2019 2020 STUDENT APPLICATION FOR ADMISSION · refer to our school handbook. 11. Registra on Fee and Tui on Registraon Fee A fee of $100.00 must accompany the enrolment form for .rst

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250.862.2377 907 Badke Rd | Kelowna BC | V1X 5Z5 [email protected]

Office Use Only Date Received: ___________________________ Date Accepted: ______________________________ Attended Heritage Christian Early Learning Center: ��Yes ��No $100 Registration Fee Receipt #_________________ Received copies of: Completed/Sent Out: ��Birth Certificate � Legal Residency Form ��Educational Support ��School Calendar � Care Card Number ��Pad Form � Finance ��Students Achieve � CRC, if needed � Parent Participation Form ��Interview ��Supply List � Gr 7-12 Student Letter ��Pastor’s Referene Form ��Learning Commons � Welcome Letter � Guardian Driver’s Licence ��Perm./Release of Liability ��MyEd��Home Contact Card � Tuition Form � Latest Report Card Issued ��Void Cheque

Phone Number for Family Directory:

2019-2020 STUDENT APPLICATION FOR ADMISSION

1. Personal Information

Student’s Name______________________________________________________________________ M � F � LAST FIRST MIDDLE

Street Address _________________________________________ City __________________ P/C _______________ Child’s Birthdate ______________________ Email ______________________________________ Student Email __________________________________ *Kindergarten Applications are available at the office or online at www.heritagechristian.ca Mailing Address (if different) ________________________________________________________________________ Present Grade _____ Grade Applied For _____ Requested Date of Admission ______________________________

2. Parental/Guardian Information

Mother _____________________________ Cell ___________________ Work ____________________________

Place of Work____________________________ Does employer offer matching gift/donation program? ( Y / N )

Father ______________________________ Cell ___________________ Work ____________________________

Place of Work____________________________ Does employer offer matching gift/donation program? ( Y / N )

Who does the child lives with? � Both Parents � Both Parents - Shared Custody � Mother Only

��Father Only ��Legal Guardian Other Than Parent ��Parent & Step-Parent � Other Please communicate below any issues relating to legal guardianship or custody of your child.

_________________________________________________________________________________________________

*NOTE: Please present your Driver’s License, the student’s Birth Certificate and Care Card to the office when submitting this application form (or a legible photocopy of these documents).

heritagechristian.ca

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3. Citizenship Information Canadian Citizen ��Yes � No Landed Immigrant � Yes ��No Legally admitted to Canada ��Yes � No If not a Canadian citizen, attach a copy of the appropriate documents. Foreign students must attach a copy of the Student Visa. Does your family/child reside in B.C.? � Yes � No If “No”, when do you expect to move to Kelowna? ____________________________________________________ _______________________________________________________________________________________________ 4. School Information How did you learn of HCS? ________________________________________________________________________ _______________________________________________________________________________________________ What are your reasons for enrolling your child in HCS? __________________________________________________ _______________________________________________________________________________________________ Please list the last school(s) your child has attended. (If possible, go back three schools.) School Address Phone Dates Attended _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Has your child ever missed school for an extended period of time due to illness, including personal reasons - social, emotional or otherwise? � Yes � No (If “Yes”, please explain) _______________________________________________________________________________________________ _______________________________________________________________________________________________ Has your child ever been suspended or expelled from school? � Yes � No (If “Yes”, please explain) _______________________________________________________________________________________________ _______________________________________________________________________________________________ 5. Academic Information Learning Assistance

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What school subjects does your child love? _______________________________________________________________________________________________ _______________________________________________________________________________________________ Is your child in need of or has your child ever received Learning Assistance in school? � Yes � No _______________________________________________________________________________________________ _______________________________________________________________________________________________ Has your child ever been assessed for and/or diagnosed with a learning disability? � Yes � No (Include ADD, ADHD, Anxiety, Autism, ODD, etc) If “Yes,” please explain and if possible attach the most recent copy of the assessment. _______________________________________________________________________________________________ _______________________________________________________________________________________________ Has your child ever been referred for or ever attended counselling? � Yes � No Do you give HCS permission to contact schools or evaluators named herein if deemed necessary? � Yes � No Has your child ever been involved in unlawful and/or violent behavior? � Yes � No (If “Yes”, please explain) _______________________________________________________________________________________________ _______________________________________________________________________________________________ Will it be important for our school to take special steps to assist with the integration of your child into the school community? _______________________________________________________________________________________________ _______________________________________________________________________________________________ 6. Church Information Name of church your family regularly attends __________________________________________________________ We believe that children can place their trust in Christ as their personal Savior and we teach this at HCS. It is important for us to know if your child has done so. When parents and children both support the elements of faith and practice as we believe and teach within the HCS community, the educational experience is much more satisfying. Please comment on your child’s spiritual condition and response to spiritual teaching. ________________________________________________________________________________________________ ________________________________________________________________________________________________ _______________________________________________________________________________________________

