Enrollment Application Form for Cornerstone Christian School

Enrollment Option

New Enrollment

Re-enrollment

Student's Full Legal Name

Grade to Enter

Student's Gender

Male

Female

Student's Age

Student's Date of Birth

Month

Day

Year

Student's Home Address

Father's Full Legal Name

Father's Cell Phone Number

Father's Email Address

Father's Home Address (if different from student's) List "N/A" if not applicable.

Father's Employer and Position (List "N/A" if currently unemployed)

Father's Work Phone Number

Mother's Full Legal Name

Mother's Cell Phone Number

Mother's Email Address

Mother's Home Address (if different from student's) List "N/A" if not applicable.

Mother's Employer and Position (list "N/A" if currently unemployed)

Mother's Work Phone Number

Student lives with

First Additional Emergency Contact Name and Relation to Student (not father, mother, legal guardian)

First Additional Emergency Contact Cell Phone Number (not father or mother)

Second Additional Emergency Contact Name and Relation to Student (not father, mother, legal guardian)

Second Additional Emergency Contact Cell Phone Number

List any student allergies

List any student physical difficulties or disabilities

Student's Physician

Student's Physician's Office Phone Number

Student's Physician's Office Address

The student is:

Right-handed

Left-handed

Ambidextrous

Yet to be determined

School Attended Last Year (List "N/A" if not applicable)

Address of last school attended

Grades have been

Names and Grades of other siblings attending (or seeking enrollment in) CCS

Church you now attend (list "N/A" if not applicable)

Reasons for selecting Cornerstone Christian School

School recommended by

It is my desire for my child to complete the upcoming school year in full at Cornerstone.

Yes

Please indicate student's t-shirt size

Enrollment Release Permissions

OTC (over-the-counter) Medical Release

I understand that Cornerstone Christian School may need to administer over-the-counter medication to my child, as needed, for minor incidents and illnesses for this school year.

I grant permission.

I do not grant permission.

I grant limited permission.

If OTC Medication is limited permissions granted, please list allowed OTC Medications below.

Emergency Medical Treatment Release

I understand that Cornerstone Christian School may need to obtain emergency medical treatment for my child in the case of an emergency this school year.

I grant permission.

I do not grant permission.

Media Release

I understand that Cornerstone Christian School uses various media to promote school activities. Student's images, names, or projects may be used for school-related purposes. Platforms may include social media, website, newspaper, brochure, or broadcast.

I grant permission.

I do not grant permission.

I grant limited permission.

If Media Release is limited permissions granted, please list allowed Media Releases below.

Field Trip Release

I understand that my child may take part in school sponsored trips away from the school premises. I absolve the school from liability to me or my child because of any injury to my child during any school activity.

I grant permission.

I do not grant permission.

Physical Education Release

I understand that my child may take part in school sponsored athletic activities. I absolve the school from liability to me or my child because of any injury to my child at school or away from school during any school athletic activity.

I grant permission.

I do not grant permission.

Please sign below to indicate your approval of all enrollment release permissions (#1-5) as you indicated above.

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Statement of Cooperation

I assure my cooperation and support to the teachers and administration of Cornerstone Christian School in the training and discipline of my child.
I realize it is a privilege, not a right, for my child to attend Cornerstone Christian School. I understand that my child may be dismissed at any time he/she is found to be out of harmony with the rules and policies of the school. I further understand that this condition extends to include the conduct of guardians as well.
Beyond the reasonable care I can expect for my child at Cornerstone Christian School, I will not hold Cornerstone Christian School or its employees liable in any case of injury to my child.
I understand the policy of the school is to make no refunds on registration fees.
If I do not pay the full annual tuition prior to the start of the school year, I agree to pay my tuition by the tenth day of each month and to complete all payments in full by the 10th of May.
I agree that, in the event that I am not able to meet my financial responsibilities with Cornerstone Christian School, I will call the office and make arrangements satisfactory with the school in order to balance my account.
I understand that if I fail to make satisfactory arrangements by the tenth day of the month a 10% late fee will be added to my account, and my child will not be able to attend class if my account is more than one month in arrears.
I agree to read, understand, and abide by the Student Information Manual given to me upon enrollment.
I give my consent and authorize the school to obtain such medical care as is reasonably necessary for the welfare of my child if I am not immediately available to give such consent.
I acknowledge that if my cooperation and support of the school, its staff, and its policies of Cornerstone Christian School is not present, in the opinion of the School Board, I may be asked to withdraw my child.
I understand that I or another representative of my family is expected to provide voluntary assistance in various activities that promote the well-being of Cornerstone Christian School for a minimum of 16 hours in this school year.

Please sign below to indicate your agreement and cooperation with the terms as stated above.

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Cornerstone Christian School

Enrollment Application Form for Cornerstone Christian School

Enrollment Release Permissions

OTC (over-the-counter) Medical Release

Emergency Medical Treatment Release

Media Release

Field Trip Release

Physical Education Release

Statement of Cooperation