Reenrollment Application 2014-2015

Hope Christian Academy
612 S. Broadway
Skiatook, OK 74070
918.396.4000
Reenrollment Application 2014-2015
________________________________ ___________________
Student’s Legal LAST Name (Please print)
Legal First Name
Legal Middle Name
Goes by (nickname)
Street Address: ___________________________ City: ________________ State: _____ Zip: ____________
Home Telephone: _________________________ Student’s Email Address: ___________________________
Date of Birth: ________________ Age: ______ Place of Birth: _____________________________________
Circle: Male/Female Student SS #: __________________ Ethnicity: ______________________________
Grade Applying to:
PK2: (3 day 8:00 – 1:00)
PK3: Circle One (2 day 8:00-1:00) or (3 day 8:00-1:00) or (Full time)
Extended Package Option:
(2 day extended - 8:00 – 3:15)
(3 day extended - 8:00 – 3:15)
PK4: Circle One (2 day 8:00-1:00) or (3 day 8:00-1:00) or (Full time)
Extended Package Option:
(2 day extended - 8:00 – 3:15)
(3 day extended - 8:00 – 3:15)
K
1
2
3
4
5
6
7
8
9
FAMILY INFORMATION
__________________
Full Name of Father/Guardian (include title: Mr., Dr., etc.)
Last Name
First Name
Street Address: _________________________ City: ___________________ State: ______ Zip: __________
Home Telephone: _________________________ Father’s Cell Phone #: ______________________________
Father’s Employer: _________________________ Occupation: ____________________________________
Father’s Email Address: __________________________ Father’s Work Phone #: _____________________
______________
Full Name of Mother/Guardian (include title: Ms., Mrs., Dr., etc.)
Last Name
First Name
Street Address: _________________________ City: ___________________ State: ______ Zip: __________
Home Telephone: _________________________ Mother’s Cell Phone #: _____________________________
Mother’s Employer: _________________________ Occupation: ____________________________________
Mother’s Email Address: _____________________ Mother’s Work Phone #: ______________
OVER
Grandparent Information:
Revised 4/13/11
________________________________________________________________________________________
Name
Address
City
State
Zip
________________________________________________________________________________________
Name
Address
City
State
Zip
Church Presently Attending: _________________________________ Pastor’s Name ___________________
Emergency Contacts/Pickup Authorization: Check the box if allowed to pick up child from school.
______________________ _________________________ ____________________ _______________
Name
Relation to Student
Address/City/State/Zip
Phone Number
______________________ _________________________ ____________________ ______________
Name
Relation to Student
Address/City/State/Zip
Phone Number
______________________ _________________________ ____________________ ______________
Name
Relation to Student
Address/City/State/Zip
Phone Number
______________________ _________________________ ____________________ ______________
Name
Relation to Student
Address/City/State/Zip
Phone Number
Other Children in Family:
_____________________________ _______________________________ __________________________
Name
Age
Name
Age
Name
Age
_____________________________ _______________________________ __________________________
Name
PLEASE check all that apply:
Age
Name
Age
Name
Age
Student lives with both parents
Parents are separated
Father is deceased
Mother is deceased
Student lives with Mother
Student lives with Father
Grandparent(s) has (have) custody
Parents are divorced
Joint custody of student is held between ________________________ and ________________________
Please describe any recent changes in the student’s life which may impact his or her performance, success,
and/or conduct at Hope Christian Academy. (i.e. family relocations, loss of a loved one, etc.)
________________________________________________________________________________________
_____________________________________________________________________________________
By signing below, I affirm that I have furnished all the information requested in this application and that all information
provided is true, complete, and honestly presented. I understand that any inaccurate or incomplete information may result
in denial of the application or expulsion from Hope Christian Academy. I authorize my child’s previous or current school as
well as all other entities who have information relevant to this application to release such information to Hope Christian
Academy and hereby release Hope Christian Academy and all entities providing information pursuant to this authorization
from all claims and liabilities arising out of or relating to this authorization.
