Virginia Beach Christian Academy

A ministry of the Pentecostal Life Center

5277 Princess Anne Rd

Virginia Beach, VA   23462

757-473-1190

Rev. Robert Thorp, Pastor                                                                    Kimberly Thorp, Principal

APPLICATION FOR ENROLLMENT

Date _____________________

Student name: __________________________________________________________

Student information: Address_____________________________________________

City,State,Zip ____________________________________________________________

Social Security Number ________________________________________________

Telephone: ____________________ Age: _______ Gender: ____ Birthdate __________

Family Information

Father’s Name: __________________________________________________________

Address:                                                                                                                                  

City, State, Zip                                                                                                                        

Home Phone:                                        Employment: _______________________________

Social Security Number: ___________________________________________________

Position: _________________________________ Work Phone: __________________

Mother’s Name: _________________________________________________________

Address:                                                                                                                                  

City, State, Zip                                                                                                                        

Home Phone:                                        Employment: _______________________________

Social Security Number: ___________________________________________________

Position: _________________________________ Work Phone: __________________

If both father and mother are not the birth parents, have not adopted the child, or do not have full legal custody of this child including decision making powers, the child’s biological parent(s) will be required to sign all registration forms.

Religious Information

Families who desire to enroll or re-enroll their child in this academy must be faithful in attendance at their home church. Please provide the following information for the family members living in the child’s home. Student planners are to be signed each Sunday by the parent to verify the child’s church attendance.

Home Church: ___________________________________________________________

Address: _______________________________________________________________

Pastor: ________________________________________ Phone: _________________

Faithfulness in Attendance:

Father    Y / N             Mother    Y / N               Applicant    Y / N

Has the applicant made a profession of faith in Jesus Christ? Y / N                                       

Has the applicant been baptized in Jesus Name? Y / N                                                      

Has the applicant been filled with the Holy Ghost? Y / N                                                      

(with the evidence of speaking in other tongues, as the Spirit gave the utterance)

General Information

The application must be filled out completely before it can be processed. The application form and enrollment fee of $50.00 must be submitted for review. A $50 testing fee must be submitted prior to testing. The $23 planner fee must accompany the final enrollment papers. These fees are received incrementally and are not refundable.

The computer fee ($150) and Curriculum fee ($350) may be added to the tuition, which is an annual fee and all are due in full on or before August 15. Those who pay these charges in full upon enrollment/re-enrollment will receive a 10% discount. Those who choose to pay it in full by July 1, will receive a 5% discount. Those families who desire to do so may request the opportunity to make semi-annual, quarterly, monthly, or semi-monthly payments. Please complete the forms entitled “financial disclosure” and “promissory note”. Your application for a “payment plan” will be considered and you will be notified of the committee’s decision. All tuitions and fees must be paid prior to the release of your child’s final report card, or participation in graduation ceremonies.

I understand that by enrolling my child in this academy, I agree to hold the academy and the church ministry harmless and free from liability in the event of any injury to my child on school grounds or on school-sponsored trips away from the school premises.

I agree to uphold and support the high moral standards of this academy by providing an example of the same in my home.

I agree to uphold and support the high academic standard of the school by providing a place at home for my child to study and giving my child encouragement in the completion of any homework assignments and daily study of all subjects.

I agree to provide a compatible computer for my child to access and synchronize his/her homework and study and to lease the required disks for his/her computer subjects.

I appreciate the standards of the school and do not tolerate profanity, obscenity in word or action, dishonor to the Godhead and the Word of God, or disrespect to the personnel of the school. I hereby agree to support all regulations of the school in the applicant’s behalf and authorize this school to employ discipline as it deems wise and expedient for the training of my child.

I understand that the school reserves the right to dismiss any child who fails to comply with the established regulations and discipline or whose financial obligation remains unpaid.

I further agree to the arbitration policy as stated in the student handbook.

I have read the Student Handbook and agree to abide by and support the policies and procedures contained therein. I understand the terms stated on this application and agree thereto.

