209 W. College St. Enterprise, AL (334) Class: T 3 4 (Circle one) Date of Birth Hours are 8:00 a.m.-12:00 noon

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Darrell Miller
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1 Wiregrass Christian Academy 209 W. College St. Enterprise, AL (334) Class: T 3 4 (Circle one) Date of Birth Hours are 8:00 a.m.-12:00 noon Hourly extended care? yes no Full-Time extended care? yes no School Year: Child's Name Address street city zip Contact address Best Number for Automatic Calling Mother's Name Address street city zip Place of Employment Home phone # Work phone # Cell phone # Father's Name Address street city zip Place of Employment Home phone # Work phone # Cell phone # Child lives with: Parents Father Mother Other If child lives with a custodial parent, does the non-custodial parent have authorization to pick up the child? Yes No Church Affiliation List siblings and their ages: Are there other members of the household? If so, list name, age, and relationship: Is your child toilet trained? Describe assistance needed and words used.

2 Does your child have any special fears? Does your child have any problems with vision or hearing? If so, please explain. Does your child have any health problems that we should be aware of? Please explain. Are there any foods or drinks that your child should not have? What does your child usually eat for breakfast? Do you have any concerns about any aspect of your child's development? Is any language other than English used in the home? If so, please describe. List illnesses your child has had Does your child have frequent colds? earaches? sore throats? stomach aches? fevers? Has your child had any serious accidents or operations? If so, please describe. Does your child have any allergies? Please describe. Does your child take any regular medication? When did your child last see a doctor? Dentist? Are there any special medical, physical, or emotional needs that the school or staff should be aware of? _ How much television does your child generally watch each day? What are your child's favorite activities? What does your child enjoy doing with mother? What does your child enjoy doing with father?

3 Does your child play well alone? In groups? Are there neighborhood playmates? If so, what ages? Does your child accept correction easily? What method of behavior control is used in your home? Please circle items below that describe your child... Happy Aggressive Friendly Moody Clumsy Dependent Stubborn Impulsive Fearful Quiet Good-natured Even-tempered Attentive Sympathetic Shy Sleepy Other: Has your child learned to...? Say nursery rhymes? Sing songs? Listen to stories? Say his or her name? State his or her age and sex? Dress self independently? Recognize and name common objects? Count? How far? Follow simple directions? Throw and catch a ball? Name basic colors? Hop on one foot? Balance on one foot? Ride a tricycle? Write name? Draw a person? Other? (Please note additional significant accomplishments.) Has your child had group play experience? Has your child been cared for by someone besides the family? If so, please describe. Has your child gone to preschool or daycare before? Please describe previous experiences.

4 What do you hope will be included in your child's preschool program? Emergency Information Persons authorized to pick up your child (include parents): Name Relationship Name Relationship Name Relationship Name Relationship If both parents are not authorized to pick up the child, please provide a copy of the divorce decree and/or custodial agreement prohibiting the unauthorized parent from picking up the child. Persons to be notified in case of emergency if parents cannot be reached: Name Phone # Name Phone # Name Phone # Child's Physician Phone # Address Emergency Hospital Preference I understand that the registration fee is non-refundable, and I agree to pay fees and accounts when due. Signature of parent or guardian Date xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Office use: Registration fee receipted Permission form signed Certificate of immunization DHR form Copy of birth certificate Photo release Book fee

5 PHOTO AND VIDEO RELEASE FORM I,, as parent or legal guardian of Child s Name (Check One) O O Grant my permission Withhold my permission for Wiregrass Christian Academy to take photographs or record a video of my child during daily and/or special activities of the school. Such photos will be placed on school bulletin boards, used in the end-of-year slide show, included on the WCA web site and Facebook page, and used in local cable television and newspaper advertisements and articles. Signature of Parent or Guardian Date BLANKET PERMISSION FORM has my permission to go on all field trips with Wiregrass Christian Academy. I understand that the child named above will be well supervised and that I

