Genesis Academy

GENESIS ACADEMY ENROLLMENT APPLICATION

Student's Information

First Name

Middle Name

Last Name

National Insurance #

Gender

Male Female

Place of Birth

Nationality

Date of Birth

Age

Entering Grade

Entering Year

SCHOOL HISTORY

Please list schools in chronological order

Name of School / Address / Years Attended

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Parent/Guardian Information

Parent/Guardian 1

First Name

Middle Name

Last Name

Relationship to Applicant

Gender

Male Female

Nationality

Street Address

P.O.Box

Home Telephone

Work Telephone

Cell Phone

Profession

Place of Employment

With whom does the child live?

Marital Status of Parents

Mother’s Maiden Name

Religious Affiliation

Billing Name

Parent/Guardian 2

First Name

Middle Name

Last Name

Relationship to Applicant

Gender

Male Female

Nationality

Street Address

P.O.Box

Home Telephone

Work Telephone

Cell Phone

Profession

Place of Employment

With whom does the child live?

Marital Status of Parents

Mother’s Maiden Name

Religious Affiliation

Billing Name

Health Information

Name of Child’s Doctor

Doctor’s Contact:

Is The Child Covered by Health Insurance?

YesNo

Name of Insurance Company

Emergency Contacts Other Than Parent or Guardian

Name

Relationship to Applicant

Contact #

Name

Relationship to Applicant

Contact #

In the case that hospitalization is necessary please indicate which hospital you wish your child to be taken to:

Doctors HospitalPMH

State child’s general health:

Please select any of the following conditions your child may have suffered from the list provided on the right.

Allergies Asthma Congenital Abnormalities Convulsions/Epilepsy Frequent HeadachesFainting Hearing Difficulties Heart Problems High/Low Blood Pressure HIV Kidney/Unitary Infections Orthopedic Problems Rheumatic Fever Skin Problems Tuberculosis Vision Problems

Please comment on any selected items from the list above.

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Is the child potty trained?

YesNo

Does this child wear spectacles?

YesNo

Is this child under special medical care?

YesNo

Does this child routinely take medication?

YesNo

Any problems, which may adversely affect ability to study?

YesNo

Any known allergies to medication?

YesNo

If you’ve answered “yes” to any of the above please give brief details:

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Please list any known emotional problems of the child:

0 /

Please list any surgical operations and the approximate dates:

0 /

Provide details of anything related to your child not covered above which might be helpful to the teachers:

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PARENT/GUARDIAN AGREEMENT FORM

Check all below in agreement with our Parent/Guardian Agreement

I HAVE READ AND AGREE TO ABIDE BY THE POLICIES AND GUIDELINES AS OUTLINED IN THE STUDENT/PARENT HANDBOOK. I AGREE TO COOPERATE FULLY WITH THE SCHOOL ON MATTERS PERTAINING TO MY CHILD’S EDUCATION.I understand that Genesis Academy is informed by Biblical teaching and rational thinking that encourage partnership with parents and members of the wider community, as well as the Government, to promote high standards of Biblical morality, ethics, justice, and social good. I understand that it is my responsibility to read the Student/Parent Handbook, Parent WhatsAppGroup, Emails, and other communications sent by Genesis Academy to keep me informed of school policies, procedures, and other necessary information. I understand that tuition and fees are subject to annual increases. I agree to meet my financial obligations to the school on time. I understand that failure to pay tuition on schedule my child will not be permitted to attend school until tuition is paid. I understand that a $100 late fee will be applied to tuition and a 2% per month charge thereafter. I understand that should I decide to withdraw my child during the course of the term that TUITION AND ALL OTHER FEES ARE NON- REFUNDABLE AND NON-TRANSFERABLE.I understand that it is my responsibility to inform the school of any occasion when it is necessary to take my child off campus during school hours. In such cases, parent/guardian are expected to sign out their child from the office.It is my responsibility to see that my child attends school regularly, on time, and fully clad in school uniform.I understand that grade level advancement is based upon mastery of grade-level benchmarks. I understand that students are promoted to a grade level if they master grade-level benchmarks and are socially ready.I understand that it is my responsibility to partner with my child’s teacher/s by periodically checking on the progress of my child.I give my child permission to accompany the class or other school-related field trips, which take place during school hours.I understand that my child/ren is/are required to enroll in the school’s insurance ($20 annual fee).I understand that in the event of minor complaints or accidents, the school will treat my child. However, in the event of a serious illness or accident, I will be contacted and asked to collect my child. In cases of emergency, Genesis Academy reserves the right to call an ambulance.I understand that Genesis Academy reserves the right to dismiss any student whose parent/s display anon-cooperative, disruptive or destructive behavior in any matter pertaining to their child or the school.I pledge my full support to the Parent Teachers Association and understand that I am expected to attend P.T.A. meetings and other related functions.

Print Name:

Date

I have read and agree to abide by the policies and guidelines as outlined in the Student/Parent Handbook.

Clear Signature

Apply Now

Student's Information

Parent/Guardian Information

Health Information

PARENT/GUARDIAN AGREEMENT FORM

VISION

To see children oriented Biblically, motivated creatively, communicate effectively, work collaboratively, and think critically while utilizing innovative pedagogies to foster growth academically, socially, and spiritually.

MISSION

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