Enrollment Enrollment Application Re-Enroll Withdrawl Notice Enrollment Application Student InfoFirst Name *Middle NameLast NameStudent's Preferred NameStudent's Gender *Please select an optionMaleFemaleStudent's Birthdate *Student's Birth Place *Student's Social Security Number *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Student's PhoneStudent's Email AddressGrade *The grade the student is to be enrolled inK4-K51st - 6th Grade7th - 12th GradeAre You A Christian? *To be completed by students grades 7-12YesNoI'm not sureOn what do you base your answer? *Father (or guardian) InfoPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Middle NameLast Name *Father's/Guardian's Phone *Father's/Guardian's Email Address *Father's/Guardian's OccupationFather's/Guardian's Employer *Father's/Guardian's Employer Phone *Father's/Guardian's Marital Status *Please select an optionSingleMarriedWidowerSeparatedDivorcedRemarriedAre You A Christian? *To be completed by students grades 7-12YesNoI'm not sureOn what do you base your answer? *Mother (or guardian) InfoPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Middle NameLast Name *Mother's/Guardian's Phone *Mother's/Guardian's/Guardian's Email Address *Mother's/Guardian's OccupationMother's/Guardian's Employer *Mother's/Guardian's Employer Phone *Are You A Christian? *To be completed by students grades 7-12YesNoI'm not sureOn what do you base your answer? *Emergency InfoContact Person to contact in case of emergency (First Choice) *(Name, Phone, Relationship to Student)Contact Person to contact in case of emergency (Second Choice) *(Name, Phone, Relationship to Student)Additional Family InfoList other children in your family (K-12) not being enrolled at Temple.(Name, Grade, School Attending)Church InfoChurch Name *Pastor *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Does your family regularly attend church? *YesNo, not faithfullyDoes your family regularly attend Sunday School? *YesNo, not faithfullyPersonal References(Other than Pastor)First Personal Reference (other than Pastor) *(Name, Address, Phone, Relationship to Student)Second Personal Reference (other than Pastor) *(Name, Address, Phone, Relationship to Student)Additional InfoWhy do you want to enroll your child at Temple? *Does your child need help in overcoming any habits? *Describe your child's personality. *(Well-behaved, responsible, temperamental, aggressive, fearful, etc.)Are there any family circumstances the school should be aware of when working with your child? *Does your child have any special abilities, awards, interests, or hobbies? *After-School CareThere is no after-school care on half days.After-School Care *There is no after-school care on half days.I will need after-school care from 12 pm until (approximate time).I will need after-school care from dismissal until (approximate time).I will not need after-school care.I will need after-school care from 12 pm until (approximate time).HoursMinutesAM/PMAMPMI will need after-school care from dismissal until (approximate time). *HoursMinutesAM/PMAMPMEducation HistoryList chronicologically all schools attended, including pre-first grade. *(Date, Grades, Name of School, Address of School)Has your child ever been dismissed or suspended from any school? If yes, please explain. *Academic RecordUpload latest report card (if possible)Drag and Drop (or) Choose FilesDate of ReportPeriod report covers (full year's averages preferred) *Has your child ever been tested for a learning disability or been in a learning disability program?YesNoIf yes, please describe the testing and/or program.Entering Grades 2-6Please indicate grades from your student's latest report card.ReadingPhonicsArithmeticScienceSpellingSocial StudiesEntering Grades 7-12Please indicate grades from your student's latest report card.Subject, GradePlease list subjects and grade earned.Health InfoPlease comment on which of the following applies to your child.Drug sensitivitiesPlease comment if applies to your child.AllergiesPlease comment if applies to your child.Required medication(Regular or periodic)Nervous conditionPlease comment if applies to your child.Other health conditionsPlease comment if applies to your child.Does your child wear glasses? Contacts? At all times?Please comment if applies to your child.Please check the box of any following illnesses or conditions your child has had. *None of the FollowingMeasles (Red)Measles (German)MumpsEpilepsyTuberculosisChickenpoxDiabetesWhooping CoughRheumatic FeverOther Illness(es)Physical Disability(s)Please list other illness(es) *Physical Disabilities *(Speech, hearing, sight, heart condition, etc.)Physician NamePhysican's PhoneNorth Carolina Opportunity ScholarshipI anticipate having the North Carolina Opportunity Scholarship for the upcoming school year.YesNoDate applied for ScholarshipTerms of AttendanceWhen I enroll my student, I give Temple Baptist School permission for my child to take part in all school activities, including bus trips, sports activities, and school sponsored trips away from the school premises. I also believe that discipline is necessary for the welfare of each student as well as for the entire school. I give my permission for my child’s teacher and/or other agent of the school to make and enforce classroom regulations in a manner consistent with Christian principles and discipline as set forth in the Scriptures. Should legal action, for any reason, be taken against Temple Baptist School or any employee or agent thereof, on my child’s behalf and the school or its agent not be found at fault, I agree to pay any attorney fees, court fees, damages or other costs that Temple Baptist School or its agent should incur to defend itself against such action. In case of an accident or illness, I request the school to contact me. If the school is unable to reach me, I hereby authorize the school to call my physician and to follow his instructions. If it is impossible for the school to call my physician, the school may make whatever arrangements seem necessary. Having carefully read all the information that has been given, I pledge my support to Temple Baptist School by: Praying for the school Upholding the school in: A. Academic Excellence B. Behavior Standards C. Standards of Dress D. Scriptural Teaching Instructing and separating my child from carnal movies and TV programs, rock music, dancing, and worldly literature Meeting financial obligations according to schedule I