________________________________                    _____________________________

signature of father                                                    Signature of mother

________________________________                    _____________________________

date                                                                              date

Standard of Conduct

The student’s attitudes, conversation, and behavior reflect the character of the institution from which he derives his training, both home and church. This form reflects the church-school’s attempts to secure students who would best adjust to the rigor of a highly disciplined training program that must set high standards. These standards will result in a charactered student to lead in the reformation of our nation and the world. The student should answer these questions each year. Younger children may need help from their parents.

Are you a Christian?                                                                                             ___________

Have you been baptized?                                                                                  ____________

When were you baptized?                                                                                  ____________

Have you received the Holy Ghost with the evidence of tongues?                       ____________

When did you receive the Holy Ghost?                                                     ____________

Do you accept the Bible as God’s Word and submit yourself to                                                        It’s principles as the final authority?                                                  ___________

In an effort to maintain the highest standards of morality, the following questions must be answered by each applicant (parents may answer for young children)

Do you smoke or use smokeless tobacco?                                                          ____________

Have you done so in the past?                                                               ____________

Do you agree not to smoke or use smokeless tobacco as long                                                             as you are enrolled in this academy?                                                   ____________

Do you drink alcoholic beverages?                                                                   ____________

Have you done so in the past?                                                               ____________

Do you agree not to drink alcoholic beverages as long as you                                                       are enrolled in this academy?                                                                     ____________

Do you use marijuana or narcotics?                                                                     ____________

Have you done so in the past?                                                               ____________

Do you agree not to use narcotics of any kind as long as you are                                     enrolled in this academy?                                                                     ____________

Are you currently sexually active?                                                                         ____________

Have you been in the past?                                                                               ____________

Do you agree to abstain from sexual activity including fornication,                                                       and homosexual acts as long as your are enrolled in this academy?             ____________

Have you ever been arrested and placed on detention or probation?             ____________

Have you ever run away from home?                                                  ____________

When? ____________________________________________________________

Will you promise not to draw, wear or display any                                                                               Anti-Christian, gang or secular music symbols?                         ____________

Will you agree to dress at church-school functions or                                                                   outings that do not require the school uniform according to                                                     the church school standards (skirts or dresses below the knee                                               for girls, long pants for boys, no jewelry, make-up etc.) and                                          agree to the following requirements for clothing at these functions:                                    

BOYS:

I will not wear tight fitting trousers, any shorts, or swim trunks in public             ____________

I will not wear tank tops or undershirts as outer clothing                            ____________

My hair will be neatly cut and combed so as not to present                                                               a shaggy appearance; the length will be above the natural                                      hairline and off the ears at all times                                                        ____________

I will not wear a beard, mustache, or stubble, and my sideburns                                                          will not be longer than mid ear                                                             ____________

I will not wear jewelry other than a watch (no rings, chains etc)                    ____________

I will not wear make-up of any kind including lip gloss                                    ____________

I will not wear nail polish – clear or of any color                                        ____________

I will not color, bleach, tint, frost etc. my hair                                           ____________

GIRLS:

I will not wear dresses that do not cover the bottom of my                                                                knee, shorts (unless under my skirt or jumper for modesty sake)                                      any type of pants, split skirts or skirts with slits that rise                                                            higher than the bottom of the knee                                                       ____________

I will not wear see through or low cut blouses                                                 ____________

My hair will be neatly combed to present an attractive appearance                   ____________

I will not wear jewelry other than a watch (rings, chains etc)                  ____________            (an engagement ring may be worn IF the student provides                                                                       a letter from the parents indicating that they approve of the                                                        engagement and a letter from her pastor indicating that he                                                         is aware of the engagement and the couple has his blessing.                                                 If the young man is also a student at this academy, a letter                                                     from his parents and pastor stating that they are aware, and                                           approve of this engagement is required)

I will not wear make-up including lip gloss                                                     ____________

I will not wear nail polish – clear or of any color                                        ____________

I will not color, bleach, tint, frost etc. my hair                                           ____________

All students:

Do you honestly agree to keep all the church-school rules and                                                           respect authority without being critical and finding fault?                 ____________

Do you want to attend this church-school?                                                             ____________

Why do you wish to attend this academy?______________________________________

________________________________________________________________________

General Policy

Students are expected to abide by these standards of conduct throughout their enrollment whether at home, church, or elsewhere. Students found to be out of harmony with the church-school’s ideals of work and life may be asked to withdraw whenever the administration determines that it is necessary.

