balancing spiritual growth and academics while seeking to...

Balancing Spiritual Growth and Academics

While Seeking to Glorify God in Everything

Temecula Christian School Application For Admission

One application per student. Please print.

2015-2016 Date: _____________

Student’s Name: _____________________________________________________________________ Phone: ___________________ First Middle Last

Entering Grade: _______ Male: ___ Female: ___ Birthdate: _________________ Birth Place: ________________________________

Address: _________________________________________________________________________________________________________

Birth Father’s Name: __________________________________________________________________________________________

May we contact you in case of an emergency? __________ Have you received Jesus Christ as your personal Savior? _____

Email: ______________________________________________________________ Phone: __________________________________

Address: ________________________________________________________________________________________________________ City State Zip

Driver’s License # & State: ___________________________________ Social Security #: _______________________________

Employer & Address: ______________________________________________________________________________________________

Occupation: _______________________________ Work Phone: __________________________ Cell Phone: _____________________

Birth Mother’s Name: ________________________________________________________________________________________

May we contact you in case of an emergency? _______ Have you received Jesus Christ as your personal Savior? _______

Email: ________________________________________________________________ Phone: _______________________________

Address: ________________________________________________________________________________________________________ City State Zip Driver’s License # & State: ___________________________________ Social Security #: _______________________________

Employer & Address: ______________________________________________________________________________________________

Occupation: _______________________________ Work Phone: __________________________ Cell Phone: _____________________

List any schools that the student has attended in the last three years, including preschool.

School Address City State/Zip Date Attended

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Does the student have any siblings attending Temecula Christian School? _______________

If yes, what are/is the name(s)?

1. ______________________________________________________________ Grade: ____________ F / M

2. ______________________________________________________________ Grade: ____________ F / M

3. ______________________________________________________________ Grade: ____________ F / M

If the birth Father and birth Mother are divorced, is the divorce final or when will it become final? ___________________________

Who has primary custody? __________________________________ (please provide the school with a copy of your papers for our

records)

Birth Father remarried? { yes { no Birth Mother remarried? { yes { no

Financial Responsible Party

Name of the responsible person(s) for tuition and fees

____________________________________________________________________ Relationship to child: _______________________

Please provide the following information if responsible party is not parents.

Address: ____________________________________________________________________ Phone #: ___________________________

Social Security #: __________________________(if someone other than yourself) Email Address:______________________________

We are in agreement that the above named child is to attend Temecula Christian School this school year. { Yes { No

Step Father’s Name: ________________________________________________________ Phone: ____________________________

Address: _______________________________________________________________________________________________________ City State Zip

Driver’s License # & State: _________________________________________ Occupation: ___________________________________

Employer & Address: _____________________________________________________________________________________________

Work Phone: ___________________________________________ Cell Phone: _____________________________________


Step Mother’s Name: _______________________________________________________ Phone: _____________________________

Address: _______________________________________________________________________________________________________ City State Zip

Driver’s License # & State: _________________________________________ Occupation: ___________________________________

Employer & Address: _____________________________________________________________________________________________

Work Phone: ___________________________________________ Cell Phone: _____________________________________


1. Does the step-parent(s) have legal guardianship? { Yes { No

2. Please list in detail the legal responsibilities that the step-parent(s) have ________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________ 3. If information from the school and/or teacher is sent home who should it be sent to if other than you __________________

The information below must be filled out completely before it is accepted.

About Our Family’s Church Check one or all boxes that apply.

1. Do you and your family attend church as a family? { yes { no

2. Name of church: ____________________________________________________________________________

3. Name of your Pastor: ___________________________________________________

4. Church attendance: { once a week { twice a week { once a month { every other week

{ every other month { other: _________________________________________

Explain custody arrangement and are there any restraining orders and against whom.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________ Please provide necessary papers for any of the above situations.

These papers will be kept in the student’s confidential files.

For office use only

Educational Background and Information

Has your child ever skipped or repeated a grade? __________

If yes, please indicate the grade(s) and briefly describe the circumstances: _________________________________

_____________________________________________________________________________________________

Has your child ever received any tutoring? ___________

If yes, please give information concerning the situation and the subject: ___________________________________

_____________________________________________________________________________________________

Is your child presently receiving tutoring? __________

If yes, please explain: ___________________________________________________________________________

_____________________________________________________________________________________________

Has your child ever been suspended, expelled or asked to withdraw from a school? __________________

If yes, please give an explanation of the circumstances: ________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

My Child’s Medication

1. Does the student have ADD? { yes { no Is he/she on any medication whether taken at home or not? { yes { no

If yes, list the medication: ______________________________________________________________________________________

2. Does the student have ADHD? { yes { no Is he/she on any medication whether taken at home or not? { yes { no

If ye, list the medication: _______________________________________________________________________________________

3. Does the student have a learning disability? { yes { no

If yes, please describe: _________________________________________________________________________________________

Is he/she on any medication whether taken at home or not? { yes { no

4. Is he/she on any medication ? { yes { no

If yes, please list medication and the reason for the medication: __________________________________________________________

______________________________________________________________________________________________________________

Will the medication left in the school office for their use? { yes { no

Please make the office aware of the medication and use. Please ask for the necessary forms to have the school administer medication.