realize that failure on my part as a parent or failure on the part of the student to comply with school policies in all areas will be grounds for dismissal.I Accept the Terms of Attendance *YesNoFather SignatureDate *Month *Day *Year *Mother SignatureDate *Month *Day *Year *Notice of Nondiscriminatory Policy As To StudentsThe Temple Baptist School admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.I Acknowledge the Nondiscriminatory Policy *YesNoStatement of Cooperation and Waiver of LiabilityIt is my understanding that it is the policy of Temple Baptist School to make no refunds of application fees, and that registration fees may only be refundable if Temple Baptist School refuses enrollment prior to the first day of school. Refund of tuition fees is based on funds remaining after the tuition payer’s incurred tuition costs, fees and other obligations are paid. I give permission for my child(ren), whose name(s) is/are set forth below, to take part in all activities including recreational activities, bus/van trips, field trips, sports activities on the premises of Temple Baptist School, and/or facilities used by Temple Baptist School for the same, and School sponsored trips away from the School premises. I indemnify and save Temple Baptist School, Temple Baptist Church, its employees and agents harmless from any liability or medical payments resulting from my child(ren) participating in the above-mentioned activities. I understand that Temple Baptist School and Temple Baptist Church do not provide medical insurance coverage for my child(ren), and that any insurance offered is at no obligation, for my convenience and that I can choose to provide other insurance coverage of my own, and that any medical expenses incurred will be paid by either my own medical coverage or myself. I also believe that discipline is necessary for the welfare of each student, as well as for the entire School. I give permission for my child’s teacher and/or other agent of the School to make and enforce classroom regulations in a manner consistent with Christian principles and discipline as set forth in the Scriptures. I understand that certain policies of the school are stated in the school handbook and that the school reserves the right to make changes to the handbook at any time. I further agree to hold the School and Church, and its agents harmless for any liability to my child(ren) or guardian or parent thereof because of any claims on behalf of my child(ren) against the School and/or Church, or any agent thereof because of any injury or alleged injury to my child(ren) unless the school is found negligent. In the event that a photograph taken and/or used by Temple Baptist School has my child(ren) in it, I give permission for my child(ren)’s picture to be used in any publications or brochures, current or future, of Temple Baptist School. Should legal action, for any reason, be taken against Temple Baptist School or Temple Baptist Church or any employee or agent thereof, on my child(ren)’s behalf and the School or Church or its agent(s) not be found at fault, I agree to pay any attorney fees, court fees, damages, or other costs that Temple Baptist School and/or Temple Baptist Church or its agent(s) should incur to defend or represent itself in/against such action. I further understand that it is the policy of Temple Baptist School and Temple Baptist Church to require withdrawal from the School commencing with the declaration of intent to pursue legal action against the School or Church or any of its agents. The statement of cooperation portion of this form will be in effect for as long as my child(ren) listed (or others to be enrolled) attend Temple Baptist School whether it be in the pre-school, elementary, junior-senior high, after school care, or summer school. The waiver of liability portion remains in effect even if my child(ren) are no longer attending TBS. I understand that should my marital/parental status change, it is my responsibility to have a corrected Statement of Cooperation and Waiver of Liability signed and updated and delivered to Temple Baptist School.I Acknowledge the Statement of Cooperation and Waiver of Liability *YesNoList children's names and grades. *Father SignatureDate *Month *Day *Year *Mother SignatureDate *Month *Day *Year *Signature of Sole GuardianDate *Month *Day *Year *Register Re-Enroll Students Being Re-enrolledEnrollment Fee: $175 for 1 child, $300 for 2 children, $450 for 3+ childrenNumber of Students Being Re-Enrolled *First Name *Last Name *Grade *First Name *Last Name *Grade *First Name *Last Name *Grade *First Name *Last Name *Grade *First Name *Last Name *Grade *First Name *Last Name *Grade *First Name *Last Name *Grade *First Name *Last Name *Grade *First Name *Last Name *Grade *First Name *Last Name *Grade *Re-Enrollment Fee *I have paid in full alreadyI have made a partial payment alreadyI have yet to pay in fullPayment Method *CashCheckAnedotTotal Paid *Enrollment fee must be paid before your child/children can be added to a class list for the upcoming school year.USDDate Paid *Re-enrollment ConsentBy reenrolling, I am confirming again my support of Temple Baptist School as given in the application. I understand cost information is contained in the 2024-2025 tuition and fee schedule and that the school handbook contains financial and policy information. I also understand that the school reserves the right to make financial changes at any time. I give permission for the School to contact me using any of the numbers and the e-mail addresses given to Temple Baptist School. This includes contact by the SchoolCast notification system and contact through the Renweb school management program.I Am In Agreement With Temple Baptist School's Re-enrollment Consent Policy *YesNoParent Signature *Date *Parent Contact InfoFather's Phone *Father's Email Address *Mother's Phone *Mother's Email Address *North Carolina Opportunity ScholarshipI anticipate having the North Carolina Opportunity Scholarship for the upcoming school year. *YesNoDate applied for Scholarship *TuitionI plan to pay tuition in full by September 1. *YesNoAfter-School CareFrom 12 pm until (approximate time)From 3 pm until (approximate time)I will not need after-school care.Submit Withdrawl Notice Withdrawl NoticeMy child(ren) will not be returning to Temple Baptist School in the fall.Reason for Withdrawl *FinancesRelocatingOtherOther reasoon for withdrawl *Child(ren) Being Withdrawn *Submit
