PARK PLACE CHRISTIAN ACADEMY. 201 Park Place Drive Pearl, MS (601)

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1 OFFICE USE ONLY: PARK PLACE CHRISTIAN ACADEMY 201 Park Place Drive Pearl, MS (601) Birth Cert. DOB SS Card Ins Cd Imm 121 HB Check # Cash Date APPLICATION FOR ADMISSION TODAY S DATE: Afterschool Care Needed: Yes: No: STUDENT INFORMATION: Applicant's Name Grade Level Last First Middle Preferred Name Date of Birth Male/Female Social Security #: Home Address City State Zip Number and Street Home Phone Other Schools Applicant Has Attended: Name of School Location Grade Date Present School Number of years attended Complete address of present school City State Zip Street Address Principal/School Head Reason for Leaving Has your child ever been suspended from any school or asked to leave? Yes No (circle one) If yes, please explain I/We hereby authorize Park Place Christian Academy to obtain all scholastic information and files from all previous schools. Has the applicant ever been recommended for special education classes or ever been diagnosed to have a learning disability by a psychologist, psychiatrist or a specialist in learning disorders? Yes No Has the applicant ever been retained? Yes No Are you aware of any social adjustment or disciplinary problems outside the home? Yes No If yes, please explain Is the applicant presently taking any medication? Yes No (circle one)if yes, what?

2 Describe any allergy, illness, diseases or physical disabilities which either have affected or may affect your child's general health, schoolwork, or participation in the school's athletic programs. Has the applicant ever been recommended for alcohol/drug treatment or behavior/emotional treatment? Yes No (circle one) If yes to any of the above, please explain: PARENT INFORMATION Parent Father Mother Step-parent Guardian Other Full Name Home Address Home Phone Address Occupation Name of Company Business Address Business Phone Cellular # Pager # Fax # Church Attending Member Yes No Parent Father Mother Step-parent Guardian Other Full Name Home Address Home Phone Address Occupation Name of Company Business Address Business Phone Cellular # Pager # Fax # Church Attending Member Yes No FAMILY INFORMATION Parents Marital Status (check all that apply) Parents married Parents separated Parents divorced Mother remarried Father remarried Mother deceased Father deceased With whom does the student live? Name(s) Relationship If parents are separated, divorced or deceased, do you have legal custody or power of attorney? Who has legal custody?

3 List additional brothers and sisters: Name/Age School (if applicable) Grade Additional Information Student s Physician Phone Emergency Friend Phone Grandparent Phone Address Grandparent Phone Address Names and phone numbers of person(s) to whom we may release your child: Name Phone Name Phone Name Phone Please include your parental perspective on your child. Include your child s strengths and abilities, special areas of interest as well as areas of concern. We appreciate your assistance in helping us to know your child better. Special Interests and Talents

4 MISSION STATEMENT AND STATEMENT OF FAITH MISSION STATEMENT: Park Place Christian Academy partners with Christian parents to provide their children a Christ-centered education founded on the Bible which fosters spiritual development and instills the vision and practice of Christian excellence in academics, character, and service to others. STATEMENT OF FAITH: 1. We believe in the absolute accuracy of the Word of God and that the Bible is verbally inspired and allsufficient as the Christian s rule of life and practice (II Timothy 3:16, 17). 2. We believe in the total depravity of man through the fall of Adam (Genesis 3: Romans 5:12-17). 3. We believe that the one true God is manifested in three persons: Father, Son, and Holy Spirit, equal in all things as eternity, omnipotence, omnipresence, and omniscience (Matthew 28:19; II Corinthians 13:14). 4. We believe in the virgin birth of Jesus Christ (Luke 1:26-35); His absolute sinlessness (II Corinthians 5:21); and in the complete justification of the believers in Christ (Acts 13:38, 39: Romans 5:1). 5. We believe in the present assurance of salvation (I John 5:11-13); the present possession of eternal life by every true believer (John 5:24; 6:47); and the eternal security of the genuine believer (John 10: 28-30). 6. We believe that the ordinances of the Lord s Supper and baptism by immersion are to be observed by the church in the Lord s absence. (Matthew 28:19; Acts 8:36-39; Romans 6:1-5; I Corinthians 11: 23-26; Acts 2:42) 7. We believe in the resurrection of all believers at the pre-millennial coming of Christ and in the review and reward of believers according to their life and works. (Luke 14:14 John 5:28, 29: Romans 14: 10-12; II Corinthians 5:10; I Corinthians 3: 11-15; I Corinthians 15: 22, 23) 8. We believe in the love of God for the entire world (John 3:16), the necessity for the new birth through the Word of the Spirit of God (John 3:3-7; I Peter 1: 23-25), the indwelling of every true believer by the Holy Spirit (I Corinthians 6:19, John 14:16, 17); the uselessness of human works and merit to obtain salvation. (Romans 4:5; Ephesians 2:8, 9; Titus 3:5) 9. We believe in the finished work of Christ through which complete and eternal atonement for sins has been effected. (John 19:30; Hebrews 9:26, 28; Titus 3:5) 10. We believe in salvation by grace alone through faith alone. (Ephesians 2:8, 9; Acts 15:30, 31) 11. We believe in the efficacy of the blood of Christ, apart from which there can be no salvation (Hebrews 9:22; Ephesians 1:7; Colossians 2:20; I John 1:7); His vicarious death (Romans 5:6-8; Luke 24:26-40); His visible ascension (Luke 24:51, 51); His present enthronement (Hebrews 1:3); and His high priestly ministry and advocacy. (Hebrews 7:25, 26; I John 2:1) 12. We believe that mankind is absolutely helpless and cannot please God in an unregenerate condition. (Romans 3:9-19; 8:8)

