Crossroads High School and Junior High
Student Registration 2017-2018
Please complete this form and send it to Crossroads High School, P.O. Box 434, Tiskilwa, IL 61368. A signed
Parent Cooperation Agreement and a $30 non-refundable registration fee, payable to Crossroads High School,
must accompany this form and are required to reserve your place. Three references from non-family members
are also required for admission. After receiving your application, CHS will contact you to arrange an interview
with parent and student as part of the admission process.
Student name __________________________________________
Birthdate ________________________
Address ______________________________________________
Phone Number ___________________
City/State/Zip _________________________________________
Age (as of 8/21/17) _______________
Year in school 2017-2018 ________________
Student e-mail address __________________________
Parent name(s) _____________________________________________________________________________
Work/cell phone # ____________________________ Parent e-mail address ___________________________
Church affiliation _____________________________________________________
T-shirt size S M L XL
Shorts size
Men’s (waist size)
S (29-32”) M(32-35”) L (35-38”) XLG (38-42”) 2XLG (43-47”)
Women’s XS(0-2) S (4-6) M (8-10) L (12-14) XLG (16-18) 2X (20-22)
If your student has completed high school courses, please indicate what course level/curriculum the student will
have completed by 8/21/17 in the following subject areas:
Bible:
____________________________________________________________________________
English:
____________________________________________________________________________
History:
____________________________________________________________________________
Math:
___________________________________________________________________________
Science:
____________________________________________________________________________
Foreign Language: __________________________________________________________________________
Other: ____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please send a transcript of high school level coursework taken at any credit-granting institutions.
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Registration form 2017
What character or personal goals would you like your child to focus on this year?
Is your student involved in a local church? What spiritual training has your student had at home or otherwise?
What academic goals would you like your child to focus on this year?
Does your child have health issues that may affect his or her learning?
What additional information about your child would be helpful in developing an appropriate and meaningful
education?
Academic Readiness
At the interview the student will be given a short diagnostic test in math, reading, and writing.
Math: This test will determine which class the student is ready to take. High school students must be ready for
Algebra I or higher.
Writing: The junior high test will involve capitalization, punctuation, and sentence combination. A student
must be able to combine information into a well-formed sentence. High school students will be asked to write
a short descriptive paragraph.
Reading: Students will read a short passage from the upcoming year’s curriculum and answer factual
information about the passage.
Students who are not prepared for Crossroads in a specific area above, may enroll in individual courses for
which they are ready.
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Note to the Parent Concerning Letter of Reference
We at Crossroads have a vision to prepare young people for a life of influence and inspire them to a lifetime of
service for Jesus Christ. To be most effective, students must share in the desire to develop these in their lives.
Please ask three non-family members to send a letter of reference for your student directly to CHS to help us
determine your student’s readiness for CHS. Letter of Reference forms can be downloaded at
CrossroadsHighSchool.net/Admission.
Parent/Student Handbook 2017-18
Parents and students should read the most current handbook to understand the philosophy, requirements, and
procedures that make Crossroads unique. Parents are required to sign a parent agreement statement saying
they have read this document and agree to support the policies in it.
Health Exams and Immunizations
In order to comply with Illinois Department of Public Health laws, all students enrolling in Crossroads High
School and Junior High for the first time are required to receive a health exam within one year prior to the start
of school and must present proof of exam and immunization record to the school prior to attending class.
Those who have chosen not to immunize their children for religious, health, or personal conscience reasons
must submit a written notice stating their reasons for declining immunizations.
2017-2018 Tuition Agreement
Tuition for 2017-2018 is $2,900.00.
Fees for 2017-2018 are $385.00, discounted to $350 if paid by April 1st, 2017. These fees are applied toward
books
field trips and activities
science lab supplies and equipment
standardized testing
art supplies
PE uniforms
There are three options for paying tuition. Please check one.

2 % discount for full payment ($2,842.00 total) on or before August 15, 2017.

Biannual payment – 1% discount for two payments of $1,435.00 ($2,871.00 total). First payment
due on or before August 15, 2017 and second payment due on or before January 15, 2018.

Ten monthly payments -- $290.00 per month due on the 15th day of each month, beginning August
15, 2017 through May 15, 2018.
Additional Discounts
The following discounts will be available for the 2017-18 school year.
 10% reduction in fees for 2nd and additional students from the same family. ($2,610 annually;
$260/month). (Early payment discounts do not apply.)
 $50 incentive for recommending a new student who enrolls.
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Tuition and Fee Administration Standards
When enrollment levels at CHS are set, a belief exists that a student who enrolls at CHS will be a student at CHS
for the entire year. These enrollment levels are used in many decisions concerning income and expenses for
the year. Therefore, the following norms will apply towards tuition and fees.
a) Full year tuition and all fees will be charged to each student account in July each year. An initial invoice will
be sent for each student detailing payment methods and options available.
b) All fees are to be paid by July 15 or at the time of student registration for those who register after July 15.
Registered students who do not pay their fees by July 15 will be assessed an additional $20.00 fee for extra
shipping on books, which will be ordered when the fees are received. A tuition payment or enrollment in an
approved payment plan is due before the first day of school. Any payment made in excess of the amount of
fees to be paid will be considered tuition. A student not making this payment or enrolling in a payment plan
agreement will not be permitted to attend classes in the semester until the account deficiency is resolved.
A $10 late fee will be charged monthly for any tuition payment not received by the 15th of the month.
c) A refund of tuition only will be granted to students who withdraw within one calendar month from the start
of each semester (e.g. one month = August 15 to September 15). The refund granted will be prorated on a per
diem basis for the length of enrollment from the first day of the semester. After one calendar month of either
semester no refund will be given for that semester's tuition.
d) If a student is asked to leave for disciplinary reasons, the right to a refund will be forfeited for the semester.
e) If a student moves due to family circumstances and is unable to attend CHS due to distance or for any other
reason besides dissatisfaction with the school, the tuition paid, or owed if unpaid, will be prorated on a per
diem basis for the length of enrollment from the first day of school, and a refund will be granted accordingly.
f) In the case of death of a student, a tuition refund will be calculated on a per diem basis for the length of
attendance from the first day of school of the semester.
g) Fees are non-refundable at anytime.
h) Tuition refunds are given on the amount paid toward the student's account which exceeds the total owed
based on the length of student enrollment.
i) Any situation not specifically covered under the above guidelines shall be handled at the discretion of the
CHS administration.
j) Enforcement of the guidelines will be handled between the Principal and the Board Treasurer, neither of
whom has full authority to grant clemency in a situation. While extenuating circumstances may come about in
certain family situations, enforcement of the Tuition and Fee Administration guidelines will only be suspended
with full consent of both the Principal and the Board Treasurer. In lieu of compliance with the guidelines, if
suspended, will be a signed agreement between the parent/guardian, the Principal and the Board Treasurer
detailing terms of payment in full, the length of which will not exceed two years.
Families desiring to apply for financial aid should apply at https://online.factsmgt.com/signin/4JKJ6. Deadline
is May 15th.
I certify that all information on the Student Registration and Profile form is true to the best of my knowledge
and I will comply with all policies and procedures outlined in the Parent/Student Handbook.
Parent Signature _____________________________________________ Date _________________________
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