Medication is not to be kept with the student while on school property. All medication must be left in the school office with proper instruc-

tions. See Administration for any exceptions that may apply.

For office use only

_____________________________________________________________________________________________ Dr.’s Name Address Phone #

Insurance Carrier:

_____________________________________________________________________________________________

Phone #: _______________________________________ Policy # ______________________________________

Temecula Christian School

Student’s Name: _____________________________________________________________ Last First M.I.

________________________________________________________________________________ Father’s Name Phone # Cell #

________________________________________________________________________________ Mother’s Name Phone # Cell #

________________________________ ___________ ________________________ Name Relationship Phone # cell #




Name of Drug Reason

__________________________________________________________ _________________________________

__________________________________________________________ _________________________________

__________________________________________________________ _________________________________

MEDICAL RELEASE

I (We) the undersigned parent/legal guardian of _______________________________ , do hereby authorize and

consent to any x-ray examination, anesthetic, medical and/or surgical diagnosis rendered under the general or special

supervision of any member of the medical staff and/or emergency room staff licensed under the provisions of the

M.D.A. or dentist licensed under the D.P.A. and on the staff of any acute general hospital holding current licenses

from the State of California, Department of Public Health. 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 treatments will not be withheld if

the undersigned cannot be reached. I (We) understand and acknowledge that our personal health/accident insurance

is in effect for the above name child. I (We) hereby release Reliance Church and Temecula Christian School from

any liability.

___________________________________________________________________ _____________________ Father/Legal Guardian Date

___________________________________________________________________ _____________________ Mother/Legal Guardian Date

Medical & Emergency Information We will always make every attempt to contact parents first, but in case we are not able to speak with you, please list emergency con-

tacts in the order in which you would like us to call. One form per student.

Food and/or medical allergies: ____________________________________________________________________

Special medical information: _____________________________________________________________________

Date of last tetanus shot: __________________________________

Are there any special medical conditions that we should be aware of? ___________

If yes, please explain: ___________________________________________________________________________

_____________________________________________________________________________________________

Is your child taking any kind of prescription drugs while at school or not? Please list all prescription drugs, inhalers

and the reason for taking it: ______________________________________________________________________

Does the student carry his/her own inhaler with them at all times? { yes { no

Is there a written plan for the use of the inhaler filled out for the student? { yes { no

Is an extra inhaler kept in the school office for the student? { yes { no

Authorization For Transportation

To Parent/Legal Guardians:

The original form is kept in your child’s records in the office. This form assists us in knowing who has

authorization to pick up your child.

If the teacher at dismissal does not recognize the person picking up your child,

they will be asked to go to the TCS office.

The office will verify if they have authorization by the information that is provided on this form.

If they ARE NOT listed, we cannot release your child without your written permission.

You may send a written note to the office

or please call ahead of time before faxing any permission or addition.

They will be asked to show ID to the office staff before taking your child off the school property.

PLEASE PRINT CLEARLY

________________________________________________ Name

________________________________________________ Name

________________________________________________ Name

________________________________________________ Name

________________________________________________ Name

________________________________________________ Name

I understand that my child will not be allowed to leave the school property with any person other than a parent/guardian, or unless the

driver is indicated on this form or the school office has received written permission from me.

_________________________________________________________ Father/Legal Guardian Date

_________________________________________________________ Mother/Legal Guardian Date

The person(s) listed below have our permission to take our child off of school property.

I will inform you in writing of any changes or additions to this list.


CONSENT AND RELEASE FORM FOR PHYSICAL EDUCATION

I, the undersigned parent or guardian, give consent for my child, _______________________________________ ,to

participate in physical education classes at Temecula Christian School. I certify that my child is able to participate

in any and all activities deemed reasonable by the instructor.

If my child has any medical conditions which may be relevant to a physician in the event of an emergency, I have

listed them below. Any activities that I do not want my child to be involved in I have listed below.

