Fillable Fairfield Christian Academy Sonzone Enrollment Checklist (Fairfield Christian Academy)

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Fairfield Christian Academy Sonzone Enrollment Checklist (Fairfield Christian Academy)

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Child’s Name
FAIRFIELDFAIRFIELD
CHRISTIANCHRISTIAN
ACADEMYACADEMY
Fairfield Christian Academy Sonzone Enrollment Checklist
Thank you for your interest in Fairfield Christian Academy’s Sonzone services.
To complete the enrollment process, please finish each item on the checklist below.
$65 Application Fee (check made payable to FCA)
Complete and Sign Family Information Page
Complete Transporation Premission Sheet (Form B)
Complete FACTS Agreement (Form C)
Sign Liability Release/Acknowledgement of Policies (Form D)
Enroll in FACTS online at www.online.factsmgt.com/signin/3CP5
for tuition payment plan
Child’s Name
FAIRFIELDFAIRFIELD
CHRISTIANCHRISTIAN
ACADEMYACADEMY
Family InformationFamily Information
First Contact Spouse
Street Address
City
State
Zip
Home Phone
Cell Phone
Work Phone
Email
Best number you can be reached at during this program?
Work
Job Title
Employer
Home
Cell
Student resides with: Father/Mother (same residence)
Mother (separate residence)
Father (separate residence)
Other:
Name (please print)
Relationship to Student
Is either parent (or other) forbidden by court order from having equal access to the child or school records?
No
Yes
Copies of custody paperwork must be submitted with this application.
Additional InformationAdditional Information
Second Contact Spouse
Street Address
City
State
Zip
Home Phone
Cell Phone
Work Phone
Email
Best number you can be reached at during this program?
Work
Job Title
Employer
Home
Cell
List any chronic physical problems and history of hospitalization:
List any diseases that your child has had:
Has your child ever been tested for behavioral, emotional or psychological conditions or any other conditions
that require specialized care?
No
Yes
If yes, please explain
Do you feel there are any characteristics relating to the health or personality of your child that may be
helpful to your child’s teacher?
No
Yes
If yes, please explain
Child’s Name
FAIRFIELDFAIRFIELD
CHRISTIANCHRISTIAN
ACADEMYACADEMY
I give ONLY the following people permission to pick up my child from Sonzone. Please list all possible
persons at this time. Please be sure to include yourself, spouse and those whom you have listed as
emergency contacts. The office must receive additional requests in writing prior to the day that a new
person will be picking up your child.
Parent/Guardian Signature
Date
Transportation PermissionTransportation Permission
Name Phone Number Relationship to Child
I give permission for my child to be included in videotaping and photos to be used by Fairfield
Christian Academy.
I
do not
give permission for my child to be included in videotaping and photos to be used by Fairfield
Christian Academy.
PHOTO RELEASEPHOTO RELEASE
ANNUAL CLASS ROSTERANNUAL CLASS ROSTER
I authorize my child’s name, my name and my phone number to be listed on the parent roster.
I
do not
authorize my child’s name, my name and my phone number to be listed on the parent roster.
FORM BFORM B
Before SchoolBefore School
After SchoolAfter School
MondayMonday
TuesdayTuesday
FridayFriday
ThursdayThursday
WednesdayWednesday
Child’s Name
FAIRFIELDFAIRFIELD
CHRISTIANCHRISTIAN
ACADEMYACADEMY
In signing the Statement of Agreement, I/We agree to the following:
1. Tuition and Fees Financial Policy: Tuition and Fees Financial Policy: Tuition and fees will be charged according to the Schedule of Tuition and
Fees adopted by the school for the applicable school year. By signing this contract, I agree to abide by the policies
relating to the payment of such tuition and fees.
2. e person(s) responsible for payment of tuition and fees:e person(s) responsible for payment of tuition and fees:
Name: ______________________________________________________ Phone: ________________________
Email address: ______________________________________________________________________________
Billing Address: _____________________________________________________________________________
3. For the next year I will pay my child’s tuition through FACTS:For the next year I will pay my child’s tuition through FACTS:
