Kld 2013 2014 application packet
description
Transcript of Kld 2013 2014 application packet
ENROLLMENTAPPLICATION
2013 - 2014
Page 1 of 3 CONDUCT AND DISCIPLINE 09-10.doc
StatementofFaith
Dear KLD Students and Parents,
The KLD leadership wishes to be clear in conveying our belief and our heart for God. We depend on the Holy Spirit to lead, rather than on fleshly promotion (Exodus 13:21). Acknowledging that fact, we stand firmly united in our belief in the Father; therefore we expect all those who work for us to participate in the carrying out of the mission of the KLD Youth Ministries.
1. The Bible is the inspired, only infallible Word of God. ( II Peter 1:18,21)
2. God eternally exist as the Father, Son and Holy Ghost. (2 Corinthians 13:14)
3. JESUS CHRIST is the only begotten SON of the FATHER (John3:16), conceived of the HOLY SPIRIT (Matt. 1:20), and born of a virgin. That JESUS CHRIST was crucified, buried, and raised from the dead; that He ascended to heaven and is seated at the right hand of the Father as the intercessor. (Acts 2:23-33)
4. Salvation comes through Jesus Christ alone, to whom we must respond with repentance, faith,
and obedience. Through Christ we come into a right relationship with God, our sins are forgiven, and we receive eternal life. (John 3:16; 16:7-11; Rom.10:13; Eph.2:5,8)
5. That those who repent and believe should be baptized with water as a symbol of baptism
with the Spirit, cleansing from sin, and commitment to Christ. (Acts 2:38; 4:10-12; 8:16; 10:47-48; 19:3-6) That (Matt 3:11; Acts 1:4-8) the true believer receives the Holy Spirit and is baptized into the Body of Christ at conversion, that the Holy Spirit indwells every believer in and is an abiding helper, teacher, gift- giver, and guide. The Holy Spirit, by whose in- dwelling the believer is enabled to live a holy life, to witness and work for the Lord Jesus Christ ,which is the standard of living that God has for His people and that it must be sought and activated by faith. (Hebrews 12:14),
6. God has called us to be and to make disciples of Jesus Christ and to be God's agents of love
and reconciliation in the world. Love is more important than the most spectacular gifts, and without love all exercise of spiritual gifts is worthless.
7. Divine healing through faith in the Lord Jesus Christ is possible and achievable. Therefore we
also minister to those who are broken-hearted and troubled in mind. (Gal 6:1)
8. God concerns Himself mercifully in the affairs of men. He hears and answers prayer. We believe in the interceding in prayer to Him for all men. (I Tim 2:1-3)
9. PRAISE and WORSHIP to God is acceptable and worthy of all His believers. (Psalm 149:1)
10. We believe in the personal return of Jesus Christ, in the resurrection of the dead, in God's
judgment of all persons with perfect justice and mercy, and in eternal reward and punishment. Ultimately, Christ's kingdom will be victorious over all evil, and the faithful will reign with him in eternal life. (Rev 22:12 – 21)
Student Acknowledgement: Date:
Parent Acknowledgement Date:
The future empowered…one life at a time 3700 NORTH COURTENAY PARKWAY, MERRITT ISLAND, FL 32953, ~ Telephone (321) 454-7333
Fee Schedule
Estimated Charges for 2013-2014 School Year After school care $ 5.00 Per day Academic Learning Lab $ 55.00 Per session
Est / End of Year Event Fee $ 80.00 If Scheduled
Late Enrollment Fee $ 125.00 After May 1st
New Student Fee $ 500.00 Application Fee $ 250.00 Books / Supplies / Curriculum $ 310.00 ID Badges $ 50.00 Return Check Fee $ 30.00 Speech Therapy - Group Session $ - May be available through County
Base Tuition $ 6,495.00 The Base tuition of $6,495.00 may increase if additional aid (as stated below)is required.
Individual Therapy $ 35.00 Per Session
Group Educational Therapy $ 20.00 Per Session
Charges that Vary Uniform Fees Pants/Skirt/Shorts @ $15.00 Polo Shirts @ $15.00 Field Trips Depends on itinerary Summer School Classes Varies by class WHEN AVAILABLE
New students must pay all upfront fees within two weeks of acceptance. Theses fees are non-refundable. All tuition is due prior to school starting unless other arrangements have been made through the Registrar’s office. Tuition insurance may be required for new families and may be waved by the Registrar’s office for returning students.
Returning students pay all re-enrollment deposits a n n u a l l y . This non-refundable deposit reserves a student's place for the upcoming school year, subject to the student's satisfactory completion of the current year.