5 13. We believe in the immediate entry into a literal hell by every person who dies without Christ (Luke 16:19-31); the resurrection of all such persons to stand before the Great White Throne of Judgment (John 5:28, 29; Revelation 20:11-13); and the consignment of all such persons into a lake of fire forever. (Matthew 25:46; Revelation 20:14, 15) 14. We believe in the separation from sin and the world by the Christian and a godly life to the glory of God. (II Corinthians 6:14, 7:1; Titus 2:11-14) 15. We believe in the rapture of the church, at the coming of Christ, to meet Him in the air (I Corinthians 15:51-57; I Thessalonians 4:13-18); the revelation of Christ at His coming to the earth prior to the setting up of His millennial kingdom (II Thessalonians 1:6-10); and the personal, literal reign of Christ over this earth of one thousand years. (I Corinthians 15:24-28; Revelation 12:1-11; 20:6) After acquainting yourself with Park Place Christian Academy s Philosophy and Statement of Belief, describe your expectations in regard to your child s education. Admission Procedure: 1. Submit completed application with a registration fee (non-refundable). 2. Submit copies of transcripts, immunization records, signed packet of authorization forms and enrollment contracts. 3. Schedule an interview with the Lower Elementary Principal (for 1st - 3rd grades) or the Headmaster (for 4th - 12 th grades). As the Parent(s)/Guardian of the student applicant named hereinabove, I/we state that we are aware of the Doctrinal Statement, Statement of Mission and Philosophy of Park Place Christian Academy and agree that upon acceptance of the herein named student, I/we will pledge ourselves to work with Park Place Staff, Administration and Faculty within these statements to the betterment of our student, and to assist and cooperate with the school in the Christian education of my/our child. I understand that the enclosed Application Fee is non-refundable. I further understand and acknowledge that continued enrollment of my/our child, if admitted to Park Place, shall be subject to the payment of all fees and charges set forth on the schedule of fees as periodically amended by Park Place and my/our child s compliance with Park Place s code of conduct and policies established by Park Place Christian Academy. I understand that the school will not administer exams, issue report cards, or post grades to permanent records until all charges are paid in full and all school property returned. I understand that Park Place Christian Academy will not release records to anyone, including me, until the above terms have been satisfied. Your signature indicates that the information in the enrollment application is correct and that you have read the Philosophy and Goals, that you are in agreement, and that you are under no financial obligation to any former school in order that records may be released to Park Place Christian Academy. Final grade placement is subject to Administrative approval, satisfactory completion of present grade, and verification of records/credits from previous school(s). Parent (Guardian) Date Guardian Date

6 NON-DISCRIMINATORY POLICY Park Place Christian Academy admits students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or make available to students at the school. Park Place Christian Academy does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions, policies, scholarship and loan programs, athletic and other school-administered programs. THE FOLLOWING MUST BE TURNED IN WITH THE COMPLETED APPLICATION: 1. Copy of Birth Certificate 2. Copy of Social Security Card 3. Copy of Current Immunization Record 4. Copy of grades and test scores from school last attended 5. Copy of insurance card (requested but not required)

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