 Tuition begins on July 5, 2015 $ 10 months for Preschool Tuition begins on August 5, 2015 $ 10 months for Extended Care begins on August 5, 2015 $ 6. I (We) plan to apply for NVCA Tuition Assistance: YES NO (K-8 only) 7. Online High School: Registration Fee and Tuition payment due at time of enrollment. STUDENT NAME GRADE/CLASS TUITION PAYMENT AMOUNT FINANCIAL OBLIGATION The partnership between North Valley Christian Academy and our families includes fulfilling our obligations to one another with integrity. NVCA commits to annual fixed costs, such as teacher salaries, benefits, and curriculum, based on parental student enrollment commitments. These NVCA expenses must be paid even when a student withdraws. Therefore, by entering into this financial commitment, families understand this is a binding agreement necessary for the healthy financial operation of NVCA. 7

9 FINANCIAL COMMITMENT CONTRACT (2 nd page) WITHDRAWAL PROVISIONS If a student is withdrawn, in writing, on or before July 4, 2015, no tuition liability will be assessed for that student. If any tuition payment has been made for the student, the entire amount will be refunded. If a student is withdrawn, in writing, between July 5, 2015 and August 10, 2015, the tuition liability will be equivalent to 20% of the annual tuition for that student. If a student is withdrawn, in writing, between August 11, 2015 and January 4, 2016, the tuition liability will be equivalent to 60% of the annual tuition for that student. If the student is withdrawn, in writing, on or after January 5, 2016, the tuition liability will be equivalent to 100% of the annual tuition for that student. All withdrawals MUST be presented in writing to the school office. If the student(s) is/are accepted for enrollment at NVCA, we, the undersigned, agree to the provisions of the Financial Commitment Contract and Withdrawal Provisions and agree to be bound by them. We further agree to act in good faith to support and encourage the faculty, staff, administration and students of NVCA with our volunteer time, financial gifts, and prayer support. Signature: Signature: Date: Date: All Tuition and Extended Care accounts must be paid through FACTS Tuition Management. Set up your account on the school website at Campus Life, Parent Links, FACTS Account. 8

10 Accessing ParentsWeb RenWeb s ParentsWeb is a private and secure parents portal that will allow parents to view academic information specific to their children, while protecting their children s information from others. For the school year you may view your child s billing statement, as well as other useful school information. All you need is an Internet-capable computer. Here s how to access our easy-to-use RenWeb ParentsWeb Make sure that the school has your address in RenWeb. In Internet Explorer, Firefox, or Safari, go to and click Logins. Type the school's District Code NV-AZ. Click Create New ParentsWeb Account. Type your address and click Create Account. An will be sent which includes a link to create your ParentsWeb login. The link is active for 6 hours. Select the Click to Create your ParentsWeb login link. A web browser displays your Name and RenWeb Person ID. Type a User Name, Password, and Confirm the password. 9

11 Click Save User Name and/or Password. A message displays at the top of the browser, "User Name/Password successfully updated." You may log in to ParentsWeb using your new User Name and Password. ParentsWeb allows you to access: o Progress reports and reports cards o Family Statement 10

12 42101 N. 41 st Dr. Suite C101 Anthem, AZ (623) Fax (623) TEACHER ANALYSIS (Grades 1-12) Name of applicant: Current Grade First Middle Last Present or last school attended: Phone Number The applicant above applied for admission to North Valley Christian Academy. We appreciate your cooperation in completing this form. Your responses will assist us in determining the appropriate placement for the student. Please complete the following information and return it to the address above or fax it to NVCA at Thank you for your time and help. Name of Teacher Years You Have Known This Student Signature of Teacher Date Would you recommend this student for acceptance into North Valley Christian Academy YES NO Does this student have any significant limitations (physical, social, emotional)? YES NO Describe any disciplinary issues in which this student has been involved: Please rate the student in each of the areas listed below: Academic Ability Exceptional Good Average Below Average Very Low Leadership Ability Exceptional Good Average Below Average Very Low Initiative & Drive Exceptional Good Average Below Average Very Low Homework Responsibility Assignments always on time Assignments mostly on time Assignments sometimes missing Assignments frequently missing Assignments never turned in on time Behavior/Attitude Exceptional Good Average Below Average Very Low Respect for Authority Exceptional Good Average Below Average Very Low Honesty/Dependability Exceptional Good Average Below Average Very Low Attendance Never Absent Rarely Absent Sometimes Absent Frequently Absent Often Absent Additional Comments: 11

13 42101 N. 41 st Dr. Suite C101 Anthem, AZ (623) Fax (623) ADMINISTRATOR ANALYSIS (Grades 1-12) Name of Applicant: First Middle Last Present or last school attended: The applicant above has applied for admission to North Valley Christian Academy. We appreciate your cooperation in completing this form. Your responses, along with the teacher recommendations, test scores and prior academic records will assist us in recommending the appropriate placement for the student. Please complete the following information and return it to the address above or fax it to NVCA at Thank you for your help. Applicant s Date of Birth Parent/Guardian Signature 1. This student is in good standing with this institution academically. 2. This student is in good standing with this institution behaviorally. 3. This student has been suspended during enrollment at this institution. 4. This student has been expelled during enrollment at this institution. 5. This student has been sent to alternative school during enrollment. 6. The family is supportive of this student. 7. The family is supportive of the decisions and policies of this institution. 8. The family is in good standing with this institution financially. 9. I recommend this applicant. Please list any special discipline or social adjustment problems: YES NO Comments: Name Signature (Please Print) Position Date 12

