Saturday, November 1st, 2014

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 ______ƒCheck if any changes in previous yrs. info

New ________

 

Grade: _________  ƒ Male   ƒ 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

ƒ  Married     ƒ  Divorced     ƒ  Separated     ƒ  Widow

 

Age ____________ Date of Birth _____________________

 

Student Resides with:   ƒ Both Parents

ƒ Mother/Stepfather     ƒ Father/Stepmother

ƒ Mother                      ƒ Father

ƒ Other (Please Explain): ________________________

 

NEW STUDENTS ONLY

 

_________________________________________

LastSchoolAttended

 

__________________________________________________

School Address

 

__________________________________________________

City                                            State                        Zip Code

 

Has your child ever repeated a grade? ƒ Yes      ƒ No

Has your child ever been dismissed,

suspended, or expelled?                         ƒ Yes      ƒ No

Does your child have any limitations

or handicaps?                                         ƒ Yes      ƒ 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

ƒ  Married     ƒ  Divorced     ƒ  Separated     ƒ  Widow

 

Church Presently Attending:

 

__________________________________________________

Name of Church                                     City

 

__________________________________________________

Denomination

 

Family Nationality:  (For Government Statistics Only)

 

ƒ  African American           ƒ  Asian/Pacific Islander

ƒ  Caucasian                        ƒ  Filipino             ƒ  Hispanic

ƒ  Middle Eastern                ƒ  Native American

ƒ  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:

 

  1. 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.

 

  1. 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.

 

  1. 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.

 

  1. 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.

 

  1. I agree to withdraw my child fromChinoValleyChristianSchoolsif at any point I am not willing to support the standards or decisions of the school.

 

  1. 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.

 

  1. 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:

 

  1. 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.

 

  1. 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.

 

  1. 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.

 

  1. (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