Special medical conditions: ______________________________________________________________________

_____________________________________________________________________________________________

Physical restrictions: ____________________________________________________________________________

_____________________________________________________________________________________________

Instructions/Medications: ________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________ _____________________ Father/Legal Guardian Date

_____________________________________________________________________ _____________________ Mother/Legal Guardian Date

CONSENT FORM FOR MEDIA RELEASE

I give consent for pictures taken during school hours, field trips or other school activities to be

placed on Temecula Christian School website.

__________________________________________________________ ___________________ Father/Legal Guardian Date

_________________________________________________________________________________ ___________________________

Mother/Legal Guardian Date

I DO NOT wish my child to participate in the following: _________________________________

_______________________________________________________________________________

_______________________________________________________________________________


29825 Santiago Road, Temecula, CA 92592

(951) 695-0025

REQUEST FOR RECORDS

School Last Attended: ___________________________________________________________ School Name

___________________________________________________________ Address

___________________________________________________________ City State Zip

_________________________________ Phone Number

_____________________________________________________ ___________________ Father/Legal Guardian Date

_____________________________________________________ ___________________ Mother/Legal Guardian Date

The parents/legal guardians of the student named below request that their complete official transcript of credits,

health records, cumulative folder, test data, behavioral evaluations, behavioral reports and other pertinent records be

forwarded to Temecula Christian School. Their use will be restricted to authorized personnel only.

______________________________________ ________________________ ________ ____________ _____

Last Name First M.I. Birth date Grade

Please forward our complete request for records to: Temecula Christian School

29825 Santiago Road

Temecula, CA 92592

Requested by:

_______________________________________________ _________________ ____________________ Signature Title Date

TCS Parent Volunteer Information

Parent volunteers are very important to us at the school. It has been proven that your child feels blessed that you are

involved in their school and they are excited to see you during their day. Some of the areas in which volunteers are

invaluable are: lunch monitoring, recess monitoring and special events. If you are interested in

volunteering, please provide the information below and a staff member will contact you.

Thank you for your involvement at Temecula Christian School.

_______________________________________________________________ ___________________________

Father/Legal Guardian Phone Number

Days Hours

Days and hours that I am available: ___________________________________________ _______________

___________________________________________ _______________

___________________________________________ _______________

Please indicate below your first, second and third choices

___ Lunch Monitoring ___ Recess Monitoring ___ special events

_______________________________________________________________ ___________________________

Mother/Legal Guardian Phone Number

Days Hours

Days and hours that I am available: ___________________________________________ _______________

___________________________________________ _______________

___________________________________________ _______________

Please indicate below your first, second and third choices

___ Lunch Monitoring ___ Recess Monitoring ___ special events

Would you like to be involved with planning field trips, fundraising, teacher appreciation and more?

The TCS Parent Committee is great way to get involved in these areas.

I am interested in serving on the Parent Committee:

______ Yes ______ No

PASTOR REFERENCE


Applicant: This section is be filled out by a parent.

Name of family: ________________________________________________________ Phone #: ______________

Address: _____________________________________________________________________________________

Name of Pastor: _________________________________ Church: _____________________________________

Which service does your child attend? ________________________

Do you attend as a family? ____________ Which service do you or your spouse attend? ___________________

Please list the names of the children applying:

Student’s name: _______________________________________________ Entering Grade: ____________




______________________________________________________________ ___________________________ Father/Guardian Signature Date

______________________________________________________________ ___________________________ Mother/Guardian Signature Date

…………………………………………………………………………………………………………………………

Pastor: ___ If you have additional information regarding this family, please check here. You may contact the school at 695-0025.

1. How long have you known the family? ____________________

2. How well do you know the student and family? _____________________

3. Please provide the following information:

Parent’s relationship to the church: Member _____ Non-member ____

Active _____ Non-active ______

Family attendance: Regular ______ Occasional ______ Seldom _______ 8-4 times/month 3-2 times/month less than once a month

Your observation of the student’s relationship with parents: _______________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

4. Which members of the family are Christians? (John 3:16;Eph. 2:8,9)

Father: __ Yes __ No Child’s name __________________________________

Mother: __ Yes __ No Child’s name __________________________________

Child’s name __________________________________

Child’s name __________________________________

5. Does the student and/or family participate in church activities? _______

If yes, please describe: __________________________________________________________________________

__________________________________________________________________________

6. At Temecula Community Church and Temecula Christian School we believe that in order to become a New Tes-

tament Christian, one must realize that he/she is a sinner (Romans 3:10, 23), believe that Jesus died for their sins

(John 3:16; Romans 10:9, 10), repent of their sins (II Cor. 7:10), and ask Jesus Christ, understanding that Jesus,

Himself is the only way of salvation, to come into their life and take away their sins (John 1:12).