Monthly Payments: TWELVE monthly payments through FACTS only. (NO cash or check payment
option.) Parents who use the automated process of tuition payments may elect to pay tuition on the 5th
or 20th of each month through the FACTS payment plan. e FACTS annual enrollment fee is $45.
I/we understand that for any student withdrawals, a two week notice is required with two week tuition payments. I/we understand that for any student withdrawals, a two week notice is required with two week tuition payments.
Any subsequent changes in my payment option will result in a $20 administrative charge. I/we further Any subsequent changes in my payment option will result in a $20 administrative charge. I/we further
understand that checks returned from the bank for insucient funds, will necessitate a $25 returned check fee understand that checks returned from the bank for insucient funds, will necessitate a $25 returned check fee
along with paying with cash through the oce. I/We realize that failure to meet this nancial agreement will along with paying with cash through the oce. I/We realize that failure to meet this nancial agreement will
result in student withdrawal. result in student withdrawal.
For any additional nancial questions, please send emails to pmccarty@fcaknights.us.
In signing this Statement of Agreement, I/we agree that I am/we are responsible for payment of all tuition and
fees for the child covered by this agreement.
Parent/Guardian Signature
Date
Parent/Guardian Printed Name
Parent/Guardian Signature
Date
Parent/Guardian Printed Name
SonZoneSonZone FACTS AgreementFACTS Agreement
FORM CFORM C
Child’s Name
FAIRFIELDFAIRFIELD
CHRISTIANCHRISTIAN
ACADEMYACADEMY
BOTH PARENTS/GUARDIANS MUST SIGN UNLESS ONLY ONE HAS ALL CUSTODY RIGHTS
is Release of Liability is executed in consideration for allowing the above-named child to enroll in Faireld Christian
Academy and to participate in activities related to the school. is Release of Liability must be signed by BOTH parents/
guardians unless only one parent/guardian has all custody rights.
We/I, on behalf of our/my child do hereby release and forever discharge and agree to hold harmless Faireld Christian
Academy, Faireld Christian Church, and the School Administration, Sta and Volunteers, from any and all loss, liability,
claims, or demands of any nature, including but not limited to negligence, which may be incurred by the undersigned, and
the child while he/she is enrolled at Faireld Christian Academy.
Furthermore, we/I and on behalf of our/my child assume all risks of personal injury, sickness, death, damage, and expenses
as a result or participation in recreation, study, and school-related activities in which the designated child is involved.
We/I, the undersigned, further hereby agree to hold harmless and indemnify Faireld Christian Academy,
Faireld Christian Church, and its School Administration, Sta and Volunteers, for any liability sustained by Faireld
Christian Academy, Faireld Christian Church as a result of the negligent, willful, or intentional acts
of the named child, including any related expenses.
Liability ReleaseLiability Release
I reviewed a copy of the Faireld Christian Academy Sonzone Parent Handbook on Faireld Christian
Academy’s website and I was provided clear and accurate information regarding all policies and guidelines of Faireld
Christian Academy. I understand the policies and guideline by which SonZone operates.
I agree to abide by all policies stated in the parent handbook. I agree to abide by all policies stated in the parent handbook. I understand that I will be notied of any changes made to
these policies.
I also understand that any breach of the center’s policies may be grounds for withdrawal from the program. A two week
notice will be provided in such a circumstance unless the infraction is severe enough to warrent withdrawal without
notice.
I further understand that failure to be prompt and accurate with payment will be grounds for withdrawal.
Acknowledgment of PoliciesAcknowledgment of Policies
Parent/Guardian Signature
Date
Parent/Guardian Signature
Date
Parent/Guardian Signature
Date
FORM DFORM D
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Fairfield Christian Academy Sonzone Enrollment Checklist (Fairfield Christian Academy)

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Completed 5 May 2021

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