As a student of Virginia Beach Christian Academy, I pledge to uphold this church school’s standards against cheating, swearing, smoking, gambling, worldly music and dancing, drinking alcoholic beverages, using or talking favorably about marijuana or narcotics, or using indecent language, and will act in a very orderly and respectful manner. I will abstain from sinful sexual activities including fornication and homosexual acts. I will maintain Christian standards in courtesy, kindness, morality, and honesty. I will strive to be of unquestionable character in dress, conduct, and other areas of life.

I agree to abide by the above standards of conduct and other regulations expected of each student enrolled in this Christian education program while I am a student attending the church-school. I will not give the impression to students, parents, or faculty that I am not in harmony with the goals, aims, and standards of the church-school.

________________________________

signature of student

________________________________

date

________________________________                    ______________________________

signature of father                                                    signature of mother

________________________________                    ______________________________

date                                                                              date

PASTORAL RECOMMENDATION

The following student, _____________________________________________________

has submitted an application for enrollment or re-enrollment in Virginia Beach Christian Academy.

Please take a moment to indicate to us whether you feel that this child should or should not be (re) enrolled. It would be very helpful to us if you would share any other comments that you feel would be pertinent.

Thank you so much for your time

Is this child faithful in church attendance?                                                      __________

Is his family supportive of his church activities by attending as well?             __________

Mom? __________                Dad? __________

Is the family faithful in payment of tithes and offerings?                                  ___________

Does this child participate in any additional ministries?                                 __________

If so, please list them __________________________________________                        ______

Do you believe that the child will be able to assimilate into a program, such as ours, where students are expected to live by Biblical standards of morality and character?

__________________                                                                                                            _

 Additional comments would be appreciated

._____________________________________________________________________________

._____________________________________________________________________________

._____________________________________________________________________________

._____________________________________________________________________________

Pastor’s signature ____________________________________ date ___________________

Please return this form in the attached envelope in order to assure privacy.

MEDICAL TREATMENT FORM

I, ___________________________________________________________ (father), and

I, ______________________________________________________________ (mother)

of ____________________________________________________________________

consent to Virginia Beach Christian Academy to secure whatever emergency medical care that they may deem necessary for my child.

I realize that they will attempt to reach me in case of an illness or emergency. I also leave the following names as emergency contacts for my children if I am unavailable.:

Name: _____________________________________ Phone: _____________________

Name: _____________________________________ Phone: _____________________

I hold the school harmless and hereby agree not to bring legal action against the academy over their exercise of this authority and in the event the school is sued, I agree to hold the school harmless against any adverse judgment.

________________________________                    ______________________________

signature of father                                                    signature of mother

________________________________                    ______________________________

date                                                                              date

LUNCH RUSH FORM

I, ___________________________________________________________ (father), and

I, ______________________________________________________________ (mother)

of ____________________________________________________________________

give my child permission to participate in the Lunch Rush program at Virginia Beach Christian Academy at the following locations:

(please check those that apply)

Pizza Hut                                                                      Long John Silver’s                            

Food Lion                                                                    El Gran Rodeo                                     

Jumbo Chinese                         

I understand that the following rules will apply and agree to abide by the same:

Student must be in high school (grades 9-12)

Student must have A privilege for the week

Students will participate in pairs

No more than two students will be in any given restaurant at the same time

Students will be dismissed for lunch rush at 11:45 to go pick up their food.

Students are to be back in the building by noon and lunch break ends at 12:30

Students will not purchase items for any other student

There will be no sharing allowed.

I understand that my child will be walking to the above named restaurants and hold the school harmless in the event of accident or injury. 

Student’s signature                                                                            Date                            

Father’s Signature: ____________________________ ______ Date                            

Mother’s Signature: ____________________________ ______               Date                            

Mother’s signature                                                                                                Date                           

ATHLETIC LIABILITY RELEASE FORM

I, ___________________________________________________________ (father), and

I, ______________________________________________________________ (mother)

of ____________________________________________________________________

give my child permission to participate in the school’s athletics program. I understand that practices and games may be conducted off school property and give my child permission to attend. I am aware that my child may be transported by privately owned vehicle and give my permission for said transportation.