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I’ve attached the Pastor’s Reference Form and returned with this application form. � Yes � No Please attach a copy of your child’s most recent Progress Report or Report Card. I’ve attached it � Yes � No For students in Grades 7 - 12 Please write a personal letter in which you indicate why you want to attend Heritage Christian School. Be sure to tell about your relationship with God. Attach your letter to this application. 7. Tell us about your child What are your child’s interests and hobbies? ________________________________________________________________________________________________ ________________________________________________________________________________________________ How can we help your child thrive? ________________________________________________________________________________________________ ________________________________________________________________________________________________ What are your biggest hopes for your child? ________________________________________________________________________________________________ ________________________________________________________________________________________________ Is there anything else you’d like us to know about your child? ________________________________________________________________________________________________ ________________________________________________________________________________________________ 8. Conditions of Registration Please check each condition: A. ___ I/We have read the Student/Parent Handbook (Admission Policy, Elem. Pg 7 & Sec. Pgs 14-16) and understand the commitment we are making.

B. ___ I/We agree to abide by the school rules and guide our child to uphold the Code of Conduct and discipline of the school as outlined therein.

C. ___ I/We agree to support the elements of faith & practice taught at the school as outlined in the handbook.

D. ___ I/We am/are willing to assist as time allows in volunteer areas of the school (see Parent Participation Program form).

E. ___ I/We agree to attend the parent orientation meeting which is held in September.

F. ___ I/We certify that all information on this application is complete and correct.

G. ___ I/We authorize Heritage Christian School to verify any of the information submitted herewith.

H. ___ I/we agree that contact information may be included on secure, web-based documents.

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I. ___ I/We agree that images taken of our child(ren) may be used for promotional purposes.

J. ___ I/We understand that HCS has a Privacy Policy based on the Personal Information Protection & Electronic Documents Act (PIPEDA), June 2015. I authorize the use of my and my child(ren)’s personal information as listed in the HCS Personal Information Privacy Policy.

K. ___ I/We have enclosed a copy of the following documents:

* My child’s most recent Progress Report/Report Card * Parent’s current Driver’s License * Student’s Birth Certificate * Student’s Care Card * Home Contact Card (enclosed in package) * Pastor’s Reference (enclosed) * Appropriate documents in regards to citizenship status * Personal student letter (for grades 7-12) * Parent Participation Form

9. Signatures Parent/Guardian ___________________________________________ Date ______________________ Parent/Guardian ___________________________________________ Date ______________________ 10. Protection of Personal Information In accordance with the Personal Information Protection & Electronic Documents Act (PIPEDA), June 2015 we are diligent to protect the information that you provide to us. For educational, Provincial funding and school promotional reasons we may appropriately disclose selected information to the following: There may be times that we choose to use images of our students for promotional purposes. No private information will accompany these images unless you are notified. *If you wish to opt out of any of these uses, please notify the school office in writing. For further information, please refer to our school handbook. 11. Registration Fee and Tuition Registration Fee A fee of $100.00 must accompany the enrolment form for first time applicants. This fee for application processing costs is non-refundable. Tuition The first month tuition amount is non-refundable after July 1, 2019 and will be processed on your first payment date as indicated on the enclosed Tuition Payment Calculation form in order to guarantee a spot for your child. This ensures that when the class is capped, other students who apply will be placed on a waiting list and not replace students who have already been accepted. Tuition rates and payment options are on the enclosed form. The Tuition Payment Calculation form must be completed and handed in with this application. Tuition Assistance Families seeking tuition assistance can complete an online application form at https://goo.gl/zMfOm0. Regular tuition will be charged until the form is submitted and approved.