Applicant Signature (if applicable): ____________________________________________________________
Father/Guardian Signature: __________________________________
Date: ________________________
Mother/Guardian Signature: __________________________________
Date: _______________________
Notice: Hope Christian Academy reserves the right at all times to modify its admission requirements and to discontinue,
modify, or change its educational programs when it determines that it is in the best interest of the school to do so.
Non-Discriminatory Policy: Hope Christian Academy admits students of any race, color, national and ethnic
origin to all the rights, privileges, programs, and activities generally accorded or made available to students
at the school. It 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, and athletic
and other school-administered programs.
Revised 4/13/11
Hope
Christian Academy
Fee Schedule 2014--2015
Enrollment Fee: (Due at the time of enrollment)
All students – $150.00
Books & Supplies Fee: (Due by June 1, 2014)
PK2 thru PK4 - $ 200.00
K-9th Grade - $350.00
Discounts
Note: All students will be responsible for providing their own school supplies.
Family Discount:
10% discount for each additional
Tuition for August 2014 to May 2015:
sibling attending HCA five days a
PK2 3 day (8:00-1:00) - $255/mo (for 10 mo) or $2,550/school year
week.
PK 3 & PK 4
Prepayment Discount:
2 day (8:00-1:00) - $200/mo (for 10 mo) or $2,000/school year
10% discount for paying tuition
semi-annual or in full by Aug. 1,
3 day (8:00-1:00) - $255/mo (for 10 mo) or $2,550/school year
2014.
Full Time (8:00-3:15) -$385/mo (for 10 mo) or $3,850/school year
IMPORTANT CHANGE
Extended Package
EACH STUDENT IS ONLY
2 day (8:00-3:15) - $255/mo (for 10 mo) or $2,550/school year
ALLOWED 1 DISCOUNT.
Lunch
Lunches may be packed and
3 day (8:00-3:15) - $345/mo (for 10 mo) or $3,450/school year
K-9th Grade
All students - $380/month (for 10 mo) or $3,800/school year
brought from home or purchased
through the HCA cafeteria. The
lunch menu is published
The following options are available for Tuition Payments:
(Payments can be paid by cash or check.)
Option 1 – Payment in full by August 1
monthly via the school website
Option 2 – Payment by semester by August 1 and January 1
and is sent home in Friday
Option 3 – Monthly payments over 10-months (August-May)
envelopes. The cost for lunch is
$2.00 for preschool & $3.00 for
K5 – 9th.
Extended Care
Extended care is available from
7:30am to 8:00am at no charge.
We also offer after school care
Payment of the financial obligations under this will be considered late if HCA has not
received full payment of tuition, fees, and expenses due by the 10th of the month in which
the above schedule indicates they are due. The penalty assessed for late payment will be
$25.00.
PLEASE NOTE: All fees are subject to change and are NON-REFUNDABLE except where students
are not accepted by the school due to classes being filled, failure to meet entrance standards, or
parents who move out of the greater Tulsa metropolitan area. For these cases, please see the
Student Handbook for the refund procedure.
from 3:25pm to 6:00pm.
Extended Care will be billed at
an hourly rate of $4.50/hour
using 15minute increments. Late
charges of $10 for every 15
minutes late will be incurred if a
child is not picked up by 6:00
p.m.
Hope Christian Academy
612 S. Broadway
Skiatook, OK 74070
(918) 396-4000
www.hcaskiatook.com
Revised 4/13/2011
HOPECHRISTIANACADEMY
(All1stGrade–9thGradeStudents&Parentsarerequiredtoreadandsign)
STUDENTCODEOFCONDUCT
Hope Christian Academy holds that the Bible is the inspired and only infallible and authoritative written Word of
God, that salvation comes through repentance and faith in the precious blood of Christ, and that regeneration by the
Holy Spirit is absolutely essential for personal salvation. Believers are to be transformed into the image of Christ
(Romans 8:29) which is the work of the Holy Spirit (I Corinthians 3:18). This transformation is to be a life-long
process (Romans 12:2). Hope Christian Academy strives to provide an environment conducive to the spiritual,
intellectual, physical, and social development of young people. Therefore, HCA provides a standard of conduct
based upon Biblical guidelines. The following Code of Conduct is presented as an agreement between the student,
the parents, and the school. Each student (1st – 9th grade) and parent is required to sign and return this form.
