Applying to CVCS
To apply to CVCS the student applicaiton form and the registration fee are due at registration.
Students new to Chino Valley Christian Schools will be assessed prior to entry acceptance. Assessments are scheduled at the time of enrollment.
Applications are available either through the school office or below:
_________________________________________________________________________________________
Chino Valley Christian Schools
2012-2013
ENROLLMENT APPLICATION
STUDENT INFORMATION
Re-Enrolling ______Check if any changes in previous yrs. info
New ________
Grade: _________ Male Female
Name ____________________________________________
(Last) (First)
Address ______________________________________
City ___________________________ Zip ____________
Home Telephone (_____)_____________________________
FAMILY INFORMATION
Name ________________________________________
Father/Stepfather/Guardian (Please circle one)
__________________________ ( _____)________________
E-Mail Address (Required) Cell Phone
__________________________ (______)________________
Employer Work Phone
_________________________________________________
Occupation
Married Divorced Separated Widow
Age ____________ Date of Birth _____________________
Student Resides with: Both Parents
Mother/Stepfather Father/Stepmother
Mother Father
Other (Please Explain): ________________________
NEW STUDENTS ONLY
_________________________________________
LastSchoolAttended
__________________________________________________
School Address
__________________________________________________
City State Zip Code
Has your child ever repeated a grade? Yes No
Has your child ever been dismissed,
suspended, or expelled? Yes No
Does your child have any limitations
or handicaps? Yes No
Please explain all YES answers: _____________________
__________________________________________________
How did you hear aboutChinoValleyChristianSchools?
_______________________________________________________________
K-11 Extended Care (Circle one) Initial: ___________
Morning Afternoon Full Time Occasional
Name ____________________________________________
Mother/Stepmother/Guardian (Please circle one)
__________________________ (______)________________
E-Mail Address (Required) Cell Phone
___________________________(______)________________
Employer Work Phone
__________________________________________________
Occupation
Married Divorced Separated Widow
Church Presently Attending:
__________________________________________________
Name of Church City
__________________________________________________
Denomination
Family Nationality: (For Government Statistics Only)
African American Asian/Pacific Islander
Caucasian Filipino Hispanic
Middle Eastern Native American
Other (Please specify) _________________________
For Office Use Only
| Reg. Date | Family ID # | Student ID# |
| Application Fee | Test Fee | |
| Payment Type | Payment Date | Data Entry Date/ |
| Other Fees: | Student Records RequestDate: | |
GENERAL AGREEMENTS
I agree to all of the following:
- I understand that Chino Valley Christian Schools admits students of any race, color, national and ethic origin and students are offered all rights, privileges and programs generally afforded or made available.ChinoValleyChristianSchoolsdoes not discriminate on the basis of race, color, national and ethic origin, in educational policies, admissions policies, and tuition programs, athletic and other school administered programs.
- I understand that I will be receiving a Student & Parent Handbook and I agree to carefully study the handbook knowing that we will be bound by the terms and standards of the handbook. I agree to giveChinoValleyChristianSchoolsmy complete support and cooperation in upholding, applying, and enforcing the standards as stated in the handbook.
- I agree to support obedience to the rules and regulations of the school. I will adhere to the schools dress code guidelines and will nurture proper conduct on the part of my child. I understand thatChinoValleyChristianSchoolswill not tolerate dishonor to God, use of profanity, pornography, obscenity in word or action, possession or use of drugs, alcohol, tobacco or weapons and disobedience or disrespect to the school staff by any student.
- I agree to supportChinoValleyChristianSchoolsin necessary discipline action. It is the policy ofChinoValleyChristianSchoolsto use the least severe means in correcting a student’s misbehavior. However, when a student chooses not to follow the standards of the school, discipline will be used including the use of suspension and expulsion.
- I agree to withdraw my child fromChinoValleyChristianSchoolsif at any point I am not willing to support the standards or decisions of the school.
- I understand that my child will be going on field trips in a school bus or in parent provided transportation. If I do not want my child to participate in field trips, I will submit in advance a written request that he/she be excused from the trip. I further understand that I will then be responsible for the care of my child on those days my child is excused. Middle/High can be excused from a field trip, but academic class participation is still required.
