Annual Student Application
School Year: _________/_________
1. Student Information
⋅ Last Name: _______________________________________ First Name: __________________________________ Middle: ______
Birthdate: ______/______/______
Grade Entering: _________
⋅ Last Name: _______________________________________ First Name: __________________________________ Middle: ______
Birthdate: ______/______/______
Grade Entering: _________
⋅ Last Name: _______________________________________ First Name: __________________________________ Middle: ______
Birthdate: ______/______/______
Grade Entering: _________
⋅ Last Name: _______________________________________ First Name: __________________________________ Middle: ______
Birthdate: ______/______/______
Grade Entering: _________
⋅ Last Name: _______________________________________ First Name: __________________________________ Middle: ______
Birthdate: ______/______/______
Grade Entering: _________
For additional children, please list on back side of form.
2.Family Information
⋅ Name: ____________________________________________________
⋅ Cell Phone Number: (_______) _______ - __________
⋅ DOB: ______/______/_______
Email Address: _________________________________________________
​Date of Birth will be used to verify your relationship to your child(ren) in the case of an emergency.
⋅ Name: ____________________________________________________
⋅ Cell Phone Number: (_______) _______ - __________
⋅ DOB: ______/______/_______
Relationship to Child(ren): ________________________
Relationship to Child(ren): ________________________
Email Address: _________________________________________________
​Date of Birth will be used to verify your relationship to your child(ren) in the case of an emergency.
REMINDER: Email is our MAIN source of communication, so please list an email that you check regularly. Also, we use the
Remind Alert System for school announcement reminders, school cancellations, school emergencies, etc. If the number you
listed above is not enrolled in this system, please let the office know.
⋅ Home Address: ___________________________________________ City/State/Zip: ______________________________________
⋅
⋅ Change in Child(ren)’s Household:
Yes
No
If yes, please explain: __________________________________________
__________________________________________
__________________________________________
__________________________________________
3. Church Information
Name of Church Attending: ________________________________________________________________________________________
Annual Student Application
Total​ Family Tuition Amount Due: $ ______________ . ______
Select Payment Schedule
Quarterly
July, October, January, April
10 Payments
September 1-June 1
12 Payments
July 1-June 1
Pay in Full
Tuition Schedule
Preschool
Half-Day
Monday-Thursday
$1,250.00
Full-Day
Monday-Thursday
$2,500.00
Kindergarten
Full-day
Monday-Thursday
$3,015.00
1st-8th Grade
Full-Day
Monday-Friday
1st Student
$3,700.00
2nd & 3rd Student
$3,200.00
4th Student
No Charge
I/We will be applying for Tuition Assistance.
Yes
No
NOTE: Due to government regulations, Covenant Christian School cannot offer the option of tuition assistance to students
enrolling in Preschool or Kindergarten. We apologize for the inconvenience.
Forms for tuition assistance will be available ​online​ or in the ​office
Due By: June 15 (First Semester)
December 15 (Second Semester)
Tuition payments are due on the first of each month. Delinquent accounts (over 10 days) will be charged a $10 late fee. If no
payments have been made after 30 days, a School Board member will contact you to make arrangements for a payment.
Delinquent accounts will be reviewed at the end of each semester. The Board has the right to dismiss the student(s) until the
account becomes current. A $10 fee will be charged for any returned checks. Tuition statements will be emailed monthly (or
sent home with student/mailed upon request).
I have carefully read Covenant Christian School’s financial policies and I agree to abide by them. I promise to pay tuition in
the manner chosen above. If problems arise, I agree to contact the appropriate school personnel in a biblical approach to
problem solving (Matthew 18:15-20).
___________________________________________________________________________
Parent Signature
______/______/_______
Date
___________________________________________________________________________
Parent Signature
______/______/_______
Date
Covenant Christian School admits applicants and students of any race, color, national or ethnic origin to all the rights, privileges, programs
and activities, generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national
or ethnic origin in the administration of educational policies, admissions policies, scholarship and loan programs, athletic or other school
administered program.