Do you believe that these steps are a necessary part of salvation? ___ yes ___ no

Do you believe that there is more to be done for salvation? ___ yes ___ no

If yes, please list what else needs to be done ____________________________________________________

_______________________________________________________________________________________

Are there any concerns we should be aware of? _____________

_______________________________________________________________________________________

What is your recommendation for their acceptance to TCS.

____ Highly Recommended ____ Recommended

____ Hesitate to Recommend ____ No Recommendation

_____________________________________________________________________ _____________________ Signature & Print Name Position/Title

________________________________________________________________________ ____________________ Name of Church Telephone

_____________________________________________________________________________________________ Church Address

_____________________________ Date

Please keep confidential and mail directly to TCS as soon as you have finished

If you did not receive an envelope please send your referral to:


29825 Santiago Rd.

Temecula, CA 92592

PARENTS: PLEASE READ THE FOLLOWING CAREFULLY

Provide for the school the following:

1. A copy of up to date shot records

All students entering 7th and 8th grades will need proof of an adolescent whooping

cough booster shot called “Tdap” before starting school.

2. Birth Certificate

3. Current immunization record

4. A copy of the doctor’s examination report of your 1st grader or your first student in the Riverside

County School

Health exams and shots must be updated

Before starting school

STUDENT’S PERSONAL INFORMATION To be filled out by all students entering 5th through 8th grade.

Please fill in all your answers for all of the questions.

1. Have you asked Jesus to be your Lord & Savior? ___ Yes ___ No

2. If yes, please give a testimony of how, when and where you met the Lord and was there anyone with you?

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

3. What kind of music do you listen to? _______________________________________________________________________________

What style of music: contemporary Christian praise and worship ____

country western ____

alternative: Christian ___ Other: ________________________________________________

other: ______________________________________________________________________________

4. Who is your favorite musician or band? _____________________________________________________________________________

5. What is your all time favorite movie? _______________________________________________________________________________

6. Who is your hero? And why? _____________________________________________________________________________________

______________________________________________________________________

______________________________________________________________________

7. List what you see as your strengths and weaknesses:

Strength Weakness

______________________________________________________ _______________________________________________________

______________________________________________________ _______________________________________________________

______________________________________________________ _______________________________________________________

______________________________________________________ _______________________________________________________

8. What do you enjoy doing the most? ________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

9. Describe your relationship with Jesus: ______________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

10. Describe your relationship with your parents: _______________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Daily Life To be filled out by parents

How would you describe your Christian faith and walk?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Does your child understand the biblical salvation? ________________________

Has your child asked Jesus to come and live in their heart? ____________

How would you describe your child’s Christian faith and walk? _____________________________________

_____________________________________________________________________________________________

Have you any knowledge that your child has taken and/or used any type of illegal drugs, alcohol, or tobacco? _____

If yes, please explain and what steps were taken? _____________________________________________________

_____________________________________________________________________________________________

What do you see as your child’s personal strengths and weaknesses and why?

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Please provide any information that maybe helpful with your child:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Parent: _______________________________________________________

ORDER FORM

One Order Form Per Student

Name: ____________________________________________________ Grade: ____

Every student must have a field trip t-shirt: (included in administrative fees)

___ Youth Small ___ Youth Med ___ Youth L

___ Adult Small ___ Adult Med ___ Adult L ___ Adult XL

Total T-Shirt Order : $ ____________

TCS Student Handbook Agreement

I/We have read, understand, and agree for myself/ourselves and my/our child(ren) to abide by

Temecula Christian School’s policies, procedures and requirements contained in the Student

Handbook.

Please sign below and return this agreement to the school office as soon as possible.

________________________________________ _____________

Father/Legal Guardian Date

_________________________________________ ______________


CONCILIATION CLAUSE Any claim or dispute, question, or disagreement arising out of or relating to this Student

handbook or any other school matter shall be settled by mediation and, if necessary, legally

binding arbitration in accordance with the Rule of Procedure for Christian Conciliation of the

Institute for Christian Conciliation, a division of Peacemaker Ministries (complete text of the

rules is available at www.Peacemaker.net). Judgment upon an arbitration decision may be

entered in any court otherwise having jurisdiction. The parties understand that these methods

shall be sole remedy for any controversy or claim arising out of this agreement and expressly

waive their right to file a lawsuit in any civil court against for such disputes, except to enforce

an arbitration decision.

*I/We have received and read the Guidelines for Christian Conciliation on the TCS

Website, www.temeculacs.com*

_______________________________________ ________________

Father/Legal Guardian Date

_________________________________________ ________________


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