Pinewood
Christian
Academy
198 Knight Boxx Road
·
Middleburg
,
FL
32068
Phone: (904) 272-6408 ·
Fax: (904) 644-0566
_________________________________________________________________
ENROLLMENT APPLICATION
(PLEASE PRINT)
STUDENT INFORMATION
Circle Grade to
Enter:
PreK K
1 2
3 4
5 6
7 8
Child’s Legal Name__________________________________________________
(First)
(Middle)
(Last)
Address___________________________________________________________
(Street)
City_________________________ State_____________
Zip________________
Home Phone
Number____________ Birthday__/__/__ Age___ Male__ Female__
FAMILY
INFORMATION
Father’s Name
_____________________ Mother’s Name___________________
Father’s Employer__________________ Mother’s
Employer_________________
Business Phone____________________ Business
Phone____________________
Head of Household________________________________
Relationship to child: __Father __Stepfather __Mother __Stepmother
__Guardian
Current Marital Status: __Married __Single __Divorced
__Widow ___Separated
CHURCH
INFORMATION
Church
Affiliation___________________________________________________
Pastor’s
Name______________________________________________________
How did you hear about
Pinewood?_____________________________________
EDUCATION
INFORMATION
List all school
attended beginning with Kindergarten
School Name
City
State
Grades Attended
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Has your
child ever been retained in any grade? _____ If yes, please state reason(s):__________________________________________________________
__________________________________________________________________
__________________________________________________________________
Has your
child ever been suspended or expelled? ____ If yes, please state reason(s):__________________________________________________________
__________________________________________________________________
__________________________________________________________________
Does your child require medication for any condition? ____ If yes,
please comment on the nature of the condition and/or the type and frequency of
the required
medication:_________________________________________________________
______________________________________________________________________________
In making
this application, I understand and agree:
·
To submit to the policies described in the Pinewood Christian Academy
Parent-Student Handbook.
·
To make all tuition payments when due.
·
As a covenantal Christian school, at least one parent/guardian in the
family must be a professing Christian, trusting in Jesus Christ alone for
eternal life, who is a member of a local church and attends worship services
regularly. The signature of your
church’s pastor serves as an endorsement of this requirement.
Professing Parent /Guardian’s
Signature:________________________
Pastor’s
Signature:_________________________________________
ENROLLMENT
PROCEDURE
1.
Pay
Registration Fee (A requirement to hold student’s place in school.)
2.
Arrange
for parent interview.
3.
Arrange
for Testing and pay fee.
4.
Arrange
for applicant placement testing if appropriate and transfer of records from
previous school.
5.
PCA will
notify you in writing with the decision regarding acceptance.
6.
Upon acceptance and admission to the
Pinewood
Christian
Academy
the following forms will need to be furnished to the school office:
·
__ Birth Certificate from Bureau of Vital Statistics
·
__ Immunization / Health Form
7.
Sign and
return contract to school office.
Pinewood
Christian
Academy
does not discriminate
on the basis of race, color, or national origin.
| 