Annual Student Application
School Year: ________ / ________
My child(ren) ________________________________________________________________________________________,
grade(s)__________________,
has/have my permission to go on any and all school-sponsored field trips with Covenant
Christian School for the above stated school year.
I understand that an adult, licensed driver will transport my child(ren) to
and from the field trip activities.
___________________________________________________________________________
Parent Signature
Primary Contact Number: (______) ______ - ___________
______/______/_______
Date
Secondary Contact Number: (______) ______ - ___________
Emergency Contact: _____________________________________
Contact Number: (______) ______ - _____________
Insurance Provider: ______________________________________
Policy Number: _____________________________
Student Information Sheet
Student Name(s): _____________________________________________________________________________________
Birthdate(s): _________________________________________________________________________________________
Address: ___________________________________________________
City/State/Zip: ___________________________
Father’s Name: ___________________________________________
Contact Number: (______) ______ - ____________
Mother’s Name: ___________________________________________
Contact Number: (______) ______ - ____________
Emergency Contact: ________________________________________
Contact Number: (______) ______ - ___________
Parent Email: ________________________________________________________________________________________
Applicable Medical Information (i.e. allergies, etc.) or Comments:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
NOTE: Emergency contacts MUST be someone outside of the child(ren)’s mother, father, or guardian listed.
Annual Student Application
Ownership
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CCS retains ownership of all student personal devices
Random inspections will be conducted without notice. This will include:
○ All stored information
○ Anything sent or received
Appropriate customization of backgrounds is allowed
No stickers or other materials can be used to decorate the device
No changing or decorating the provided personal device protection case
Only the student and their parents/guardians should use the device and use should be limited to school related
purposes
Damage, Loss, or Theft
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Students are responsible for a $100 deductible if:
○ Personal device is lost or damaged off of school property
○ Personal device is damaged on school property as a result of carelessness, abuse, or neglect
Report any issues to the school ASAP (damaged, lost, stolen, etc.)
○ Personal devices will be randomly inspected for damage and students held responsible for unreported issues
found
To ensure the protection of the personal device:
○ Do not tamper with case or screen protector
○ Do not eat or drink around device
Parent/Guardian Responsibilities
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Talk to your student about values and standards that your student should follow on the use of the Internet (just as
you would for all media information sources; television, movies, telephone, etc.).
Establish ground rules for at home use
○ If you do not want your child to bring home their personal device, you may sign a form indicating this
Monitor your child’s screen time while at home:
○ Appropriate internet usage (school filters may not be the same once students leave our network)
○ Appropriate screen time per day
Student Responsibilities
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Using personal devices in a responsible and ethical manner in accordance with CCS values
Using personal devices in an appropriate manner so as to not damage school equipment
Only use with teacher permission and as directed.
Notifying teacher if:
○ Personal device is lost or damaged
○ Student receives correspondence containing inappropriate or abusive language or if subject matter is
questionable
If brought home, be sure to bring back for class each day.
○ If left at home, students are responsible for getting course work completed as if their personal devices were
present
○ It is not the teacher’s responsibility to make modifications to the lesson due to a student’s lack of
responsibility
The use of the Covenant Christian School internet connection is a privilege, which may be revoked by the
administrator(s) of the system at any time for abusive conduct. Such conduct would include, but is not limited to, the
placing of unlawful information on the system, and the use of obscene, abusive or otherwise objectionable language
in either public or upon registration of complaint, private message or other systems that are accessed through the
CCS connection. The staff of CCS will be the sole arbiter of what constitutes obscene, abusive, or objectionable
language or conduct.
That the use of the Covenant Christian School internet connection is a privilege, which may be revoked by the
administrator(s) of the system at any time for conduct that embarrasses, harms, or in any way distracts from the good
Annual Student Application
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reputation of the CCS staff, students, or any organizations, groups, and institutions with which the CCS internet
connection is affiliated. The staff of CCS will be the sole arbiter of what constitutes unacceptable behavior.
