Ka returning student admissions package 2013-2014c

Kingdom Academy ______________________________
of Bluffton, Inc.
Admission Package
Any parent who is interested in enrolling a child in Kingdom Academy of Bluffton, Inc. should request an Admission Package from the school. The package contains the following materials: 1. Admission Procedures 2. School Registration Form 3. Student Application Form 4. Statement of Parents or Guardian 5. Medication Form 6. State Health Records 7. General Waiver – Field Trips 8. A list of supplies required for each student 9. Non-discrimination Policy Admission Procedure
1. Request an Admission Package from the school or download from the 2. Read the enclosed literature carefully. 3. Fill out all of the forms in the Admissions Package and return them to Kingdom Academy ______________________________
of Bluffton, Inc.
School Registration Form
For each child, please give the following completed forms to one of the board members or mail to Kingdom Academy: Student Application Form Statement of Parents or Guardian Medication Form General Waiver – Field Trips BOOK FEES
Make the check payable to Kingdom Academy of Bluffton, Inc., send to the school address, and note it is for book fees. Kingdom Academy ______________________________
of Bluffton, Inc.
STUDENT APPLICATION FORM
Date ___________________________ Student’s name ________________________Birthdate___________Grade_____ Address _________________________________________________________ City/State/Zip code _________________________________________________ Last School Attended (If applicable)_____________________________________ Parents or Guardians ________________________________________________ Home Telephone _________________________________________ Parental place of employment __________________________________ Work Telephone _________________________________________ I have read and will support the Kingdom Academy Handbook. Signature of Father ___________________________________Date_________ Signature of Mother ___________________________________Date_________ Signature of Guardian ___________________________________Date_________ Kingdom Academy ______________________________
of Bluffton, Inc.
Statement of Parents or Guardian
We understand the policies and standards of Kingdom Academy and pledge our support of the school and its administration. 1. Kingdom Academy of Bluffton, Inc. has full discretion in the discipline of our child. 2. Kingdom Academy of Bluffton, Inc. has full discretion for grade placement of our child regardless of the grade completed prior to transfer. 3. Kingdom Academy of Bluffton, Inc. can expect our practical help and prayerful support in a mutual effort to train our children. 4. Kingdom Academy of Bluffton, Inc. reserves the right to suspend or dismiss any student who does not cooperate with the education process. Father ______________________________ Date _________________ Mother _____________________________ Date _________________ Guardian _____________________________ Date _________________ Kingdom Academy _________________________________
of Bluffton, Inc.
MEDICATION FORM
For Student: ________________________________________________________________________ Please initial and sign below:

____I do not wish my student to have any of the medications listed below.
This student, with the supervision of a responsible staff member, has my permission to take the
following medications we have available at school: please circle which option you want if the choice is
tablet or chews. A note will be sent home to notify the parent of all medication dispensed at school.

(36-47 lbs) ____ Children’s Acetaminophen 240 mg (3 soft chews)
(48-59 lbs) ____ Children’s Acetaminophen 320 mg (4 soft chews) (48-59 lbs) ____ Ibuprofen 200 mg (1) cap (check only if they can swallow) (60-71 lbs) ____ Children’s Acetaminophen 400mg (5 soft chews) or 360mg (1 Reg Strength) (60-71 lbs) ____ Ibuprofen 200mg (1 cap) (72-95 lbs) ____ Children’s Acetaminophen 480 mg (6 soft chews) or 360mg (1 Reg Strength) (72-95 lbs) ____ Ibuprofen 200mg (1 cap) (>96 lbs) ____ Acetaminophen Reg Strength 360 mg (1), ES 500mg (1 ) ( > 12yrs , >96 lbs) ____ Ibuprofen 200 mg (1or2) ( > 12yrs , >96 lbs) ____ Acetaminophen Reg Strength 360 mg (1or2) or ES 500 mg (1or2) Please list below any medication other than the above. It must be sent to school in the original container with a written permission slip. Medication_________________________________________________________________________ Dates/Time/Dosage__________________________________________________________________ Signature of Parent Or Guardian________________________________________________ Date____________________ Kingdom Academy ______________________________
of Bluffton, Inc.

Every year Kingdom Academy is required to send immunization records or waivers to
the state. This is recorded online at a site called CHIRP. Kingdom Academy cannot
access CHIRP without your consent. You may refuse consent. Please fill out the form
accordingly.
CHILDREN’S INFORMATION:

NAME_________________________________________BIRTH DATE_____________
NAME_________________________________________BIRTH DATE_____________
NAME_________________________________________BIRTH DATE_____________
NAME_________________________________________BIRTH DATE_____________
NAME_________________________________________BIRTH DATE_____________
NAME_________________________________________BIRTH DATE_____________
NAME_________________________________________BIRTH DATE_____________
PARENT OR GUARDIAN:

I GIVE Kingdom Academy consent to access my child’s records on CHIRP.
NAME (print)__________________________________________DATE_____________
SIGNATURE____________________________________________________________
I DO NOT GIVE Kingdom Academy consent to access my child’s records on CHIRP.
NAME (print)__________________________________________DATE_____________
SIGNATURE____________________________________________________________
Kingdom Academy _________________________________
of Bluffton, Inc.
General Waiver – Field Trip

No child will be allowed to participate in an activity until his/her parent or guardian
signs this form.
I hereby certify that my son/daughter, _____________________________________, has permission to participate in school field trips during the 2013-2014 school year. I have the choice to decline his/her participation when notified about specific field trips. I agree and do hereby release and discharge any teacher, employee, or other person engaged in the activity, from all claims, present and future, known or unknown, in any manner arising out of the activity. I further understand and agree that this release shall hold any teacher, employee, or other person engaged in field trip activities, harmless from any and all liability relating to my son/daughter for any and all personal injury or illness that may be suffered by my son/daughter. I also agree to hold them harmless from any loss of property by my son/daughter that may occur during the field trip activities. Signature of Parent or Guardian _______________________________ Date ______________ EMERGENCY MEDICAL RELEASE
In case of an emergency in my absence, I give permission to the school authorities, or its representatives, to obtain medical treatment for my child. Signature of Parent or Guardian _______________________________ Date______________
Kingdom Academy _________________________________
of Bluffton, Inc.
Supply List For Students
Addition / Subtraction (1-20) flashcards (for home summer (make sure your child has pencils through out the year) 2 notebooks 1 regular size, 1 small (for reading assignments)
Kingdom Academy _________________________________
of Bluffton, Inc.
Supply List For Students (Continued)
Computer headset with microphone for Rosetta Stone Computer headset with microphone for Rosetta Stone *There may be additional items needed during the school year. Kingdom Academy of Bluffton, Inc. 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 or ethnic origin in the administration of its educational policies, admissions policies, scholarship and loan programs and athletic and other school administered programs.

Source: http://kingdomacademy.us/wp-content/uploads/2012/07/KA-RETURNING-STUDENT-Admissions-Package-2013-2014C.pdf