Preschool/Kindergarten Application for New Enrollment

This application is for new preschool and kindergarten students applying for admission to Berean Academy. A $50 application fee is required and will be refunded if the child is denied admission.

School Year *

Date of Application *

Month Day Year

Child's Name *

First Name Middle Name Last Name

Child's Birth Date *

Month Day Year

Note: Tennessee state law requires children to have reached their fifth birthday by August 15 of the year they enter kindergarten. Berean Academy does not make exceptions to this statute.

Program *

Half Day Full Day

Child's Gender *

Male Female

Parent/Guardian Information

Guardian 1's Name *

First Name Last Name

Guardian 1's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Guardian 1's Home Number

Area Code Phone Number

Guardian 1's Mobile Number

Area Code Phone Number

Guardian 1's E-mail

Guardian 1's Employer

Guardian 1's Occupation

What is Guardian 1's relationship to the child? *

Guardian 2's Name *

First Name Last Name

Guardian 2's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Guardian 2's Home Number

Area Code Phone Number

Guardian 2's Mobile Number

Area Code Phone Number

Guardian 2's E-mail

Guardian 2's Employer

Guardian 2's Occupation

What is Guardian 2's relationship to the child?

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Church Membership? *

Yes No

Name of Church

Which factor(s) most influenced your decision to apply to Berean Academy's preschool?

Academic Quality Christian Atmosphere Tuition Value Location Safe & Secure Environment School Philosophy/Values

Please list any previously attended preschools or kindergartens.

Has the child ever been suspended or asked not to return to a preschool or school? *

Yes No

If yes, please write an explanation.

State any chronic health, emotional, or physical problem(s) the child has.

Does the child have any learning diffiiculties? *

Yes No

Has child ever been recommended for any special testing? *

Yes No

Does the student require modifications to meet academic requirements? *

Yes No

If you answered "yes" to any of the previous three questions, please explain.

Please name two references (non family members) for the child who can provide information relevant to his or her character.

Reference 1

First Name Last Name

Reference 1's Phone Number

Area Code Phone Number

Reference 1's Relationship to the Child

Reference 2

First Name Last Name

Reference 2's Phone Number

Area Code Phone Number

Reference 2's Relationship to the Child

In making this application, I understand that

Since the fees do not cover the actual cost of educating my child, we recognize that our participation is needed in prayer, service, and gifts in order to properly share in his/her training.
The school reserves the right to dismiss any student who does not respect its standard or cooperates in the educational process.
After acceptance, a place will be held for my child when te enrollment form and teh non-refundable registration fee have been submitted to the school by the date indicated on the acceptance letter.
It is hereby understood that the guardians will pay tuition for the amount stated by the school office. No refunds will be made for fees. Children transferring to another program and having attended one day or more of any month will owe the full month's tuition.

Statement of Cooperation

I pledge loyalty to the aims of the school and will bring any and all questions and criticisms directly to the administration so that they may be properly considered by those in authority.
We will read the Statement of Faith and the Philosophy of Education and are willing to have our child trained in accordance with them.
We will read the Student Handbook and will cooperate fully in seeing that the rules and regulations laid down there are met.
I give Berean Academy permission for my child to take part in all school activities, including sports and school-sponsored trips away from the school premises.
The teacher and administration are hereby given full discretion in the discipline of our child. This would include the issuing of suspensions and expulsion from the school program.
I agree to hold the school and its agents harmless for any liability to my child or any guardian or parent thereof because of any claims on behalf of my child against the school or any agent thereof because of any injury or alleged injury to my child. Should legal action, for any reason, be taken against Berean Academy or any employee or agent thereof, on my child’s behalf and the school or its agent not be found at fault, I agree to pay any attorney fees, damages or other costs that Berean Academy or its agent should incur to defend itself against such action, and would immediately withdraw my child from school as soon as such action had begun.
This statement of cooperation will be in effect for as long as my children attend Berean Academy or Preschool.
The school reserves the right to dismiss any student who does not cooperate with the educational process. If a student is dismissed for any reason, the tuition will be prorated on a monthly basis for that period of time that the child is in school.

Notice of Non-Discrimination

Berean Academy admits all qualified applicants regardless of race, gender, color, or national and ethnic origin.

Confirmation/Submission

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature: Use your mouse to sign.

FEE

Registration Fee $ 50.00

Application for Preschool/Kindergarten Enrollment