6 will be notified of the time and place of the field trips. I agree that I will not hold responsible Wiregrass Christian Academy, the teachers or parent chaperones, or Wiregrass Christian Academy board members in case of accident or injury to the child named above. Signature of Parent or Guardian Date THIS FORM MUST BE NOTARIZED SECTION 2. FORM OF AFFIDAVIT (for parent/ guardian) STATE OF ALABAMA COUNTY OF: Coffee Before me, a Notary Republic in and for said State and County, appeared and is known to me, after being duly sworn or affirmed, says as follows: That affiant is the parent or legal guardian of the minor child/children ; that affiant has been notified by Joan B. Howell, a representative of Wiregrass Christian Academy, that said school has filed notice and is exempt under law from regulation by the Department of Human Resources. Parent/Legal Guardian Sworn, or affirmed to and subscribed before me this day of

7 , 20. My commission expires WIREGRASS CHRISTIAN ACADEMY 209 W. College Street Enterprise, AL (334) Price List for School Year Registration Fee : A non-refundable registration fee in the amount of $50.00 must be paid for each child registering for any class in the school year. No discount is applicable to this fee. The registration fee must be paid to officially reserve a place for your child. Book Fees : All book fees are due by June 30, 2017 Toddler Class : Pre-School : $ monthly (full-time M-F 6:45 a.m. 5:30 p.m.) $ monthly (part-time M-F 8:00 a.m. 12:00 p.m.) Hourly care is not available to children in the Toddler class. Registration Fee: $50.00 Book Fee: $50.00 (K3/K4) M-F 8 a.m. 12:00 noon $ monthly $ monthly (full-time M-F 6:45 a.m. 5:30 p.m.) Registration Fee: $50.00 K-3 -- Book Fee: $80.00 K-4 Book Fee: $ Children who stay after 12 noon should bring a lunch from home. Elementary School : ( K-6th grade) M-F 8 a.m.-3:00 p.m. : $ monthly Registration Fee: $50.00 Book Fee: Varies per class Tuition for the second child in the same family will be discounted by $20.00 per month. There are 3 options for tuition payment. These are annual, semi-annual, and monthly. Annual payment is due by August 10 (or within 10 days of registration date if student is a late enrollee). Semi-annual tuition payments are due on August 10 and January 10. Monthly tuition payments are due by the 10 th of each month. A $25.00 late fee will be charged if payment is not made by the 15 th of the month.

8 Extended care is available at the rate of $ 4.20 per hour. This charge will be billed on your statement at the end of each month. Anyone who arrives before 7:45 a.m. or leaves more than 15 minutes after school hours (noon or 3 p.m.) will be charged for extended care. You must sign your child in at the office if dropped off before 7:45 a.m. or after 8:05 a.m. All children must be signed out at the office if they are picked up any time other than their normal pick-up time. We must have your child s immunization certificate (blue card) on file prior to the first day of school. Parents of all new students must bring a copy of the child s birth certificate. Nondiscriminatory Policy Wiregrass Christian Academy shall not discriminate against any person on the basis of race, color, national or ethnic origin, sex, or age as related to admissions policies, educational policies, scholarships, loan programs, and athletics or other school programs.

9 TUITION PAYMENT PLANS TODDLER TODDLER ANNUAL (P-T) ANNUAL (F-T) By August 10 By August 10 $ $ SEMI-ANNUAL SEMI-ANNUAL August 10 $ August 10 $ January 10 $ January 10 $ monthly payments 10 monthly payments August May August May $ each month $ each month PRESCHOOL PRESCHOOL ANNUAL (P-T) ANNUAL (F-T) By August 10 By August 10 $ $ SEMI-ANNUAL SEMI-ANNUAL August 10 $ August 10 $ January 10 $ January 10 $ monthly payments 10 monthly payments August May August May $230 each month $430 each month ELEMENTARY ANNUAL By August 10 $ SEMI-ANNUAL August 10 $ January 10 $

10 10 monthly payments August May $310 each month

REGISTRATION FORMS. Child s Full Name: Birth Date: / / Boy Girl. Child s Full Name: Birth Date: / / Boy Girl

REGISTRATION FORMS. Child s Full Name: Birth Date: / / Boy Girl. Child s Full Name: Birth Date: / / Boy Girl REGISTRATION FORMS Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Address: City: State: Zip Code: Child #1 Days of the