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__________________________________________________________ FAMILY Last Name:

SLAVIC CHRISTIAN ACADEMY – Spokane ENROLLMENT APPLICATION 2013-14 HOME Address: _____________________________________________________________ City: ________________________________ State: _________ Zip Code: _____________ HOME Phone: (_____)____________________________________ Student Information: Last Name

MEMBER Tuition

First Name

☐RE-Enrolling Family

☐Church Member (SCA Location)

☐NEW Family Enrollment

☐NON Member (Other Churches)

FATHER’s Full Name: ________________________________________________________ Cell: (____)______________E-mail: ________________________________________________ MOTHER’s Full Name: _______________________________________________________ Cell: (____)______________E-mail: ________________________________________________

Date of Birth

SS number (high school only)

M/F

NON-MEMBER Tuition

Books & Activity

(150 sch. days)

(150 sch. days)

(due in August)

$200mo/$16.00day

$250mo/$20.00day

$200

Hot Lunch

$250mo/$20.00day

$300mo/$24.00day

$250

(150 sch. days):

1-5th grades

$280mo/$22.40day

$330mo/$26.40day

$300

6-8th grades

$300mo/$24.00day

$350mo/$28.00day

$325

9-12th

$325mo/$26.00day

$375mo/$30.00day

$350

Tuition (by Grade Level)

K4 K5

grades

Enrollment Fee (per STUDENT):

(150 sch. days):

through completion of 30 service hours per family/year (for single parent home 15hrs/yr). In case on service hours’ incompletion, we agree to pay off the remaining hours ($10/hr). ___7.We understand that withdrawal penalty will apply for any withdrawal reasons and school records will be on hold until all accounts are settled and materials returned. Student Commitment 6-12 Grades: I, ______________________________________, (additional student)______________________________________, agree to abide by the school’s standards of conduct, uniform, and other regulations expected of me at Slavic Christian Academy and will not give the impression to students, parents, or faculty that I am not in harmony with the goals, aims, and standards. Outside of SCA I will uphold its principals. School Event Permission (please initial):

____I hereby certify that my child has permission to participate in field trips and other related school events that are part of the school curriculum. ____I hereby grant permission for SCA to photograph/videotape my son/daughter for school project publication or website. Church Affiliation/Church Name: ________________________________________________________________________ Pastor’s Full Name: ____________________________________________________ Years of membership: __________ Church Attendance: ☐Weekly ☐Occasionally Children participate in: ☐Sunday School ☐Teens Group ☐Choir Emergency contact/pick up permission: Name

Phone

Relationship to child

Pick up? yes/no

Grade in 2013-14

PE Tshirt size

☐Early $25 (due by March 30th) ☐Regular $50 (April June 30th) ☐Late $75 (July – August and thereafter) ☐Primary (PK-2) $2.00

School Bus

Parent Agreement (please initial): ____1. We will faithfully support the school through our prayers and positive attitude, and share any complaints, questionable or negative comments, with ONLY the people involved (administration or faculty), and NOT around our child. ____2. We will uphold the spiritual emphasis of Slavic Christian Academy and support the high academic standards of the school by providing a place at home for our child to study and to give our child encouragement in the completion of assigned homework. ____3.We agree with the standards of conduct and discipline and grant authority to the teacher and administration to discipline our child when necessary. We further agree to cooperate and discipline our child at home. ____4.We understand that parent’s failure to comply with the established regulations and discipline, parental commitment, and financial obligations will forfeit the student’s privilege to attend SCA. We understand that withdrawal penalty will apply for any withdrawal reasons. ____5.We understand that we need to have our own medical and major accident insurance in case of an emergency situation during school hours at the church facility and school related events. We give permission to the school authorities, in case of emergency, to obtain medical treatment for child in our absence. ____6.We understand that SCA is a tuition driven school and so required each family involvement