Families may choose between three tuition payment plans: one annual payment, two semester payments, or 10 monthly payments. A finance charge of 12% applies to the semester and monthly payment plans. Financing is also available through outside sources; please see Mrs. Deaton for details.
Tuition does not include charges for, special events, field trips, and graduations. These fees and similar charges vary by grade level and will be charged where applicable.
Student Name: Amount Due:
Parent Acknowledgement by Signature:
KLD Youth Ministries, Inc. a registered 501(c)3 organization.
Confidential Page 1 of 4 Last Revised: 3/31/2009
Application Fee: ________
Date Submitted:
_________
Check # ________________
School Year Applying for:
Today’s Date
Student’s Full Legal Name Date of Birth Male Female S tuden t s SS#
Address
City Zip
Mailing Address (if different) City ______________________________________________________Zip _________________________
Phone (Home) Phone (Cell)
School Presently Attending Grade:
Please list the names of other siblings that will be attending the KLD Learning Center?___________
Does the student reside with Parent? ☐ Yes ☐ No Who: ____________________________________ Are Parents � Married ☐Divorced ☐ Widowed ☐Separated ☐Single ☐Remarried Please provide information on whom the student resides with: (supporting documents may be required)
Father’s Name Occupation
SS#:
Employer Work Phone
Mother’s Name Occupation
SS#:
Employer ______________________________________ Work Phone __________________________
Step Parent’s Name (if applicable) ______________________________________________________
If not any of the above, with whom does the student reside? ____________________________________
Who has authority to pick up your child? ☐ Father ☐ Mother ☐ Step Parent ☐ Other
Father’s Cell _____________________________________ Mother’s Cell _________________________
Step Parent’s Name _____________________________________ Cell __________________________
Other’s Name _____________________________________ Other’s Cell _________________________
Other’s Relationship to student? ________________________________________________________
Student Information
Parent Information
Confidential Page 2 of 4 Last Revised: 3/31/2009
Has your child been enrolled in or recommended for any of the following special classes ☐ Learning Disability ☐ Speech Therapy ☐ Physically Handicapped
Please explain any above checked items
Has your child had any problems with discipline in a previous school? ☐ Yes ☐ No
If yes, please explain
Child’s Primary Physician Name: Phone:
Does your child have any unusual or chronic health issues? ☐ Yes ☐ No
Please list any conditions that may include major surgeries, seizures, asthma, diabetes, etc.
Please list any medication (s) prescribed for the above listed condition (s): We require that parents notify the school of any changes in medication by the following school day. 1.
2.
Physician
Physician
Please list any mental health diagnosis(es)(Anxiety, Depression, Add/ADHD):
Psycho-social evaluations must accompany this application if the above is filled out. Please see Administrator for further information. As well, please provide a list of medication (s) prescribed for the above listed diagnosis (es).
1. Physician
2. Physician
Do you authorize health screening for your student? Please initial your response. Yes No
Do you authorize emergency medical treatment? Please initial your response. Yes No
Are you financially able to meet the monthly tuition requirements? ☐ Yes ☐ No
Comments
What do you see as your part in your child’s education?
What is your practicing religion?
Is a language other than English used in the home? If yes, indicate language
I/We certify that the above information is complete and accurate. I/We understand that any information found to be inaccurate may be considered grounds for my/our child’s dismissal from KLD. Signature of Father Date
Signature of Mother Date
Medical / Health Information
Agreement
Confidential Page 3 of 4 Last Revised: 3/31/2009
Gender: ☐ Female � Male
Race: � American Indian or Alaskan Native � Asian or Pacific Islander � Black � White � Hispanic � Combination of Two or More Races (if checked supply the code from the attached list): Code:
Person with a disability: � Yes If yes, do you need accommodations during the application for admission process? � Yes If yes, please describe the accommodations needed.
Person who is an English language learner or limited English proficient: ☐ Yes If yes, do you need language assistance during the application for admission process? ☐ Yes If yes, please describe the assistance needed.
VOLUNTARY INFORMATION SECTION
The information requested in this section is not required for admission. Submission of the information is entirely voluntary. Information submitted voluntarily by the applicant will not affect the applicant’s admission to the school. The information, if supplied, will be used for monitoring equal educational opportunity in this school and used for grant information only. In addition, note that applicants with disabilities may voluntarily self-identify for the purpose of requesting reasonable accommodations during the entire application and admission process. Applicants who are English language learners or limited English proficient may voluntarily self-identify for the purpose of receiving interpretive services during the entire application and admission process.
NON DISCRIMINATION POLICY
The education branch of the KLD Youth Ministries Inc admits students of any race, color, national or ethnic origin, disability, sex or age to all the rights, privileges, programs, and activities gen- erally afforded or made available to students at the school. It does not discriminate on the basis of race, color, national or ethnic origin, disability, sex or age in administration of its educational or admissions policies, scholarship and other programs or employment.