I understand that a sports physical is required for my child to be allowed to participate in any extracurricular athletic program at this academy. I also understand that whenever students participate in athletic programs, there is an element of risk involved, and release Virginia Beach Christian Academy of all liability in the event that an injury occurs while my child participates in the sports program.

________________________________                    ______________________________

signature of father                                                    signature of mother

date ________________________________             date                                                 ______

APPLICATION FOR TRANSPORTATION

Student Name: _____________________________________ Age ___________

Address:                                                                                                                      

Phone                                                      Cell phone                                                  

Names of additional siblings to be picked up at the same address

                                                                                                Age                             

                                                                                                Age                             

Transportation desired is for (please check one)

Before school only                  After school only                   Both ways               

I, ___________________________________________________________ (father), and

I, ______________________________________________________________ (mother)

apply for transportation provided by Virginia Beach Christian Academy. I understand that my child will be transported to and from the address listed above and agree to “hold harmless” the school or its representatives as they provide my service for my child.

I understand that this contract is for the period of the entire school year. I also understand that my child may be denied transportation in the event that his/her behavior is inappropriate.

I agree to pay the assigned fee (as follows) on the first Monday of each month from September 1 through May 1.

First child both ways $ 150.00 

Additional siblings both ways _________ number @ $25 each $__________

First child one way $ 75.00

Additional siblings one way _________ number @ $12 each $__________

Total monthly fee $__________

                                    Date                                                                 Date                

signature of father                                                    signature of mother

APPLICATION FOR BEFORE & AFTER/ CHILD CARE

Student Name: _____________________________________ Age ___________

Time of arrival: ____________ Time of departure ____________

Please check those that apply below, in order for us to be sure that we always have enough staff on duty to meet your child’s needs. Thanks!

School days only ______ All open days ______ Summer weeks _______

I, ___________________________________________________________ (father), and

I, ______________________________________________________________ (mother)

apply for registration in the before and after care program for my child. I realize that the hours of operation are from 6:30am – 5:30pm. The standard fee is $20.00 per week for before school care, $35 per week for after school care, $50 per week for both, and $65 for ½ day kindergarten student care, during the 36 week school year. Care for a full day on non-school days will be an additional $20.00 per day. I am also aware of the fact that a ten week program is available in the summer months for a fee of $100.00 per week for children K-5 and up. The weekly fee for before and after, as well as the tuition for the 10 week- summer program will be added to your tuition packet.

I further understand that staff scheduling and the Virginia legal code limit the number of hours my child may remain after the school day is over, and agree to the $1.00 per minute. Late pick up charge, if my child remains on the school grounds before or after his assigned drop off or pick up time.

I also understand that Virginia Beach Christian Academy reserves the right to remove my child from this program if I habitually fail to abide by the drop off and pick up schedules, or if my child becomes a discipline problem in the after school hours.

________________________________                    ______________________________

signature of father                                                    signature of mother

________________________________                    ______________________________

Date                                                                             Date

TUITION WORKSHEET

Student’s Name: _________________________________________________________

Enrollment fee 50.00 due with forms                                                                  

Testing Fee 50.00 due prior to testing                                                            

Planner fee 23.00 due with contract                                                                      

Due with re-enrollment forms                                       $ ________________

The following figures are to be added together in order to calculate your total due

Basic Tuition                                                                                                             

Computer fees 150.00                                                                                        

Curriculum fee $ 350.00                                                                                       

Homework Disks _______ @ $ 15.00                           __________________

Before and After charges                                                                                    

TOTAL                                                                                $ ________            _______

Athletic fee of $50.00 and a completed athletic physical is due by September 1 for all participants.

Full Day Child Care – non school days during the academic year

$20 per day will be added to your bill as needed.

Late fees will be billed at a rate of $1 per minute and are due with the following payment

Tuition and fees are due in full by August 15. Families may request the opportunity to make semi-annually, quarterly, monthly, or semi-monthly payments. If you desire to apply for a payment plan, please complete the forms entitled “financial disclosure” and “promissory note”.