Ministry of Education Community Health Clinic Sports Organizations

Other HCS Families via our school directory Media for Sporting or Promotional Events

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12. Parent Drivers If you will be driving HCS students (other than your own children) to/from any field trips or school events at any time during the coming school year, we require that you apply for a volunteer criminal record check and submit to the office a copy of your driver’s license and your insurance papers showing a minimum of 2 million liability.

� I will be driving and have attached the required documentation

� I will not be driving

� I am uncertain of whether I will be driving

� I have applied for a Criminal Record Check through the HCS office

I acknowledge items in sections 10 through 12 above. Signature __________________________________________________ Date ________________________

PASTOR’S REFERENCE FORM

This section to be filled out by the Applicant. Family Name ________________________________ Church Affiliation ___________________________________ Names of children applying to Heritage Christian School: Name Age Name Age __________________________________ _____ ________________________________ _______ __________________________________ _____ ________________________________ _______ This section to be filled out by the Pastor. Name of Church ___________________________________ Pastor’s Name __________________________________ Address of Church _________________________________________________________________________________ Church Phone ______________________________________ Church Fax ___________________________________ 1. How long have you known this family? __________________________________________________ 2. How long have they attended your congregation? ___________________________________________ 3. Does this family attend services and functions regularly? ______________________________________ 4. Does this family have membership in your church? ___________________________________________ 5. List areas/ways in which this family is involved with/contributes to the life and ministry of the church. _____________________________________________________________________________________ 6. List ways that you believe this student would benefit from attending Heritage Christian School. _____________________________________________________________________________________ 7. Comments __________________________________________________________________________ _____________________________________________________________________________________ Pastor’s Signature _______________________________________ Date _________________________



� I authorize my $200 pre-authorized debit for Parent Participation fee to be withdrawn on June 1, 2020. This amount will only be withdrawn from the authorized account if hours are not completed.

Returned Payments Policy - There will be a $25 charge should any payment be rejected by the financial in-stitute for any reason.

Signature: ___________________________________________ Date: _______________________

� I would like to help sponsor an HCS student: ($__________/year or $_________/mo.)

Tuition Payment Calculation Form 2019-2020

Secondary Grad Fee ___ # of gr 12 children enrolled X $200

Secondary Tuition Supplement ___ # of gr 8-12 children enrolled X $250

Additional Yearbooks (softcover) (Each family receives one complimentary yearbook)___ # X $20

Total Tuition Fees for 2019-2020 (Total of B + C)

Additional One-Time Fees (pre-authorized for Oct 15, 2019)

Tuition Fees

G

D

B

A

C

Total Additional Fees for 2019-2020 (Total of E + F)

E

F

� Registration Fee (Non-refundable) for new families, OR

Registration Fee & Re-enrolment Deposit/Fee

Tuition Amount based on number of children enrolled (see Tuition Scale on re-verse of this form). Tuition Assistance discounts will be taken later if applicable.

� Re-enrolment Fee (Non-refundable) for re-enrolments submitted after Feb 22, 2019.

$100 � Re-enrolment Deposit applied to the family account in September (non-refundable), for enrolments received on or before February 22, 2019, OR

� I have paid my Registration Fee / Re-enrolment Deposit/Fee

A payment of $100.00 per family must accompany the application form(s). This is non-refundable.

� One-Time Pymt (pre-auth. for Sept 23)

� Semi-Annual or Quarterly Pymts (pre-auth. for the 23rd of Sept & Jan OR Sept, Nov, Jan & Mar)

� 10 Month Auto Debit Plan (Sept through June)

Check One:

(Please Note: Credit cards are only accepted for one time payments)

� I authorize my additional one-time fees to be withdrawn by pre-authorized debit on October 15, 2019.