Confidential Page 4 of 4 Last Revised: 3/31/2009
Not Hispanic or Latino
Hispanic or Latino
One race
White 01 33
Black or African American 02 34
Asian 03 35
American Indian or Alaska Native 04 36
Native Hawaiian or Other Pacific Islander 05 37
Combination of Two Races
White & Black or African American 06 38
White & Asian 07 39
White & American Indian or Alaska Native 08 40
White & Native Hawaiian or Other Pacific Islander 09 41
Black or African American & Asian 10 42
Black or African American & American Indian or Alaska Native 11 43
Black or African American & Native Hawaiian or Other Pacific Islander 12 44
Asian & American Indian or Alaska Native 13 45
Asian & Native Hawaiian or Other Pacific Islander 14 46
American Indian or Alaska Native & Native Hawaiian or Other Pacific Islander 15 47
Combination of Three Races
White & Black or African American & Asian 16 48
White & Black or African American & American Indian or Alaska Native 17 49
White & Black or African American & Native Hawaiian or Other Pacific Islander 18 50
White & Asian & American Indian or Alaska Native 19 51
White & Asian & Native Hawaiian or Other Pacific Islander 20 52
White & American Indian or Alaska Native & Native Hawaiian or Other Pacific Islander 21 53
Black or African American & Asian & Native Hawaiian or Other Pacific Islander 22 54
Black or African American & Asian & American Indian or Alaska Native 23 55
Black or African American & Native Hawaiian or Other Pacific Islander & American Indian or Alaska Native
24 56
Asian & Native Hawaiian or Other Pacific Islander & American Indian or Alaska Native 25 57
Combination of Four Races
White & Black or African American & Asian & American Indian or Alaska Native 26 58
White & Black or African American & American Indian or Alaska Native & Native Hawaiian or Other Pacific Islander
27 59
White & Asian & American Indian or Alaska Native & Native Hawaiian or Other Pacific Islander
28 60
White & Black or African American & Asian & Native Hawaiian or Other Pacific Islander 29 61
Black or African American & Asian & American Indian or Alaska Native & Native Hawaiian or Other Pacific Islander
30 62
Combination of Five Races
White & Black or African American & Asian & American Indian or Alaska Native & Native Hawaiian or Other Pacific Islander
31 63
Revised on: 5/10/2010 1:08:00 PMPage 1 of 2
STUDENT AGREEMENT STATEMENT
PLEASE READ CAREFULLY and place your initials beside each statement to indicate your agreement.
In making this application, I/We agree that:
1. We will accept the challenge to “train up a child in the way he should go” and state that this
training will be carried on in the home. We shall place our trust in KLD to extend that training more completely.
2. We have read the Parent/Student Handbook and agree to abide by all standards, procedures,
and regulations therein.
3. We will pray for the school’s staff.
4. If for any reason our child does not respond favorably to the school’s standards, guidelines, or expectations, which causes us to withdraw him/her we understand that all fees up to and including 30 days from the time of written notification of withdraw are our responsibility. Also, if your child is enrolled for ten or more days in a semester you are responsible for the entire semester’s fees. Tuition is calculated on the basis of the entire year; therefore, no reduction can be made for vacations or school holidays. Tuition is not based upon daily attendance. Should a student transfer before the end of the school year, the parents are responsible for the monthly installments through the current month enrolled. In addition, if a re-enrolled student withdraws after June 1, there is a $250 withdrawal fee. Fees, discounts, and incidental charges are neither prorated nor refundable and cannot be allocated to the accounts of siblings. Also, if any student is on a scholarship withdraws throughout the year they must pay the prorated scholarship amount.
5. We will pay all tuition and fees promptly and according to school policies. Late fees will be
th
added to payments received after the 10 th
of the month and again after the 20 of the month. When a tuition account is two months in arrears, the student(s) may be withdrawn from school, and records will be withheld until required payments are made in full.
6. If our student is withdrawn, we will notify the school office in writing at least 30 days
prior to the planned withdraw date.
7. Our child (ren) will participate on scheduled field trips and other school activities.
8. We understand that KLD Learning Center does not provide voluntary medical insurance coverage for students. Should a student become injured on the premises or during a school sponsored event, the student’s family insurance is the primary carrier.