14 SPECIAL CONCERNS PS- Grade 12 STUDENT NAME GRADE APPLYING FOR (circle one) PS PK K Please answer all of the following questions. Having a special concern will not in itself disqualify your student from attending North Valley Christian Academy. However, in order to make appropriate enrollment decisions and to know whether we can serve the needs of our students, please complete this form as thoroughly as possible. YES NO Does your student have or has your student had an IEP (Individual education plan)? If yes, what year was the plan written? Date of anticipated retesting: YES NO Does your student have (or had in the past) a 504 Plan? When written? YES NO Has your student ever received special education services? If so, please explain: YES NO Has your student ever been referred for special education testing? If so, please explain: YES NO Has your student had any previous problems with attendance (extended absences, tardies, truancy, chronic illness)? If so, please explain: YES NO Has your student received any detentions, suspensions, or expulsions? If so, please explain: YES NO YES NO YES NO YES NO YES NO Has your student ever been asked to withdraw from a school? If so, please explain the circumstances: Has your student undergone counseling (pastoral or professional) for any reason? If so, please explain: Does your student have a health condition that may affect his or her ability to learn? Examples would include, but are not limited to, attention deficit disorder, hearing or vision impairments, mood disorders, etc. If so, please explain: Does your student have a health condition that will require accommodations in the classroom? Examples would include, but are not limited to, diabetes, seizure disorders, gastrointestinal disorders, orthopedic issues? If so, please explain: Are there any other factors in your student's life about which we should know to help us provide the best possible education? If so, please explain: Failure to tell the truth during the admissions process or failing to disclose factors that may impact your student's education at North Valley Christian Academy are sufficient grounds to deny admission or may subject your student to expulsion per school policy. Please acknowledge that you have read and understand this policy by signing below. PARENT/GUARDIAN DATE 13

15 K-12 th GRADE TUITION ASSISTANCE PROCESS Scholarships are available through many private School Tuition Organizations (STO s) utilizing the state of Arizona private school tuition tax credit program. Families requesting assistance from NVCA must first apply for scholarships through this program before any NVCA grants will be considered. Several of these STO s are listed below. Families are encouraged to apply to as many as possible. Requirements and guidelines vary by organization. NVCA Tuition Assistance Process 1. Complete the online "FACTS Grant & Aid Assessment" at This is a third-party service for the determination of each family's financial need. The information that you provide on the Tuition Assistance Grant Application will generate a confidential report by Facts Grant and Aid Assessment. There is a one-time fee payable to FACTS. This report will provide a recommended amount of assistance; however, the NVCA Grant Committee will make the actual grant determination. 2. Facts Grant and Aid Assessment sends the processed assessment to NVCA. 3. Application deadlines are May 1, 2015 and October 15, NVCA Financial Grant Committee reviews all applicants and determines grants. Families are notified by June 1, 2015 and November 1, School Tuition Organizations (STO) Arizona Christian School Tuition Organization (ACSTO) P.O. Box 6580 Chandler, AZ Arizona Private Education Scholarship Fund N. Frank Lloyd Wright Blvd. #210 Scottsdale, AZ Arizona Scholarship Fund (ASF) P.O. Box 2576 Mesa, AZ Arizona School Choice Trust, Inc. (ASCT) P.O. Box 1616 Glendale, AZ

16 K-12 th GRADE TUITION ASSISTANCE PROCESS Institute for Better Education (IBE) 5151 E. Broadway, Suite 1600 Tucson, AZ Lutheran Education Foundation, Inc. (LEF) P.O. Box Phoenix, AZ LEF Awards are based on financial need. Fall applications are due by May 1st. Families need to fill out a FAIR (Financial Aid Independent Review) form. Forms are available online at (Use school code: 600 and Password: lef600). School Choice Arizona, Inc. (Kindergarten and NEW 1 st 8 th grade students) 2241 E Pecos Rd. Suite 3 Chandler, AZ Tuition Organization for Private Schools (TOPS) P.O. Box Mesa, AZ NVCA S.T.A.R. Program Families may generate income to help offset tuition costs through Student Tuition Annual Rebates. Rebates are offered on gift card purchases to local and national retailers. To utilize this program, families need to submit the STAR registration form. For information contact the school business office. North Valley Christian Academy does not discriminate in regard to race, creed, color, handicap, familial status or national origin. 15

17 PARENT WAIVER FOR EXTENDED CARE Preschool Grade 8 PARENT WAIVER FOR EXTENDED CARE Preschool Grade 8 School Year I, _, give North Valley Christian Academy staff members permission to sign my child(ren), (Print each student s first and last name) in and out of the Extended Care classroom and the Preschool classrooms (if applicable) as necessary on my behalf. Parent Name (please print) Parent Signature Date THIS SIGNED FORM MUST BE ON FILE FOR EVERY STUDENT. (Signing this form does not enroll your child in Extended Care. Rather, in the event that you might be late picking up your child one day from school, completion of this form will allow your child to be placed in Extended Care until you arrive.) 16

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