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MANDATORY FORMS LIST

The following forms must be filled out and returned with a photocopy of the following:

If there is a privacy, political, or religious issue concerning any of the following, please discuss with the secretary.

- Social Security Card
- Current Immunization Records
- Student Birth Certification
- Proof of Health Insurance
- Student Driver's License (If Applicable)
- Student Vehicle Insurance (If Applicable)

If you have questions, please feel free to call. To insure that your child will have a place at Trinity Christian Academy, these forms must be filled out and returned with the tuition.

I release and hold harmless Trinity Christian Academy and its agents from any charges or fees, or loss of property, limb, or life that may be incurred or occur if insurance ceases or no longer is in force as required by the school.

________________________________________________________________
Parent or Legal Guardian Signature

________________________________________________________________
Date

PLEASE TELL US HOW YOU HEARD ABOUT US ON THE LINE BELOW!!

______________________________________________________________________________________________

Trinity Christian Academy
Registration 2011-2012
Grade Enrolling ______

Student's Name: _____________________________________________________¬¬¬¬¬___________
Last First Middle

Student's SSN: ________________________

Student's Date of Birth: __________________

Father/Guardian Name: _______________________________________________________

Mother/Guardian Name: ______________________________________________________

Address: ___________________________________________________________________

City: ________________________________ State: ____________ Zip: ______________

Home Phone: ______________

Dad Work: ___________ Dad Cell: _____________

Mom Work: __________ Mom Cell:_____________

Guardian Work:__________ Guardian Work:__________

Payment Schedule

K-3 through 12th
1st child - $3,285 per school year
($365 x 9 months)
2nd child - $3,015 per school year
($335 x 9 months)
3rd child - $2,745 per school year
($305 x 9 months)
4th child - $2,475 per school year
($275 x 9 months)

(Every child after the 4th is FREE!)

Tuition will be discounted by 10% if paid in full
by September 1, 2011; however, there will be no refunds if the student(s) leave(s) Trinity Christian Academy prior to the last day of the year.

* Payments are due the 1st of each month.
**Tuition subject to change**

Payment Obligation

I agree to pay the monthly tuition rate of $__________ beginning _______________.

* Payments are due the 1st of each month.
* Accounts that become 30 days delinquent will result in withdrawal of the student.

Parent Signature: _________________________

Date: ___________________

Administration Signature: ___________________

Date: ____________________

Trinity Christian Academy
119 Myrtle Ave
Hollister, MO 65672
417-334-7084
417-334-1794 (Fax)

Request for Release of Records

Request To:

________________________________________________________________
Previous School Name Fax Number Address

It is required that a copy of each document(s) checked which you may have for the student(s) listed be forwarded to Trinity Christian Academy. Your assistance and cooperation is appreciated.

____ Academic Records
____ Immunizations
____ Standarized Test Scores
____ Family Info. Sheets
____ Health Records
____ Intellectual Educational Reports
____ Other

Students Name Date of Birth Last Grade Attended

__________________________________________________________________

_______________________ _____________________
Signature of Parent/Guardian Date

_______________________ _____________________
Signature of Administration Date

Trinity Christian Academy

New, Returning, and Transferring, and Home Schooled Students

Trinity Christian Academy expects, and reserves the right to request and receive any information regarding the transfer of any student as it pertains to discipline, drug use, (or paraphernalia), probation, illegal activity, or anything falling under the jurisdiction of the juvenile court.

Any student or parent that does not disclose leaving another school truthfully, or any problem that arises at any time will cause the loss of the privilege of attending Trinity Christian Academy for the student.

If at any time the administration suspects the violation of any drug law, the school will request a drug test once, or on a continual basis, as deemed necessary. The student and parents shall comply with the request, at their expense, or the student will be expelled immediately.

If the student is under suspicion of drug use and remains in school, the school will request drug counseling and Church attendance. Non-compliance will result in expulsion.

Any expulsion, as stated above, or any other reason will result in the loss of registration, tuition, fees, and any tuition paid.

All students and parents must sign prior to attendance of the first day of school.

_______________________ _____________________
Student Signature Date

_______________________ _______________________
Parent Signature Date

Medical and Health Care Authorization

I/We hereby authorize Trinity Christian Academy to include ___________________________________
in the following procedures.

1. Emergency medical care for accident or illness during the school hours or during a school function.
I also give my permission for Trinity Christian Academy to take my child(ren) to the nearest
emergency facility when they deem it necessary.

Proof of Medical Insurance for each student is required. Those with no medical insurance must carry
student accident insurance for the school year.

In case of emergency during school hours, you may contact me.

________________________ _________________________
Father or Legal Guardian Phone Number

________________________ _________________________
Mother or Legal Guardian Phone Number.

If I/We cannot reach you, please notify:

___________________ ________________ _______________
Name Relationship Phone Number

Name of Family Doctor: ___________________

____________________________
Father or Legal Guardian Signature

____________________________
Mother or Legal Guardian Signature

Consent To Treat

Student Name ____________________

Grade ________

Trinity Christian Academy

_____ Does or_____ Does Not

Have permission to give my child over the counter medications for headaches, general body aches, nasal congestions, coughing, scratchy throat, or mild scrapes and abrasions.