2. Tax Information Payee(s) are issued a charitable tax receipt in February for the portion of tuition paid that pertains to religious instruction (please note, any payments for which a charitable tax receipt has been issued are non-refundable). The receipt amount var-ies from year to year and is calculated in accordance with Canada Revenue Agency requirements. In recent years, on aver-age, Heritage Christian School families have benefited by receiving a charitable tax receipt equivalent to approximately 60% of total tuition. This benefit may be used to reduce the amount of personal income tax paid and, consequently, reduce the total cost of tuition. For Example: A family with two children would pay $6,805 in annual tuition, or $680.50 per month, and receive a charitable tax receipt of approximately $4,083. Based on 2018 tax rates, the charitable receipt would generate non-refundable federal & provincial tax credits of approxi-mately $1,818.54. Therefore, the annual net-after-tax cost of tuition would be $4,986.46 ($6,805.00 - $1,818.54) or $498.65 per month, $181.85 less than the posted monthly tuition rate. 3. Secondary Tuition Supplement The Secondary tuition supplement of $250 per grade 8 to 12 student allows for many middle and secondary school programs (ie. reduced retreat costs, electives, field trips, chrome books, etc.). It can be paid in full or built into the monthly tuition pay-ments. This is non refundable. 4. Tuition Assistance Families seeking financial assistance can complete an assistance application available online after February 22, 2019 at https://goo.gl/zMfOm0. Regular tuition will be charged until the application is submitted and approved. Assistance is based solely on your family’s income and allocated funds for this program are limited. CRA requirements: Families receiving a Tuition Assistance Bursary will be issued a T4A in the youngest student’s name. 5. Parent Participation To further our community spirit every family will complete 20 volunteer hours in areas of the school where they feel gifted. Once you’ve completed your hours, let the HCS office know so that $200.00 will not be debited from your bank account on June 1st, 2020. It is our desire to see that each family participate in their child’s education so that it is not necessary to de-posit the preauthorized payments.

1. Tuition Tuition is received to supplement the cost of education for students. HCS is a Group 1 Independent School, and receives 50% of the per-student-funding given to School District #23. If you choose to withdraw your student(s) early from HCS, the first months tuition as well as 10% of the remaining tuition for the year will be held to cover administration costs.

Tuition Scale 2019-20 Total Payable Average Tuition Cost per Child Monthly Payment Amount

Daycare & Pre-Kindergarten - registration/tuition forms are available at the HCS Office

Kindergarten - Half Time $2,310.00 $2,310.00 $231.00

Kindergarten - Full Time $4,620.00 $4,620.00 $462.00

One Child $4,620.00 $4,620.00 $462.00

Two Children $6,805.00 $3,402.50 $680.50

Three Children $7,820.00 $2,606.67 $782.00

Four Children $8,370.00 $2,092.50 $837.00

Five + Children $8,715.00 $1,743.00 or less $871.50

Per Year Per Month

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PERMISSION AND RELEASE OF LIABILITY

__________________________________________________________________________________________________________ Student Name Phone Number Emergency Number __________________________________________________________________________________________________________ Address City Postal Code Location and dates are as indicated in the school newsletter or by letter sent home from the teacher through-out the school year.

The undersigned represents to Heritage Christian School, (hereafter referred to as HCS), that he/she is the natural parent or the legal guardian of the above named child; and the undersigned does hereby consent to such minor child taking part in all field trip activities off of school property with the full understanding of its inherent risks insofar as such activity will involve learning and sporting activity and mingling with other indi-viduals and groups, and there is always the risk of injury, illness, loss or expense. The undersigned acknowledges and accepts the risk of such injury, illness, loss or expense, and does hereby release and discharge HCS from any and all claims, demands or liability that may arise on account of such in-jury, illness, loss or expense and the undersigned agrees to fully indemnify and hold harmless HCS from any and all demands, claims, actions or proceedings that may be brought by or on behalf of the above named child for any injury, loss, damage or expense, together with the costs associated with the defense thereof, in connection with participation in the field trip or off school property function. The undersigned further agrees to comply with the rules and regulations as established from time to time pertaining to supervision and disci-pline of students during field trips and/or off school property functions.