Student Code of Conduct
1. I understand that by enrolling as a student at Hope Christian Academy, I am accepting all school policies
outlined in the student handbook and the policies established by the school administration.
2. I shall adhere to the HCA Standardized Dress Code Policy as administered by the school to promote
excellence in character development.
3. I will show respect and submit myself to those in authority at HCA as well as any rules or regulations
established by the school, realizing that attendance is a privilege and not a right.
4. I realize that I am expected to put forth my best effort in homework, in preparation for quizzes and tests,
and in special academic projects since one of the primary reasons for enrolling as a student in HCA is
academic training. I understand that attendance is an essential element of learning and I shall put forth my
best effort in regular and timely attendance.
5. I understand that communication and interaction between parents, students, faculty, and administration is
encouraged. Communication should be carried on in a constructive and Biblical manner. I will seek to
follow the Matthew 18 principle in resolving conflict.
6. I shall refrain from the following destructive behaviors regarding the use of my words:
 Gossiping (repeating information about others that is not my concern or not edifying, whether true or
untrue)
 Slander (repeating information about others that is untrue)
 Mockery (disdainful or disrespectful talk about those in authority, the church, or scriptural principles)
 Profanity, Obscenity, Vulgarity, and/or Offensive Slang
7. I shall not lie, cheat, or steal. I am not only expected to adhere to this policy, but also to promote and
encourage my peers to do the same (I Chronicles 29:7).
8. I will refrain from the possessions of firearms, or any object used, intended or disguised as a weapon while
on school property or a school-sponsored function.
9. Fighting, whether it is physical or verbal, yelling or arguing with each other will not be tolerated.
10. I understand that HCA has standards of sexual conduct and social behavior that are based on Biblical
guidelines rather than those of the culture, the popular media, or peer groups. I shall govern my behavior to
hold to these standards.
11. I shall use any and all electronic media (cell phones; cameras; mp3 players; e-mail; internet; and websites,
such as myspace.com and facebook.com; etc.) in a manner that is constructive and Biblical. I shall make
my websites immediately accessible to HCA Administration at any time upon their request.
12. I shall not at any time use or possess drugs, tobacco, alcohol, and/or pornography since these are certain
destroyers of self-discipline, self-control, and definitely against God’s plan for Christian people.
13. I understand that the sovereignty of Jesus Christ is challenged by various forms of alternative teachings
(i.e., occult practices/teachings). I shall not be involved in these areas, and I shall not promote their practice
among other students.
14. I shall maintain Christian standards of courtesy and kindness in the way I treat others. I shall show respect
for my fellow students and the staff in my speech, attitudes, and actions.
15. I will uphold the HCA Student Code of Conduct at all times (on and off campus).
I have read, accept, and will abide by Hope’s 2014-2015 Student Code of Conduct
____________________________________________________________
Student Signature
____________________________
Date
____________________________________________________________
Parent/Guardian Signature
____________________________
Date
Hope Christian Academy
2014/2015 Tuition and Fees Contract
The undersigned hereby enters into a contract for the payment of all tuition, fees, and
expenses incurred for the enrollment of a student in Hope Christian Academy (HCA) for
the 2014/2015 academic school year. This contract is for the payment of all tuition, fees,
and expenses for the enrollment of
______________________________ (Student)
______________________________ (Student)
______________________________ (Student) ______________________________ (Student)
The undersigned agrees to be financially responsible and liable for payment of all financial
obligations related to the enrollment of the student identified above, consisting of annual
tuition paid according to the payment plan selected below, together with fees and expense
that may be assessed during the academic year for curriculum, lab fees, academic and
social club fees, and other expense related to education of the above student.
Academic Tuition
For information on HCA Tuition please refer to the 2014-2015 Fee Schedule. Payment in
full or by semester will earn a 10% discount. Also, we offer a multiple children enrollment
discount of 10% off each additional child enrolled. Discount will come off of the lesser
tuition amount. EACH STUDENT IS ELIGIBLE FOR ONLY 1 DISCOUNT APPLIED.