Your application will be reviewed by committee and you will be notified of the results

PROMISSORY NOTE

STUDENT(s): __________________________________ ACADEMIC YEAR _______

Total Financial Obligation (from tuition worksheet) $_______________________

To Whom It May Concern:

This is to certify that I, Mr. ____________________________________, father of the above named student, and I, Mrs. ___________________________________, mother of the above named student do contract to Virginia Beach Christian Academy – a ministry of the United Pentecostal Church of Virginia Beach $ _____________________ in US currency as my total financial obligation for the _______________ academic year.

I understand that the tuition is an annual fee and is to be paid in full by August 15. I understand that if I pay the above tuition amount in full by July 1, I will receive a 5% discount on the basic tuition rate.

I understand that I may opt to apply for a semi-annual, quarterly, monthly or semi-monthly payment plan and intend to do so. I understand that my credit history may render me ineligible for any payment plan. If, however, my request for monthly payments is approved, I understand that failure to comply with the terms of the installment contract will result in the following actions: A $5 per day late fee will be levied commencing with the first day after the due date. My child will not be admitted to class if my account becomes ten days past due and will not be readmitted until all past due funds have been paid; financial probation will result at the occurrence of a second offense. A third offense results in the requirement that the balance of my year’s tuition be paid in full within thirty days or my child will be removed from the academy. Additionally, report cards, transcripts, and participation in graduation exercises may not take place until the account is cleared.

I understand that I may use Mastercard, Visa, cash, checks, or money orders to transfer funds to the academy. Additionally, I am aware of the fact that there is a $30.00 fee for any check that is returned for any reason. I understand that this fee will not be waived.

I understand that my payment history with this academy becomes a part of my credit record and agree to pay all expenses and fees incurred as a result of any attempt to collect past due funds on this account.

______________________                ____                                                                                        signature of father                                                    signature of mother

Witnessed by ___________________________

Dated this _______ day of _________________ 19____

Financial Disclosure

I understand that I am under no obligation to provide the following information to Virginia Beach Christian Academy or its representatives. I also understand, however, that failure to do so will render me ineligible for any payment options for which I may apply.

I hereby grant Virginia Beach Christian Academy permission to review my credit history and banking practices in order to determine my eligibility for a payment plan.

Father’s Name: ______________________________________________________

Social Security # ______________________________________________________

Mother’s Name: ______________________________________________________

Social Security # ______________________________________________________

Address ______________________________________________________

City/State/Zip ______________________________________________________

Home phone ________________________ Work Phone _________________

Father’s employer ______________________________________________________

Position ______________________________________________________

Length of time ______________________________________________________

Monthly gross income _________________ other income _________________

Mother’s employer ______________________________________________________

Position ______________________________________________________

Length of time ______________________________________________________

Monthly gross income _________________ other income _________________

Home: Own __________ Rent ____________ How long at this address _________________

Your monthly rent or mortgage payment _______________

If less than 1 year, your previous address:____________________________________

Checking: Bank ________________________________________________

Account number ______________________________________

Savings: Bank ________________________________________________

Account number ______________________________________

Please list any loans or credit cards

Name of lender __________________________ Account # _________________

Balance ___________________ Monthly payment __________

Name of lender __________________________ Account # _________________

Balance ___________________ Monthly payment __________

Name of lender __________________________ Account # _________________

Balance ___________________ Monthly payment __________

Name of lender __________________________ Account # _________________

Balance ___________________ Monthly payment __________

Name of lender __________________________ Account # _________________

Balance ___________________ Monthly payment __________

Name of lender __________________________ Account # _________________

Balance ___________________ Monthly payment __________

Please list any additional lenders on the back of this sheet. Thank you.

Select your desired payment frequency

_____ Pay in full by July 1 5% off basic tuition

_____ Semi – monthly ( 2 payments per month July – June)

_____ Monthly (1 payment per month July – June)

_____ Quarterly (July, October, January, April)

_____ Semi – annually (July, January)

Monthly payments are due on the first OR fifteenth of each month. Semi-monthly payments are due on the first AND fifteenth of each month.

Select payment method

Payments may be made in cash, Mastercard, Visa, or check.

Father’s signature and date ____________________________________

Mother’s signature and date ___________________________________

Witnessed by ___________________________ father