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MATANZAS CHRISTIAN ACADEMY

e-mail: matanzasacademy@comcast.net fax: 904-359-9026

Student Name: First:                                    Middle:                                    Last:                          

Grade Level Applying for: 

Age:              Sex:               Date of Birth:                                  SSN:

Street, City, St., Zip:

E-Mail:                                                             Student Cell Phone#

Address Current School:

______________________________________________________________________________________________________________________________________________

Parent/Guardian Name:

Street Address:

City, State, Zip code:

Home Phone:                 Work Phone                       

Cell Phone:

E-Mail:

Occupation:

Religious Affiliation:

　FEES 

FEES are on a yearly basis, reguardless of payment method.

                       *Yearly Enrollment: $350

                       *On Line Tuition Yearly:  $1500 (does not include Private Tutoring)

                       *Curriculum $300 (unlimted Courses)

                       *Testing: 40

             Yearly Total: $2190

      ****SENIORS: $2290 (includes Cap/Gown, Graduation Ceremony, Graduation Reception, Transcripts, College Counseling)

 Hiring of Private Tutoring/Learning Centers/Study Hall fees are on and above the On Line Tuition AND are payable to that corporation. 

All fees are NON-REFUNDABLE

PAYMENT METHOD

____ Credit Card  

____ Money Order/Personal Check

____ Pay Pal to Ms Harris(tammilet@ yahoo.com) + $5.00 processing fee

PARENTAL COOPERATION AGREEMENT (initial)

_____ I realize I am ultimately responsible for the behavior and academic performance of my children.

_____ I am sufficiently satisfied with the curriculum, teaching methodology, Statement of Faith, and Philosophy of  Education of the School to enroll my child(ren) at Matanzas Christian Academy.

_____ I will have my child obey the School Dress Code and Student Code of Conduct

_____ I will read and support the goals and policies of the Parent/Student Handbook.

_____ I understand that all fees are due annually. If a payment plan isbeing used and my child leaves mid year, any remaining fees are still due. 

Parent/Guardian/applicant Signature or Facsimile:        

Date:

School Official:

Date:_______________________________________________________________

OFFICIAL USE ONLY:  Student Code of Conduct Signed Yes ___ No___, Handbook MM/DD/YYYY Courses set MM/DD/YYYY

 Transcript received MM/DD/YYYY   Immunization&Physical up to date Yes __   No__   Birth Certificate Yes__  No __,  SSN Yes__ No __ 

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STUDENT SELF-ASSESSMENT