9. We will promote the spirit of unity within the school by following the Matthew 18
principle.If a problem arises, we will first contact the school personnel who can help (rather than those not involved). We will follow the proper chain of command when necessary until the problem is resolved. The parties to this agreement adhere to Christian principles 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 community in conformity with the biblical injunctions of I Corinthians 6:1-8, Matthew 5:23-24, and Matthew 18:15-20. Therefore, the parties agree that any claim or disputes arising out of or related to this agreement including, but not limited to, claims arising from statute, ordinance, regulation, case law or any other source shall be settled by biblical based mediation. If resolution of the dispute and reconciliation do not result from such effort, the matter shall then be submitted to an independent and objective arbitrator for binding arbitration. The parties agree that the mediation and arbitration process will be conducted in accordance with the “Rules of Procedure for Christian Conciliation” contained in the Peacemaker Ministries booklet, Guidelines for Christian Conciliation, (http://www.peacemaker.net) which both parties will have had opportunity to review. The parties agree 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 against one another in any civil court for such disputes except to enforce a legally binding arbitration decision. Each party, regardless of the outcome of the matter, agrees to bear one-half of the fees and costs of the arbitrator and any other arbitration expense. The parties to this agreement have had an opportunity to consult legal counsel before signing this agreement.
10. I give permission for my child(ren) to be photographed and/or videotaped. I understand
that these may be used on the KLD website or in other promotional materials produced for the school or the KLD Youth Ministries; however full names will not be disclosed.
11. Recommendation for admission of the applicant is at the discretion of the KLD
Administration. Final approval of admission is determined by the KLD Admissions Committee.
12. We have carefully read the above guidelines and have accurately completed all
items outlined in this application, and we agree to uphold all guidelines as part of the PI family.
Father’s Signature Date _________________________________________________________________ Mother’s Signature Date
_________________________________________________________________ Student’s Signature Dat
2013-‐2014 KLD School Calendar
Wednesday August 7 Teachers Report Monday August 19 Students Report
Friday August 30 Sign McKay Checks Monday September 2 Labor Day/Holiday for All Monday September 9 Professional Development
/Day/No school Friday September 13 Interims Posted & Issued Friday October 4 Professional Development Day
Wednesday October 16 First 9 weeks Ends Tuesday October 25 Report Cards Issued Friday November 1 Sign McKay Checks Monday November 11 Veterans Day/Holiday for All Friday November 15 Second Interim Ends Monday November 18 Interim Posted & Issued Friday-‐Monday November 23-‐25 Thanksgiving Holiday Friday December 20 End of First Semester Saturday December 21 Winter Vacation Begins Monday
January 6 Last Day of Winter Vacation Thursday January 9 Second Semester Begins Thursday January 16 MLK Jr. Birthday/Holiday for All Friday January 17 Report Cards Issued Monday February 3 Sign McKay Checks Sunday February 9 Third Interim Ends Friday February 14 Interims Posted & Issued Thursday February 20 Presidents Day/Holiday for All Friday March 14 Third 9 weeks Ends Monday March 24 Report Cards Issued Monday-‐Friday March 24-‐28 Spring Vacation Wednesday April 2 Sign McKay Checks Friday April 6 Holiday for All Thursday April 24 Forth Interim Ends Tuesday April 29 Interims Posted & Issued Thursday May 29 End of Second Semester Monday May 26 Memorial Day/Holiday for Staff Tuesday June 3 Last Day for Teachers Friday June 13 Report Cards Issued
� During the school year, emergency days may be taken for hurricanes or other related causes. This may cause make-‐up days to be scheduled.
� Other adjustments or changes to the School Calendar may be done with notice to parents.
KLD Field Trip Permission Slip Periodically, throughout the 2013-2012 school year KLD will take field trips, to further enhance your child’s education, this form is meant to provide your permission for your child to attend such trips over the school year. This form will be kept in your child’s file. I give my permission for to attend fieldtrips
with KLD that may be driven by other Staff, Parents, or Chaperones. I hereby grant authorization to the KLD or its representatives, to provide emergency medical attention to the above said student in the event of a medical emergency while away on KLD field trips. I also hereby agree to hold harmless KLD and its representatives, for any and all actions, damages, or liabilities arising out of the negligent acts of others, in regards to any accident or sickness or treatment thereof incurred by my said KLD student during or from KLD field trips. It is necessary that this form remain on file for every student going on any field trip throughout the year with KLD Learning Center (KLD High School, KLD Junior High School, KLD Elementary, or KLD Academy). No student will be allowed to leave the fieldtrip site or KLD property without parental/guardian permission.
Students allergies, if any___________________________________________
Parent/Guardian
Address
Phone
Signature (Please bring photo I.D.)
STATE OF FLORIDA COUNTY OF BREVARD The foregoing instrument was acknowledged before me this day of
, , by .
Notary Public Personally Known , OR Produced Identification Type of Identification Produced
_____________________________________________________________________________________________