Clover Hill Homeschool Academy



-30480-182880ITEMS TO INCLUDE WITH APPLICATION:_____ Tuition Contract_____ Medical Info Form_____ Spiritual Ref/Test. Form_____ Application Fee00ITEMS TO INCLUDE WITH APPLICATION:_____ Tuition Contract_____ Medical Info Form_____ Spiritual Ref/Test. Form_____ Application Fee DATE _______________________________________ Chesterfield Christian Academy KINDERGARTEN APPLICATIONMail form to: Chesterfield Christian Academy, P.O. Box 1711, Midlothian, VA 23113APPLICATION/REGISTRATION FEES AND TUITION: Acceptance is not finalized until all forms and fees are received. Forms include: (1) Application Form (2) Tuition Contract (attached) (3) Spiritual Reference Form (4)Application Fee: There is a one-time application fee for Kindergarten of $65. This fee is due with the application.Upon acceptance, CCA will send an (5) Admission Interview Time and link to the (6) Handbook Signature Page and (7) Emergency Info form (DIFFERENT THAN MEDICAL INFO FORM) that will be due before student can attend class *All students applying for classes at CCA should have an approved Notice of Intent on file with their local school board.Name of Student(S) :________________________________________________________ ________________________________________________________ PARENT INFORMATIONMom’s first name: Last name: ____________ Dad’s first name: Last name: ___________________ Address: City: Zip: Home phone: Primary email: Mom’s cell: Dad’s cell: __________ Initial Volunteer Requirement: Each family is required to volunteer one time per year in one of following capacities: (1) morning set-up, (2) afternoon clean-up or (3) lunch monitoring. If this presents a hardship for your family, please email CCA administration at cca4uinfo@ NOT REQUIRED IF YOU ARE REIGSTERED FOR ONLINE CLASSES ONLY. __________Initial All application fees are non-refundable. *All payments are made directly to the Academy, payable to “CCA”. **If you are in need of financial aid or are interested in monitoring a study hall, please see the “Tuition” page of our website and also submit the necessary form.*By signing below, I understand that I release Chesterfield Christian Academy, the instructors, and/ or the facility owner of any liability and/or compensation for any bodily injury or damage/theft to personal property. *By signing below, I give CCA permission to use photographs taken of my child/ren throughout the school year to be used in publications related to Chesterfield Christian Academy. *By signing below, I acknowledge that submission of the Registration/Application Form does not guarantee admission and that the Spiritual Reference Form must also be completed. The Directors of CCA will determine the final decision for admission. *I have read, understand, and agree to CCA’s policies, procedures, and statement of faith.Parent SIGNATURE Date Chesterfield Christian Academy Last Name______________________Tuition Agreement 2018-2019TERMS OF CONTRACTTuition is calculated annually and divided into ten (10) equal monthly payments unless families choose to pay in full or by semester.Date to pay in full is August 7th.Dates to pay by Semesters are August 7th and January 7th. Second semester in full is due by January 7th. Sibling discounts are offered as follows:10% discount of the class tuition for the second child enrolled in the same classParent’s initials ______________Withdrawal from ClassesOnce the first payment is made, parent is responsible for the full tuition of the class. See Handbook for more details.In the event that the child must be withdrawn from Chesterfield Christian Academy prior to the completion of the school term, tuition will be due in full unless an exception is made and approved on by the Co-Directors. Parent’s initials Tuition will not be prorated for illnesses, vacation, or holidays. In the event of illness more than thirty (30) days, exceptions will be made at the discretion of the Co-Directors.Parent’s initials If more than two payments are missed, the student will not be allowed to attend class until account balance is paid in full.A $10 fee is charged for each returned check. Our bank utilizes a service in collecting unpaid funds that may incur additional charges. The account will be placed on a cash-only status after 2 returned checks.Parent’s initials ____________Chesterfield Christian Academy has the right to cancel classes if enrollment does not meet the minimum of six students. In the event that this is the only class in which a student was enrolled, parents have the option of a refund of the registration fee or to enroll the student in a different class.Parent’s initials ____________PAYMENT PLAN (Check One)____ Option 1: Full tuition in one payment due by August 7, 2018. Second semester only classes, full payment is due January 7, 2019. Amount will be bill electronically. ______ Option 2: Pay by each semester. Amounts will be billed electronically and are due August 7, 2018 and January 7, 2019. Parents’ social security numbers are mandatory when choosing Option 2. Option 3: Ten monthly installment (Annual tuition divided by 10) due the 7th of each month, amount will be billed electronically. The first payment is due August 7, 2018 and the tenth payment is due May 7, 2019. Parents’ social security numbers are mandatory when choosing Option 3. There is a late fee of $15 for payments received after the 7th. ________ Option 4: Second Semester classes installment due the 7th of each month, amount billed electronically January – May. Payments can be made in person at our CCA location OR mailed to:CCAPO Box 1711Midlothian, VA 23113I have read, understand, and agree to all terms in the Tuition Agreement._________ Signature of parents or guardians Date____________________________________ ____________________________________ (mandatory for Option 2 & 3)Father’s Social Security Number Mother’s Social Security Number ................
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