Tuition Due.
Option
Option
Option
There are three possible payment plans for tuition.
1: Payment in full by August 1, 2014.
2: Payment by semester by August 1, 2014 and January 1, 2015.
3: Monthly payments over 10-months (August-May)
Curriculum Fee
The book/supply fees for PK2 through PK4 students enrolled for the academic school year
is $200.00. The book/supply fees for K-9th grade students enrolled for the academic
school year is $350.00. Payment of this fee is due June 1, 2014 or at the time of
enrollment.
Please check which payment plan you will be following:
1) Full payment of all annual tuition due by 08/01/2014 _____ (10% discount on
the full tuition of any student enrolled for 2014.)
2) Two equal semester payments due on 08/01/2014 and 01/01/2015 for the full
tuition due for all students enrolled. _____ (10% discount for payments made
by this method)
3) Ten equal monthly payments are due on the 1st day of the month beginning
August 2014 and ending May 2015 for the full tuition due for all students
enrolled. _____
Before & After School Care
If any of the above students utilize After School Care at HCA there will be a fee charged per
day per student. There is no fee for Morning Care, but $4.50/hour per student for
Afternoon Extended Care. If the student attends Extended Care, payment of the fees due
will be payable upon your receipt of the monthly Extended Care bill.
OVER-
Late Payment
Payment of the financial obligations under this will be considered late if HCA has not
received full payment of tuition, fees, and expenses due by the 10th of the month in which
the above schedule indicates they are due. The penalty assessed for late payment will be
5% of the amount due or $25.00 whichever is greater.
Default
Payment of the financial obligations under this contract will be considered in default of
contract if HCA has not received full payment of tuition, fees, and expenses due as of the
first day of the month following the month in which the above schedule indicated they are
due (30 days past due). If any student’s Tuition and Fee Contract is 30 days past due the
financially responsible party for the contract will be notified by both letter and telephone
contact of the default status. Payment of all monies due will be required. If any student’s
contract is 60 days past due all report cards and transfer records will be held by HCA. If
HCA must pursue collection of any amount due under this contract all reasonable
expenses incurred, including attorney’s fees will be the financial obligation of the
undersigned.
Disputes
If a dispute arises between HCA and any family regarding past-due tuition, HCA reserves
the right to bring the dispute before the school board for further review.
Mediation / Arbitration Clause
The parties to this agreement are Christians and believe that the Bible commands them to
make every effort to live at peace and to resolve disputes with each other in private or
within the Christian church (see Matthew 18:15-20; 1 Corinthians 6:1-8). Therefore, the
parties agree that any claim or dispute arising from or related to this agreement shall be
settled by biblically-based mediation and, if necessary, legally binding arbitration. The
parties understand that these methods shall be the sole remedy for any controversy or
claim arising out of this agreement and expressly waive their right to file a lawsuit in any
civil court against one another for such disputes, except to enforce an arbitration decision.
By signing this contract, I certify that I have read and fully understand my financial
obligations to Hope Christian Academy and will pay said financial obligations in this
contract and abide by its terms.
Name:_______________________________
Signature:________________________ Date_______
Hope Christian Academy
Student Corporal Punishment Policy
*THIS FORM IS NOT APPLICABLE FOR PK2 – PK4*
I hereby authorize Hope Christian Academy to administer corporal
punishment (paddling) in accordance with the Parent and Student
Handbook, including all subsequent revisions:
“Punishment may include written assignments, in-school
suspensions/out-of-school suspensions, or calling parents/guardians
and requiring them to come to the school to administer corporal
punishment (paddling). Additional episodes may result in HCA
school personnel administering corporal punishment for those
parents/guardians that have given written permission. The corporal
punishment permission slip must be on file in the Admissions Office.
School administered corporal punishment may be given by a school
official of the same gender and witnessed by one other adult.”
I (we) agree with the corporal punishment policy.
Father’s/Guardian’s Signature ____________________________ Date ____________
Mother’s/Guardian’s Signature ____________________________ Date ____________
*Corporal punishment is only administered after the parent has
been contacted and conferred with administration.