New or Returning

☐Elementary (3-5) $2.25

☐Middle School (6-8) $2.50 ☐High School (9-12) $3.00 ☐ S. Rosauers $3.00

☐S. Fred Meyer $2.75

☐Grocery Outlet $2.50

☐E. Garland $2.25

☐N. Crestline $2.00

Payment Options: ☐Annual Payment 5% ☐Semester Payment 2% ☐Quarterly ☐MONTHLY (12 payments on the 10th of each month, Aug-July) Auto Pay ONLY *In order to secure the discount, the amount should be paid by August 10th (Annual payment), by August 10th & February 10th (Semester payments). If payment is not received by the due date, the discount will be removed. Family Discounts: ☐1st – the oldest child 0% ☐2nd to oldest child 5% ☐2nd to oldest child 10% ☐4th to oldest child and the following children 100% (FREE) Ministry Discounts: Local campus school pastor, senior pastors, appointed pastor assistants, lead choir directors, youth and teen ministry leaders, Sunday and language school directors may receive up to 30% in total discounts. Indicate your church ministry: ☐_____________________ * Verification is required and 15 ministry service hours/year at SCA. Scholarship/Award: 9-12th only for SCA returning students: ☐ Scholastic $250 per semester (minimum GPA of 3.7 or above for the last semester) . Financial Aid available for low income families upon request (tax verification and two last checks required for both parents): ☐Early Award (~25%) is due by March 30th. ☐ Regular Award (~15%) is due by June 30th. ☐ Late Award (~10%) July 1thereafter. *A family total discount may not exceed 30%. *Financial aid recipients volunteer service hours (lunch assistants: one day/year=6hours): 25% - 10 days, 20%- 8 days, 15%- 6 days, 10%- 4 days, 5% - 2 days. Enrollment Process: (1) You will receive your 2013-2014 Enrollment Agreement upon review and processing of your Enrollment Application. (2) Please review and submit enrollment cancellation and/or any questions to the SCA SD Office within two weeks upon receiving your 13-14 Enrollment Agreement. (3) After TWO WEEKS, your 2013-2014 Enrollment Agreement with SCA is valid as issued. OFFICE USE ONLY (initial when completed): ☐Enrollment/Payment Option ☐Policy Review ☐Entrance Test ☐Transfer Records ☐Certificate of Immunization Status – filed out & signed by parents. ☐Student/Service Card Notes:_______________________________________________________________ ______________________________________________________________________ ___

Parent 1 Signature:______________________________________________ Parent 2 Signature:_______________________________________________ Date: _____________________ ---------------------------------- SCA-Portland Enrollment Application 2013-14 Last Updated 02.20.2013 ----------------------------------


SCA AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS 2013-14 Payment Option 1 I (we) hereby authorize Slavic Christian Academy Online, hereinafter called COMPANY, to initiate debit entries to my (our) bank account on the 10th of every month during the school billing cycle (August-July). ☐ Checking Account ☐ Savings Account Please print neatly all information below! DEPOSITORY NAME: ________________________________________________________________________________________________ CITY: _____________________________________ STATE: _______________ ZIP: _________ Phone: __________________________ TRANSIT/ROUTING #: ____________________________________ ACCOUNT #: _________________________________________

PLEASE ATTACH A VOIDED CHECK FROM YOUR CHECKBOOK

HERE This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. I understand that thirty (30) days notice, in writing, to the COMPANY is required if I change banks and/or accounts. Name: ____________________________________________________________Signature: ____________________________________________ Date: _____________ (Please print)

SCA AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS 2013-14 Payment Option 2 - available for Annual, Semester, and Quarterly payments ONLY. Credit card Information Your Name: __________________________________________________________________________________ (Your name as it appears on your credit card)

Type of Credit Card: ☐Visa ☐MasterCard ☐American Express

Credit Card #:_____________________________________ Expiration Date: __________ security Code #: ______ E-mail Address: _______________________________________________________________________________ Address: _____________________________________ City:____________________St. ______Zip ____________ (this address must be the billing address for the credit card holder)

Phone Number: (______) ________-___________ Emergency Number: (______) _______-______________ Amount to be charged $ ________.______

☐Annual

☐Semester

☐Quarterly

I, _____________________________________, hereby authorize Slavic Christian Academy to charge my credit card account. Cardholders Signature: __________________________________________ Date: _________________


SCA Spokane 2013-14 Enrollment Application (2pgs)