That the Covenant Christian School staff reserves the right to review any material stored in files to which all users
have access and may edit or remove any material which the staff, in its sole discretion, believes may be unlawful,
obscene, abusive, or otherwise objectionable.
That all information services and features contained on CCS internet connection are intended for the educational use
of its patrons, and any commercial or unauthorized use of those materials or services, in any form, is expressly
forbidden.
To abide by such rules and regulations of system usage as may be promulgated from time to time by the
administrator(s) of the CCS connection.
In consideration for the privilege of using the CCS internet connection and in consideration for having access to the
information contained on it, I hereby release the CCS connection and its operators and sponsors, CCS and its faculty
and staff, and all organizations, groups and institutions with which the CCS internet connection is affiliated for any
and all claims of any nature arising from my use, or inability to use, the CCS internet connection.
My access to and use of the CCS network connection is subject to such limitations as may be established by the
administrator(s) of the system, and may be changed from time to time.
Student Activities Strictly Prohibited
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Sending, accessing, uploading, downloading, or distributing offensive, profane, threatening, pornographic, obscene,
or sexually explicit materials
Spamming-sending mass or inappropriate emails
Usage of camera or other recording device without expressed consent and monitoring of teacher
Usage of any messaging service or chat rooms without prior staff permission
Changing personal device’s settings or bypassing web filters
Downloading or changing apps
○ No games or non-school related apps will be used
Vandalism to your personal device or another student’s personal device
Usage of any other personal devices during school hours
Cyber Safety
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●
●
●
Do not provide personal information over the Internet
No usage of social media or messaging services
Do not randomly peruse Internet
Never accesses questionable sites or material
Discipline
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●
Inappropriate use of the personal devices will result in immediate disciplinary action
○ Confiscation of device
○ Parent/teacher conference
○ Suspension of all technology privileges
○ School suspension
CCS recognizes that not all personal device misuse is the same. Each case will be reviewed independently and
consequences will administered as deemed fitting.
Annual Student Application
Ownership
●
●
●
●
●
●
CCS retains ownership of all student personal devices
Random inspections will be conducted without notice. This will include:
○ All stored information
○ Anything sent or received
Appropriate customization of backgrounds is allowed
No stickers or other materials can be used to decorate the device
No changing or decorating the provided personal device protection case
Only the student and their parents/guardians should use the device and use should be limited to school related
purposes
Damage, Loss, or Theft
●
●
●
Students are responsible for a $100 deductible if:
○ Personal device is lost or damaged off of school property
○ Personal device is damaged on school property as a result of carelessness, abuse, or neglect
Report any issues to the school ASAP (damaged, lost, stolen, etc.)
○ Personal devices will be randomly inspected for damage and students held responsible for unreported issues
found
To ensure the protection of the personal device:
○ Do not tamper with case or screen protector
○ Do not eat or drink around device
Parent/Guardian Responsibilities
●
●
●
Talk to your student about values and standards that your student should follow on the use of the Internet (just as
you would for all media information sources; television, movies, telephone, etc.).
Establish ground rules for at home use
○ If you do not want your child to bring home their personal device, you may sign a form indicating this
Monitor your child’s screen time while at home:
○ Appropriate internet usage (school filters may not be the same once students leave our network)
○ Appropriate screen time per day
Student Responsibilities
●
●
●
●
●
●
●
Using personal devices in a responsible and ethical manner in accordance with CCS values
Using personal devices in an appropriate manner so as to not damage school equipment
Only use with teacher permission and as directed.
Notifying teacher if:
○ Personal device is lost or damaged
○ Student receives correspondence containing inappropriate or abusive language or if subject matter is
questionable
If brought home, be sure to bring back for class each day.
○ If left at home, students are responsible for getting course work completed as if their personal devices were
present
○ It is not the teacher’s responsibility to make modifications to the lesson due to a student’s lack of
responsibility
The use of the Covenant Christian School internet connection is a privilege, which may be revoked by the
administrator(s) of the system at any time for abusive conduct. Such conduct would include, but is not limited to, the
placing of unlawful information on the system, and the use of obscene, abusive or otherwise objectionable language
in either public or upon registration of complaint, private message or other systems that are accessed through the
CCS connection. The staff of CCS will be the sole arbiter of what constitutes obscene, abusive, or objectionable
language or conduct.