HOPE CHRISTIAN ACADEMY 2014-2015
STANDARDIZED DRESS CODE FOR STUDENTS (K -9th Grade)
SHIRTS - Shirts need to be worn tucked in. Polo style (long or short sleeves) in black, grey, or white. Oxford
button-down shirt with button down collar (long or short sleeves) in white. Turtlenecks can be worn under
sweaters, polos, jumpers, or Spirit t-shirts or sweatshirts in black, grey, white, or purple. Peter Pan collar
blouses in white (girls only). No patterns, insignias, or brand symbols.
SWEATERS - Cardigan, zip, V-neck pullover or V-neck vest in white, black, or grey. No patterns, insignias, or
brand symbols.
PANTS - Docker/uniform style pant (cotton twill) in black or tan khaki. Pleated or flat front; zipper fly; regular,
straight, flared, tapered, or boot cut; no cargo or carpenter style, no draw string waists; no hip huggers; no bell
bottoms; no denim, corduroy, knit, or polyester material; must be worn at the appropriate waist level.
SHORTS - Docker/uniform style walking short (cotton twill) in black or tan khaki. Pleated or flat front; zipper fly;
no cargo or carpenter style, no draw string waists; no hip huggers; no denim, corduroy, knit, or polyester
material; must be worn at the appropriate waist level.
CAPRIS (Girls only) - Docker/uniform style capris (cotton twill) in black or tan khaki. Pleated or flat front; zipper
fly; no cargo or carpenter style, no draw string waists; no hip huggers; no denim, corduroy, knit, or polyester
material; must be worn at the appropriate waist level.
SKORT/SKIRT/JUMPER (Girls only) - Solid skort in black or tan khaki (no shorter than 4” from the floor when
kneeling). May be elastic waist with no belt. Solid skirt in black or tan khaki (no shorter than 4” from the floor
when kneeling). May be elastic waist with no belt. Solid jumper in black or tan khaki (no shorter than 4” from the
floor when kneeling). Polo dresses in black, white, grey or purple (no shorter than 4” from the floor when
kneeling). Black or khaki colored shorts must be worn underneath skirts and jumpers for modesty.
BELTS - Belts must coordinate with clothing. All 1st through 9th grade students must wear a belt with pants,
shorts and skirts (if there are belt loops present on the skirt). Belt buckles and belt adornments should reflect
Christian standards of good taste and modesty.
TIES - All grades may wear ties with the Oxford shirt only. Colors to be kept to solid black, purple or silver.
Stripes and/or designs are not acceptable.
SOCKS - Socks and tights must coordinate with clothing. Brightly colored, striped, or patterned socks or tights
should not be worn.
LEGGINGS - Leggings may be worn during cooler weather. Colors limited to white, black, and grey. Any lace
trimming should be the same color as the legging. Brightly colored, striped, or patterned leggings should not be
worn.
SHOES - All grades need to wear non-marking shoes to protect the gym floor. Tennis shoes are recommended
and must be laced with appropriate colored laces and tied during the school day. Casual or dress shoes are also
permitted. No boots of any kind, flip-flops, “Crocs”, roller skate shoes, or house slippers.
SPIRIT DAY ATTIRE - Throughout the year, Administration will select specific days as “Spirit Days”, primarily
the last school day of the week and while attending HCA field trips. These days are open for students to wear
their HCA Spirit t-shirts or sweatshirts with blue jeans, blue jean capris, and blue jean shorts (no overalls
permitted). The only acceptable color of jean is blue. Jeans and Spirit shirts may not be altered in any way (e.g.
markings, drawings, pins, rips, tear, holes, etc.). Spirit Hoodies are only allowed on Spirit dress days. Spirit
t-shirts and sweatshirts may be purchased from the school office. Those students who wish not to participate in
Spirit Day will be expected to be in full school uniform.
AFTER SCHOOL ATTIRE - The same standards of modesty, tightness, and shortness that apply to school
uniforms apply to attire worn at after school functions as well as athletic practices.