AUTHORIZATION

I give permission for my son/daughter to attend HCS off-property functions. I have read the above Permis-sion and Release of Liability and agree to its provisions. Signature________________________________________________ Date____________________________ Relationship to minor______________________________________________________________________



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��Good ��Concern ��Good ��Concern ��Good ��Concern ��Good ��Concern

HOME CONTACT CARD 2019-2020

1. Student Information Student(s) Name Grade Care Card Number Health: Also see below

_________________________________ ________ _______________________

_________________________________ ________ _______________________

_________________________________ ________ _______________________

_________________________________ ________ _______________________ 2. Emergency Contact Information

Persons to be contacted in emergency (other than parent, in order of preference): Name: _______________________________ Relationship: _____________________ ��Can Pick Up from School

Home #: _________________ Work #: _______________ Cell #: ________________

Name: _______________________________ Relationship: _____________________ ��Can Pick Up from School

Home #: _________________ Work #: _______________ Cell #: ________________ Other persons (and relationship) to whom we are authorized to release the student(s) from school:

______________________________________________________________________________________________

______________________________________________________________________________________________ 3. Health Information

Doctor’s Name: ______________________________ Phone: _______________________

Chronic health conditions the child has (i.e. asthma, diabetes, epilepsy, allergies): Student(s) Name: Description of Condition Medication Required:

____________________________ _________________________________ ______________________

____________________________ _________________________________ ______________________

____________________________ _________________________________ ______________________

____________________________ _________________________________ ______________________ Will the school be required to administer medication? ��Yes ��No

If yes, please see the office for forms to be filled out by the guardian and the child’s doctor. Parent or Guardian Signature: _____________________________________ Date: _______________________

NOTE: All information on this card is kept strictly confidential.



Appendix A

The following are suggested formats for Student Registration Forms to verify parental/legal guardian

lawful admission to Canada and residency in British Columbia. This information should be included in the General Student Record.

LEGAL RESIDENCY OF PARENT

(If parents are deceased, use Appendix B)

To be completed and signed by a parent or legal (court-appointed) guardian.

If legal guardian, attach a copy of court order appointing you as legal guardian.

(Lawfully admitted into Canada) I am (please X one):

�� A Canadian citizen (if not born in Canada, please attach photocopy of citizenship paper/card)

� A landed immigrant (attach photocopy of landed immigrant status papers)

� Lawfully admitted to Canada under one of the following documents (please mark the appropriate box below and attach

photocopy of document):

� Admission as a refugee claimant

� A person claiming refugee status who has a letter of no objection

� Student authorization (student visa) for two or more years (or issued for one year but anticipated to be renewed for

one or more additional years.

��Employment authorization (working permit) for two or more years (or issued for one year but anticipated to be

renewed for one or more additional years)

� A person carrying out official duties as a diplomatic or consular official (with a foreign representative acceptance

counter foil in his/her passport)

� Other - document description: (must be cleared with Immigration Canada)

___________________________________________________________________________________

___________________________________________________________________________________

(Residency in British Columbia)

1. I am a resident of British Columbia (please X one):

��Yes Residency address: _______________________________________________________________

__________________________________________________________________________________________

� No I am not a resident of British Columbia

Confirming signature: 3. Parent’s/legal guardian’s name: ____________________________________________________________

Parent’s/legal guardian’s signature: _________________________________________________________

Date: ____________________________________________________________

Ministry of

Education

Office of the Inspector of

Independent Schools

Mailing Address:

PO Box 953 Stn Prov Govt

Victoria, BC V8W 9H

Telephone: (250) 356-2508

Facsimile: (250) 953-4908

Appendix B

LEGAL RESIDENCY OF PARENT (Deceased)

To be completed and signed by the student or a knowledgeable adult (one who knew the student’s parent(s) and has knowledge of

the facts respecting their decease and the matters set out in this document).

(Deceased parent was lawfully admitted into Canada)

1. The student’s deceased parent was at the time of death: � A Canadian citizen

� A landed immigrant

(Deceased parent was resident in British Columbia)

2. The student’s deceased parent was at the time of death a resident of British Columbia (please X one):

��Yes Residency address: _________________________________________________________

___________________________________________________________________________________

��No Not a resident of British Columbia

Confirming signature:

Student: ___________________________________________________________________________________

Knowledgeable adult’s name: __________________________________________________________________

Knowledgeable adult’s signature: _______________________________________________________________

Date: ___________________________________

Ministry of

Education

Office of the Inspector of

Independent Schools

Mailing Address:

PO Box 953 Stn Prov Govt

Victoria, BC V8W 9H

Telephone: (250) 356-2508

Facsimile: (250) 953-4908

��New Family

I choose to participate in the PPP and have picked 3 or more activities from the list below.

