Enrollment Form – Chesapeake Christian Academy

Child Registration Form

Please take the time to thoroughly complete the form.

Child’s Information:

Child’s Full Name*

Birthdate*

Nick Name

Street Address 1*

Address Line 2

City*

State*

Zip Code*

Home Phone*

Email*

Child’s Age*

Sex:*

Parents’ Information:

1. Parent’s Full Name*

1. Parent’s Work Phone*

1. Employer*

1. Cell Phone*

2. Parent’s Full Name*

2. Parent’s Work Phone*

2. Employer*

2. Cell Phone*

Nearest Relative (not living w/you)*

Relative’s Phone*

Background:

Does family attend a local church?*

Church Name*

Parent: Have you asked Jesus into your heart?*

If parents are separated or divorced with whom does the child live?

If divorced and you would like mail outs to go to other parent, please fill out the following:

Legal Status of Child’s Custody

Are any legal situations that we need to be aware of?*

Yes

Please attach a copy of the court instructions*

Contacts:

1. Emergency Contact-Name*

1. EC-Home Phone*

1. EC-Relationship*

1. EC-Cell Phone*

2. Emergency Contact-Name*

2. EC-Home Phone*

2. EC-Relationship*

2. EC-Cell Phone*

Who is authorized to pick up child (this list must include the two names mentioned above:*

Who is NOT authorized to pick up child:*

Medical Information:

Physician’s Name*

Does your child have Physical/Learning Difficulties?*

Does your child have any chronic illness?*

Is your child on any prescribed medication?*

Physician’s Phone*

If yes, please describe the physical/learning difficulties:*

If yes, please describe the chronic illness:*

If yes, please provide more information about the medication:*

Hospital Preferred (in case of accident):*

Policy #*

Medical Insurance Company:*

Group #*

Agreement:

The school agrees to notify parent (or otherwise responsible party named on this form) whenever this child becomes ill, and the parent/guardian agrees to pick up the child thereafter. The parent/guardian authorizes the school to obtain immediate medical treatment if an emergency occurs when parents cannot be located immediately.

Parent Digital Signature – Agreement*

Yes, I agree to digitally sign this document with my full name

Former School*

Desired entrance date:*

Digital Signature of Agreement – Parent Full Name*

Signature Date*

School Handbook:

I/we have read through the online copy of the Chesapeake Christian Academy Handbook outlining the policies of Chesapeake Christian Academy. I/we understand and agree that it is my/our responsibility to follow the policies set forth in the Handbook.

Click here to open and read a copy of the Chesapeake Christian Academy Handbook before continuing the applicaiton.

Parent Digital Signature – Handbook*

Yes, I agree to digitally sign this document with my full name

Digital Signature – Handbook Compliance*

Signature Date – Handbook Compliance*

School Student Photos:

Chesapeake Christian Academy would like permission to take photos of your child to use on our bulletin boards, in the classroom, post on the Brightwheel App, the school website and for our professional photographer to use for individual and class photos. We will never reference your child by name or provide specific information regarding your child outside of the Academy. The pictures will only be used in an appropriate and professional manner to market and showcase Chesapeake Christian Academy.

My child’ photo may be taken*

Parent Digital Signature – Student Photos*

Yes, I agree to digitally sign this document with my full name

Digital Signature – Student Photos*

Signature Date – Student Photos*

Mission Statement:

The mission of Chesapeake Christian Academy is to provide a Christ-centered education to all students with the word of God as our foundation and to help each child attain their full potential as a whole person so that each individual may impact his/her own world for Christ.

Statement of Faith:

I believe in:

1. The Bible is God’s unique revelation to people. It is the inspired, infallible Word of God, and the supreme and final authority on all matters upon which it teaches. No other writings are vested with such authority.

2. There is only one God, creator of heaven and earth, who exists eternally as three persons—Father, Son, and Holy Spirit, each fully God yet each personally distinct from the other.

3. All people are created in God’s image and matter deeply to Him. Central to the message of the Bible is that God loves people and invites them to live in communion with Himself and in community with each other.

4. Apart from Jesus Christ, all people are spiritually lost and, because of sin, deserve the judgment of God. However, God gives salvation and eternal life to anyone who trusts in Jesus Christ and in His sacrifice on his or her behalf. Salvation cannot be earned through personal goodness or human effort. It is a gift that must be received by humble repentance and faith in Christ and His finished work on the cross.

5. Jesus Christ, second Person of the Trinity, was born of the Virgin Mary, lived a sinless human life, willingly took upon Himself all of our sins, died and rose again bodily, and is at the right hand of the Father as our advocate and mediator. Some day, He will return to consummate history and to fulfill the eternal plan of God.

6. The Holy Spirit, third Person of the Trinity, convicts the world of sin and draws people to Christ. He also indwells all believers. He is available to empower them to lead Christ-like lives, and gives them spiritual gifts with which to serve the church and reach out to a lost and needy world.

7. Death seals the eternal destiny of each person. At the final judgment, unbelievers will be separated from God into condemnation. Believers will be received into God’s loving presence and rewarded for their faithfulness to Him in this life.

8. All believers are members of the body of Christ, the one true church universal. Spiritual unity is to be expressed among Christians by acceptance and love of one another across ethnic, cultural, socioeconomic, national, generational, gender, and denominational lines.

9. The local church is a congregation of believers who gather for worship, prayer, instruction, encouragement, mutual accountability, and community with each other. Through it, believers invest time, energy, and resources to fulfill the Great Commission—reaching lost people and growing them into fully devoted followers of Christ.

Parent Digital Signature – Mission & Statement of Faith Agreement*

Yes, I support and agree with the Statement of Faith and Mission Statement of Chesapeake Christian Academy

Digital Signature – Mission & Statement of Faith Agreement*

Signature Date – Mission & Statement of Faith Agreement*