- I agree to resolve any non-financial disagreements with Chino Valley Christian Schools in conformity with Biblical injunctions of 1 Corinthians 6:1-8, Matthew 5:23 & 24, and Matthew 18:15-20. I agree that any claim or dispute arising out of, or related to this agreement or to any aspect of the school relationship, including any non-financial claim or statutory claims shall be settled by Biblically- based mediation. If resolution of the dispute and reconciliation do not result from such efforts, that matter shall then be settled by arbitration in accordance with the rules of procedure for Christian conciliation of the Institute for Christian Conciliation. I agree that these methods shall be the sole remedy for any non-financial controversy or claim arising out of the school relationship or this agreement and expressly waive my right to file a lawsuit againstChinoValleyChristianSchoolsin any civil court for such disputes, except to enforce a legally binding arbitration decision.
My/our signature(s) below indicates that I/we have read and agree to the terms presented above:
Signature ____________________________________ Relationship ____________________ Date ____________________
Signature ____________________________________ Relationship ____________________ Date ____________________
TUITION PAYMENT INFORMATION
Name of person(s) responsible for tuition payments:
Last _______________________________________ First ____________________________ Middle __________________
Address _____________________________________________________________________________________________
Street City State Zip Phone Number
Employer ____________________________________________________________________________________________
Address Work Phone Number
Relationship to Student _________________________________________________ Date of Birth ____________________
Drivers License Number ________________________________________________
FINANCIAL AGREEMENT
I agree to all of the following:
- I agree to meet all financial obligations related to our child’s enrollment atChinoValleyChristianSchoolsincluding fees described on the current schedule of fees and other incidental fees that may arise. I understand that failure to meet our financial obligations in a timely manner (accounts which are 30 days behind) will result in my child’s suspension or expulsion.
- I agree to pay promptly on the first of each month as shown on the schedule of fees. I understand that a late fee of $25.00 per month will be assessed and added to our bill for each payment received after the 5th of the month and that a $25.00 fee will be charged for checks returned by my bank for any reason. I understand that after two times returned, it will result in cash or money order payments only for the remainder of the year. If my account becomes more than 30 days behind, I understand that my child (-ren) will not be allowed to return to school and that my account will be suspended until my account is brought current and a $50.00 reinstatement fee is paid. I further understand if nonpayment remains, this matter will be sent for collection and attorney fees and costs will result.
- I understand that Occasional Care will automatically be billed to my account on the following business day after Occasional Care was used. I further understand that I cannot make changes to my Extended Care status in the middle of the month and there are no refunds for unused Extended Care.
- (Returning students only) The application processing fee will be waived for returning students. I understand that an enrollment application will not be accepted if my account is not current.
My/our signature(s) below indicates that I/we have read and agree to the terms presented above:
Signature ____________________________________ Relationship ____________________ Date ____________________
Signature ____________________________________ Relationship ____________________ Date ____________________
EMERGENCY INFORMATION
Persons, other than parent(s), who live locally that are authorized to take child from school or in case of illness or emergency:
Name ____________________________________________Relationship ________________________ Tel. # __________________
Name ____________________________________________Relationship ________________________ Tel. # __________________
Name ____________________________________________Relationship ________________________ Tel. # __________________
Name ____________________________________________Relationship ________________________ Tel. # __________________
Name(s) of persons absolutely NOT AUTHORIZED to pick up child from school (Legal document MUST be on file.)
Name _____________________________________Relationship _______________________________________________
Name _____________________________________Relationship _______________________________________________
AUTHORIZATION TO TREAT MINOR: I/We, the undersigned parent or legal guardian of __________________________________________,
A minor, do hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis and treatment and emergency hospital care which is deemed advisable by and is to be rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the medicine practice act and on the staff of any acute general hospital holding a current license to operate a hospital from the State of California, Department of Public Health. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power to render care which the aforementioned physician in the exercise of his best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached, This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California.
__________________________________________________________________ ______________________________________________
Parent/Guardian Signature Date
Allergies to Drugs/Foods: ______________________________________________________________________________________
List any restrictions: __________________________________________________________________________________________
Special medications or pertinent information: ______________________________________________________________________
___________________________________________________________________________________________________________
Physician’s Name: ___________________________________________________ Phone: (_____)____________________________
CHINO VALLEY CHRISTIAN SCHOOLS
4166 RIVERSIDE DR.
CHINO, CA 91710
Phone #: (909) 613-1381
Fax #: (909) 613-1383
website address: www.cvcs.com
Accredited by:
Association of Christian Schools International
and
Western Association of Schools and Colleges
Developing and nurturing children through excellence in Christ-centered education