Significant Health History __________________________________________________

Rx meds taken on daily basis (Include those given before and after school)

________________________________________________________________________

Treatment/Medication exemptions: We have no products in the Nurses Station containing ASA or PPA.
Any meds or treatments you DO NOT want your child to receive.

________________________________________________________________________

If your child needs an OTC or Rx medication that needs to be given during school hours the medication needs to be sent in the original container with a note from the parent on times and amount to be dispensed. NO medications will be dispensed that is sent in envelopes, baggies, or Tupperware.

Date: ______________

Parent or Legal Guardian Signature _____________________

__________________________________________________
Phone Number (Must be able to be reached during School hours)

Thank You

Trinity Christian Academy Authorized Pick Up
(Required for all Elementary Students)

Student's Name _______________________

Grade/Teacher ________________________

Please note that the following individual(s) are authorized by me/us to pick up my child/ren from Trinity Christian Academy.

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Trinity Christian Academy
Conditions of Enrollment and Pledge of Cooperation

Dear Academy Patrons,
As an essential part of the enrollment process, the pledge written below must be completed. It serves as a protective legal hedge for the benefit of our families and the school. In the interest of being good stewards, we must make every attempt to insulate our school against costly lawsuits and/or other forms of avoidable disruption. Please understand that we dearly value your patronage and ask that you realize our mission and purpose has not changed even though the climate around us has required that we be "wise as serpents" yet "harmless as doves."

I pledge to apply myself wholeheartedly to my intellectual pursuits and to use the full powers of my mind for the glory of God.
I pledge to grow in my spirit, developing my own relationship with God.
I pledge to develop my body with sound health habits through the required physical fitness program and by participating in wholesome physical activities.
I pledge to cultivate good relationships socially with others and to seek to love others as I love myself. I will not lie; I will not steal; I will not curse; I will not be a talebearer. I will not cheat or plagiarize; I will do my own academic work and will not inappropriately collaborate with other students on assignments.

CONDITIONS OF ENROLLMENT AND PLEDGE OF COOPERATION
1. I understand that it is a privilege, and not a right, for my child to attend Trinity Christian Academy ("TCA"). I further understand that all students are accepted on a probationary status. I further understand that the school reserves the right to dismiss any student who does not cooperate with any phase of the educational program and process, be it curricular or extra curricular, or whose attitudes and actions are not in harmony with the aims and ideals of TCA. I give TCA's administration full discretion in the discipline of my child, including the issuing of demerits, referrals, detention, suspension (in-school or out), and expulsion from the school for conduct deemed by TCA to be improper, regardless of where the incident(s) giving rise to such discipline occurs.
2. In order to preserve the spiritual atmosphere nurtured at TCA, I understand that discipline will be more swiftly and rigorously enforced than in a public school environment or in some other private schools. I further understand there may be times where I disagree with the discipline imposed upon my child. I further understand that in the event of such disagreement, I am to request a conference with the principal and /or his or her designee(s) of the educational unit involved.
3. I understand that TCA, in the interest of nurturing its school atmosphere and spiritual goals, has a "Zero Tolerance" policy regarding possession and/or use of drugs on or off campus. If in the judgment of TCA's administration, it is determined my child(ren) should be drug tested, I agree to have my child(ren) tested, at my own expense, by an appropriate medical provider approved by TCA to conduct such drug test. If I am unwilling to permit such a drug test, or to release the results of such test to TCA, I shall withdraw my child(ren) from TCA and thereby waive all rights to any recourse.
4. I understand and agree to the need for, not random, but reasonably determined investigations of student activities which may involve and include searching my child's or children's belongings (i.e., book or carrying bag, lunch box, purse, gym bag, etc.) and locker. In the case of secondary students, I also give permission for any motor vehicle in my student's possession to be searched for stolen or other improper items. I ask that TCA's administration make a reasonable attempt to contact me prior to such a search in order to allow me to be present. If I am not available by telephone after reasonable efforts to contact me have been made by TCA, I permit TCA's administration to search the vehicle.
5. I agree to fully cooperate with TCA's administration regarding all actions requested of me pertaining to my child's or children's enrollment at the school and in the enforcement of its rules and policies. I agree to uphold the aims and ideals of the school and to encourage my child(ren) to likewise abide by the aims and ideals of the school.
6. I understand that my child's or children's continued enrollment at TCA is conditioned upon my prompt and timely payment of all tuition and fees (including late fees).
7. I acknowledge receiving and reading a copy of TCA's current handbook before execution of this application. I agree that my child's or children's enrollment at TCA is subject to all terms and conditions of the handbook which are fully incorporated herein by reference.

PLEASE SIGN AND RETURN THIS PAGE. REGISTRATION CANNOT BE COMPLETED WITHOUT THIS
FORM.
I have read, or reviewed with my parents, and understand and agree to abide by the provisions of the school handbook Student Name _________________________________________________ Grade___________________________
Student Signature _______________________________________________ Date____________________________
Parent Signature_________________________________________________ Date____________________________