2022-2023 Registration

ENROLLMENT

Please select type of enrollment:(Required)

Existing Student

New Student

Hope Coalition Student (Available for preschool only)

STUDENT INFORMATION

Student's Name(Required)

First Last

Preferred Name

Gender(Required)

Male

Female

Birth Date(Required)

Enter date as mm/dd/yyyy

2024-2025 Class Registration(Required)

PARENT OR GUARDIAN INFORMATION

Primary Contact One

Name(Required)

First Last

Relationship to Student(Required)

Mobile Phone(Required)

Email Address(Required)

Primary Address(Required)

Street Address Address Line 2 City State ZIP Code

Place of Employment

Work Phone

Primary Contact Two

Name

First Last

Relationship to Student

Mobile Phone

Email Address

Second Address

Address is different than Contact One

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Place of Employment

Work Phone

FAMILY INFORMATION

Child is living with:(Required)

Other living arrangements:

Are there any family situations we should be aware of?

Additional siblings not attending Abiding Savior Academy (names and ages):

Language spoken at home:

Church affiliation:

Religion

HEALTH INFORMATION

Please enter "none" for any fields that do not apply.

Enter any medical conditions your child has that we should be aware of:(Required)

List any allergies your child has:(Required)

List any prescribed medications your child is taking:(Required)

List any specific dietary requirements:(Required)

Family Doctor:(Required)

Family Doctor Phone:

Hospital Preference:(Required)

REQUIRED DOCUMENTS

The following documents are required as part of your application. The application will not be considered complete until received via upload or submitted to the Abiding Academy office. Photo uploads will be accepted.

Upload Birth Certificate

Max. file size: 100 MB.

Upload Immunizations or Medical Release Waiver

Max. file size: 100 MB.

EMERGENCY CONTACT INFORMATION

Emergency contact information in case a parent or guardian CANNOT be reached. If you have more than two contacts, please type them in the comments below. Please type only one contact per line.

Emergency Contact One(Required)

First Last

Phone(Required)

Relationship(Required)

Emergency Contact Two

First Last

Phone

Relationship

AUTHORIZED DROP OFF/PICKUP CONTACT INFORMATION

List individuals authorized to pick up your child (other than the primary contacts). If you have more than two contacts, please type them in the comments below. Please type only one contact per line.

Authorized Contact One

First Last

Phone

Relationship

Authorized Contact Two

First Last

Phone

Relationship

TUITION

Abiding Savior Academy offers the option to pay tuition over a nine-month or twelve-month period. If you choose the twelve-month option, please note that payments for the 2024-2025 school year begin on June 1st. The twelve-month payment plan option is only available to those who register by March 1, 2024.

Please choose a payment plan option for this child:(Required)

9-month payments beginning September 1st

12-month payments beginning June 1st

12-month payments are not available for preschool or Junior Kindergarten
Please utilize the comment section for questions regarding payment plans.

REFERRAL

If you were referred to Abiding Savior Academy by a specific family, please enter their name here. New families referred to Abiding Savior Academy (K-12) and the referring family will receive one month’s tuition free for the child/student with the lowest tuition rate. Please note that the referring family name must be included with the submission of this application and may not be added at a later time.

Referred By

CONSENTS

I give my consent for the following (please check all that apply):

For my child's photo to be included in social media such as the Academy Facebook page, school presentations, advertising, programs, etc.

For our family's information to be included in the Abiding Savior Academy School Directory

By electronically signing this form, I hereby grant my permission for the following:

For my child to use all the play equipment and to participate in all the activities of the school
For my child to leave the school premises for neighborhood walks or excursions to places of interest under the supervision of staff members or approved volunteer parents
For my child to participate in the Christian curriculum provided by Abiding Savior Academy
For the teacher or acting teacher to take whatever steps necessary to obtain medical care as warranted
For the emergency treatment of my child, if requested by Abiding Savior Academy, the authorized school provider for my child

Comments:

Electronic Signature(Required)

By electronically signing this form, you are verifying the information within it to be correct and accurate with appropriate consents as indicated.

Are you enrolling another child?(Required)

Yes

ENROLLMENT

STUDENT INFORMATION

PARENT OR GUARDIAN INFORMATION

Primary Contact One

Primary Contact Two

FAMILY INFORMATION

HEALTH INFORMATION

REQUIRED DOCUMENTS

EMERGENCY CONTACT INFORMATION

AUTHORIZED DROP OFF/PICKUP CONTACT INFORMATION

TUITION

REFERRAL

CONSENTS

Contact

Academics

MEMBERSHIP