That the use of the Covenant Christian School internet connection is a privilege, which may be revoked by the
administrator(s) of the system at any time for conduct that embarrasses, harms, or in any way distracts from the good
Annual Student Application
●
●
●
●
●
reputation of the CCS staff, students, or any organizations, groups, and institutions with which the CCS internet
connection is affiliated. The staff of CCS will be the sole arbiter of what constitutes unacceptable behavior.
That the Covenant Christian School staff reserves the right to review any material stored in files to which all users
have access and may edit or remove any material which the staff, in its sole discretion, believes may be unlawful,
obscene, abusive, or otherwise objectionable.
That all information services and features contained on CCS internet connection are intended for the educational use
of its patrons, and any commercial or unauthorized use of those materials or services, in any form, is expressly
forbidden.
To abide by such rules and regulations of system usage as may be promulgated from time to time by the
administrator(s) of the CCS connection.
In consideration for the privilege of using the CCS internet connection and in consideration for having access to the
information contained on it, I hereby release the CCS connection and its operators and sponsors, CCS and its faculty
and staff, and all organizations, groups and institutions with which the CCS internet connection is affiliated for any
and all claims of any nature arising from my use, or inability to use, the CCS internet connection.
My access to and use of the CCS network connection is subject to such limitations as may be established by the
administrator(s) of the system, and may be changed from time to time.
Student Activities Strictly Prohibited
●
●
●
●
●
●
●
●
Sending, accessing, uploading, downloading, or distributing offensive, profane, threatening, pornographic, obscene,
or sexually explicit materials
Spamming-sending mass or inappropriate emails
Usage of camera or other recording device without expressed consent and monitoring of teacher
Usage of any messaging service or chat rooms without prior staff permission
Changing personal device’s settings or bypassing web filters
Downloading or changing apps
○ No games or non-school related apps will be used
Vandalism to your personal device or another student’s personal device
Usage of any other personal devices during school hours
Cyber Safety
●
●
●
●
Do not provide personal information over the Internet
No usage of social media or messaging services
Do not randomly peruse Internet
Never accesses questionable sites or material
Discipline
●
●
Inappropriate use of the personal devices will result in immediate disciplinary action
○ Confiscation of device
○ Parent/teacher conference
○ Suspension of all technology privileges
○ School suspension
CCS recognizes that not all personal device misuse is the same. Each case will be reviewed independently and
consequences will administered as deemed fitting.
Annual Student Application
Student Pledge for Personal Device Use
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I will​ take good care of my assigned personal device.
I will​ never leave my personal device unattended.
I will​ never loan out my personal device to other individuals.
I will​ protect my personal device from damage.
I will​ use my personal device in ways that are appropriate, meet CCS expectations, and are educational.
I understand​ that my personal device is subject to inspection at any time, without notice, and remains the property of
CCS.
I will​ follow all policies outlined in the CCS ​Personal Device Agreement​, both on and off school premises.
I will​ be responsible for all damage or loss caused by neglect or abuse; including the $100 deductible for
replacement.
I will​ file a police report in case of theft, vandalism, or other such acts.
I agree​ to return the CCS personal device in good working condition.
I understand and agree to follow the guidelines included in the CCS ​Personal Device Agreement.
Student Name (Printed): ___________________________________________________________
Student Signature: ________________________________________________________________
Date: ______/______/______
I understand and agree to the responsibilities on myself and my student, outlined in the CCS ​Personal Device Agreement​.
Parent Name (Printed): _______________________________________________
Parent Signature: ___________________________________________________
Date: ______/______/______
--------------------------------------------------------------------------------------------------------------------------------------------------________
I want to opt out of my student taking the personal device home.
Opt Out Signature: ________________________________________________________________________