Hope Christian Academy
2014-2015 Emergency Information & Authorization to Administer Non-Prescription Medication
Student’s name: ____________________________________ Birth date: _______________________ Sex: M
F
Address: ______________________________________________________________________________________________
Parent/Guardian (First Contact): ___________________________________ Relationship: _____________________
Phones: (H) ____________________________ (W) ___________________________ (Cell) __________________________
Email: ________________________________________________________________
Parent/Guardian (Second Contact): _________________________________ Relationship: _____________________
Phones: (H) ____________________________ (W) ___________________________ (Cell) __________________________
Email: ________________________________________________________________
Health History
Physician: ___________________________ Phone: ________________________ Insurance: ______________________
Does your student have any potentially life threatening allergies to medicine or anything else?
Yes
No
(If yes, please list/explain symptoms noted and report if an EpiPen is required) ___________
_______________________________________________________________________________________________________
Does your student have any chronic or significant health problems, or any physical limitations?
Yes
No
(If yes, please list) _____________________________________________________________________
_______________________________________________________________________________________________________
Is your student being treated with any prescription medications at home or school? Yes
No
(If yes, please list) _____________________________________________________________________________________
Authorization to Administer Non-Prescription Medication
I hereby authorize the school nurse or other school personnel designated to administer medications, to
administer acetaminophen (Tylenol), ibuprofen (Advil/Motrin), diphenhydramine (Benadryl), calcium
antacid (Tums), & other non-prescription first aid medications to my student with the following exclusions:
_______________________________________________________________________________________________________
Students will receive authorized medications at the discretion of school personnel except the medication
excluded by parent/guardian above.
Authorization for Treatment
I hereby authorize any physician, surgeon, or dentist on the medical staff of the nearest medical facility,
to administer any emergency treatment/procedure or medicine necessary and advisable. I also authorize
the use of an ambulance, if necessary, to transport my child. I further agree to pay for all services
provided for my child. If this is not satisfactory, please list specific emergency instructions in the event
that you cannot be reached. ___________________________________________________________________________
_______________________________________________________________________________________________________
Preferred Hospital: ____________________________________________________________________________________
Signature of Parent/Guardian: _____________________________________________ Date: _____________________
Revised 4/13/11
HOPE CHRISTIAN ACADEMY
Permission to Publish Form
Student’s Name _________________________________________
Parent’s Name___________________________________________
This information is most often used for class lists for parents to
contact one another, Valentine’s Day, Birthday invitations, the local
newspaper, Facebook and our website.
Please initial each of these permission statements that apply:
____I(We) give permission to publish our address.
____I(We) give permission to publish our phone number.
____I(We) give permission to publish our email.
____I(We) give permission to use our student’s photo (still or video)
for publication/broadcast and marketing purposes.
____ I(We) give permission for our student to participate in school
fundraisers.
____I(We) certify that all statements provided by us are true.
My signature below is an acknowledgement that I understand that,
if checked, the above statements may be implemented by HCA.
Parent/Guardian Signature:________________________________ Date:____________
All information must be completed.
Non-Discriminatory Policy: Hope Christian Academy admits students of any race, color, national
and ethnic origin to all the rights, privileges, programs, and activities generally accorded or
made available to students at the school. It 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, and athletic and other school-administered programs.
Records Release Request
Mail to: Hope Christian Academy
Attn:
Student Records
612 South Broadway
Skiatook, OK 74070
Phone: 918-396-4000
Fax:
918-396-4009
Date Request:
Requested by:
HOPE
Christian Academy
_______________________________________________________________________________ Birthday_______/_______/_______
The above student, who formerly attended your school, has enrolled with Hope Christian Academy. Please send all
school records including: Cumulative record, transcript, disciplinary records, grades and up to date attendance of wit,
health and immunization records, standardized and criterion referenced tests and/or I.E.P. etc.
Is this student currently suspended or expelled from your school?
Would this student be accepted in your school upon wishing to re-enroll?
Is this student’s account current?
Yes  No 
Yes  No 
Yes  No 
Permission is hereby granted to release all records requested above.
______________________________________________________________________
Signature of Parent/Guardian
______________________
Date
________________________________________________________________________________________________________________
Previous school name, address, and phone number