Parent Participation Form 2019 – 2020 Name:_________________________ Phone #:____________________ Email:_______________________________

Children: Name:_________________________ Grade:_____ Name:__________________________ Grade:______

Name:_________________________ Grade:_____ Name:__________________________ Grade:______

��I choose not to participate in the PPP. HCS is authorized to transfer $200 from my bank account

on June 1st, 2020 using the Pre-authorized Debit Form that I have signed.

****************************************************************************************

��Book Fair

��Cleaning/Janitorial

�� Grad

��Fundraising

��A-thons

��Car Washes

��CHEC - Christian Home Education Conference

��Locker Maintenance & Clean Up

��Lost & Found

��Maintenance (painting inside or outside, yard work/repairs

��Prayer Group (approx. 1/2 hour, one day per week)

��Parent Meetings (refreshments, greeting)

��Promotions

��Safety Patrol Supervision

� ��8:00-8:35am �� 2:50-3:20pm

��Secondary Textbook Room Maintenance

��September Family BBQ

��Bus Driving

�� Classroom Helper - Grade(s) ___________

��Computer Room Supervision

��Drama (costume design, makeup, shopping, greeting, promotions)

��Elementary Playground Supervision

Lunch Time (11:50am-12:50pm)

��Field Trips

�� Department Help

��Elementary Reading Programs ��Learning Commons ��Office ��Special Education ��Other

��Secondary Retreats

��Sports: Coaching (please check one)

� � ��Basketball ��Soccer ��Other

��Other ________________________________

_________________________________________

Areas below require a Criminal Record Check (CRC). If you are choosing one of these areas, please fill in the attached CRC for any adult (18 & over) who may partici-pate (there is no cost to the applicant)

�� Home Stay (application forms available)


TRANSACTION INFORMATION WE AUTHORIZE THE PAYEE TO DEBIT MY ACCOUNT (ATTACH VOID CHEQUE or equivalent banking information)

TYPE OF PAD: PERSONAL/HOUSEHOLD X BUSINESS Same as 2018-19 ACCOUNT TYPE: CHEQUING X CPA TRANSACTION TYPE AMOUNT: $_____________________ START_____________________ END ______________________ FREQUENCY: WEEKLY __________ BI-WEEKLY ____________ MONTHLY OTHER __________ The debit will be processed to your account on the 23rd day of the months associated with the above payments.

PAYOR INFORMATION:

NAME(S): ____________________________________________ ADDRESS: ____________________________________________ POSTAL CODE: _____________________ HOME: ________________ BUS: ______________________

SIGNATURE

APPLICANT: _____________________________________________ DATE: _______________________________________

CANCELLATION (10 BUSINESS DAYS NOTICE IS REQUIRED) I may revoke authorization at any time, subject to providing notice of at least (10) business days before the next EFT debit is sched-uled. I may obtain a sample cancellation form, or more information on my right to cancel a EFT agreement at my financial institu-tion or by visiting www.cdnpay.ca. I have certain recourse rights if any debit does not comply with the agreement. For example, I have the right to receive reimburse-ment for any EFT that is not authorized or is not consistent with the EFT agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.cdnpay.ca.

CANCEL THIS PRE AUTHORIZED DEBIT (PAD) PLAN AGREEMENT EFFECTIVE ______________________, 20 _______ SIGNATURE: __________________________________________ DATE: ______________________________________

I waive any and all need for signatures to change payment arrangements or withdrawal date as long as there is permission via telephone conversation or email instruction by the payor. The payee will provide 10 calendar days notification of a change. Initials: I have read and understand and accept the terms and conditions of this agreement for participation in the EFT plan. I warrant and guarantee that all persons whose signatures are required to sign on this account have signed this agreement below.

I authorize payments for Tuition, Parent Participation Program and Additional Fees as indicated on the 2019-2020 Heritage Christian School Tuition Calculation form. (initials)

PRE AUTHORIZED DEBIT (PAD)



REQUEST FOR RECORDS

Date:

School:

Please release the necessary academic and health records (including IEP and assessments, if appli-cable) to Heritage Christian School and release the student/s in MyEd.

Thank you.

NAME BIRTHDATE GRADE

Sincerely,

Jessie Keith Admissions Secretary [email protected]

