New Students Enrollment ApplicationName(Required) First Last Preferred Name (Nickname) Gender(Required)Date of Birth(Required) Place of Birth (City, State or Country)(Required)Grade in Fall(Required)Previous School Attended(Required)Previous School Phone(Required)Previous School Attended(Required)Race(Required) American Indian or Alaska Native Asian Black or African American Hispanic/Latino Middle Eastern or North African Native Hawaiian or Other Pacific Islander White Two or more racesMother's Name(Required)Father's Name(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country In case of an emergency which parent should be contacted first(Required) Mother FatherMother's Email(Required) Father's Email(Required) Church AffiliationFather CellFather WorkMother CellMother WorkREGISTRATION FEE is due at time of Enrollment and are NON-REFUNDABLE.(Required) I agreeThe Annual Tuition is $4,950.00 (per student) if paying monthly (11 months) or $4,700 if PAID IN FULL. Payment Options (mark “x” for selection):(Required) (11) equal payments of $450.00 due on the 1st of each month, $4,950.00 (per student). We will charge an electronic fee of $100.00 (per student, per year) upon your first payment made electronically. The final tuition payment is due on June 1st. Registration of $400- and first-month’s tuition is due upon registration ($850.00). (1) Paid in full tuition totaling $4,700. Registration is $400.00. Both tuition and registration are due upon registration ($5,100)iceFINANCIAL POLICIES(Required) I agree● Tuition payments are due on the 1 st of each month. A $15 charge applies if the payment is received after the 7th. ● Monthly Statements will be sent home with your student. ● Accounts will be charged a $15.00 fee for any returned checks. ● If more than one check is returned, future payments must be made with a cashier’s check or money order. ● Student(s) will be required to remain at home for any account delinquent 30 days until the account is brought current. ● Student (s) will be disenrolled if the account is more than 60 days delinquent. ● A 30-day written notice is required before withdrawing your student(s).PARENT ORIENTATION – MANDATORY FOR ALL FAMILIES(Required) I agreeParent Orientation is a MANDATORY meeting for all FAMILIES. Date in August 16,2025 at 8:30 AMPERMISSION GRANTED(Required) I agreeI understand that I am responsible to fill out a permission slip for the students listed on this form to attend any school-sponsored activities/field trips. I also grant emergency permission, at the school’s discretion, for my child/children to receive medical treatment should it be necessary.ADMISSION AND CONTINUED ENROLLMENT CONDITIONS(Required) I agree● Students and parents must be committed to their student’s academics ● Students must show a desire to grow and mature in their personal relationship with Jesus Christ ● Students’ behavior must not negatively impact the management of the classroom ● I will read the JCS Parent Handbook, and I am in agreement and will adhere to the policies and procedures ● I agree with and will adhere to the Statement of Faith, Purpose, and Statement of Marriage, Gender, and Sexuality in the Parent Handbook. If at any time I find, I cannot continue in agreement and adherence, I will disenroll my students.Parent/Legal Guardian’s check below indicates that I have read, understand, and agree with the above Financial and Admission policies as stated on both sides of this form.(Required) I agreeJourney Christian School does not discriminate based on race, color, or gender. Attendance at Journey is a privilege and as such, we reserve the right to disenroll any student.Family Information Disclosure K – 6 th Grade StudentsStudent’s Full Name(Required)Grade in Fall(Required)If any of the following questions apply to one of your students, Please indicate the student’s name before answering the question.Please disclose all information with integrity. Our ability to maintain the best learning environment for Journey Christian School students is determined by the full knowledge of your student’s background.Family DynamicsWith whom does the student reside?If the student does not live with one or both of their biological parents, please explain the reason:Is your student involved in a children’s church program on a weekly basis? Yes NoDo you attend church on a weekly basis? Yes NoChurchConduct/Social/EmotionalHas your student received detention at their previous school? Yes NoPlease explain what the detention was served for?Has your student ever been suspended and/or expelled from any school? Yes NoPlease explainHas your child experienced any social/emotional challenges? Yes NoPlease explainAcademic/Resource Program HistoryDo you have concerns about your child regarding any learning difficulties? Yes NoPlease explainHas your student ever been tested for or diagnosed with any learning disability? Yes NoPlease explain in detail what test was administered and what were the suggested recommendations?Please check the appropriate box (if applicable): Current IEP Current 504 OtherPlease provide a copy of the applicable document with enrollment application.PhysicalDoes your student have any physical disabilities that would prevent him/her from participating in the regular Physical Education program? Yes NoPlease explainPlease list any accommodations the student has been given in previous schools and any other concerns you may have regarding your student.Δ
