Westside Christian Academy
Enrollment Information for 2015-2016
Attached are the enrollment/re-enrollment forms for the upcoming school year. Please complete and return to the main office
as soon as possible in order to secure a spot for your child next year. Also attached is a registration form for the Extended Care
program. Please fill out and return this form ONLY IF you are interested in using the Extended Care program for the 2015-2016
school year. YOU DO NOT NEED TO PAY NOW for Extended Care registration. Registration for Extended Care will be billed in
August.
Needed for enrollment:
Current Students:
*$225.00 Registration Fee per student (3K-8); $100.00 for Nursery OR
Deferred Payment Option (see re-enrollment form)
*completed Re-enrollment Form
*updated immunizations if applicable
New Students:
*$225.00 Registration per student (3K-8 ); $100.00 for Nursery
*a copy of student’s birth certificate
*up-to-date immunization certificate on SC Form
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*entrance testing scheduled with WCA Office Manager ($20.00 for K5-2 /$40.00 fee for 3 -8 )
*proof of physical from doctor (by start of school)
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The fees and tuition are as follows:
Grade Level
Book Fee
Tuition
Due June 1, 2015
Tuition Monthly
(12 months)
Tuition Monthly
(10 Months)
Due Aug 2015-July 2016
Due Aug 2015-May 2016
3K
$190.00
$2,317.00
$193.08
$231.70
4K
$190.00
$2,420.00
$201.67
$242.00
5K
$240.00
$2,956.00
$246.33
$295.60
1st-5th Grade
$290.00
$3451.00
$287.58
$345.10
6th-8th Grade
$315.00
$3,574.00
$297.83
$357.40
Discounts: There is a 5% discount for tuition paid in full for ALL grades, including Nursery. This discount will only apply if
payment is received by August 1st. A 10% Multiple Child Discount applies to children who attend WCA and reside within the
same household. First child is full price and subsequent children receive the 10% discount. The 10% discount applies to
children within the same family but does not apply to children enrolled in the Nursery program. Families with multiple
children who are paying in full may receive both discounts. The 5% Paid in Full discount is taken first and then the 10% MultiChild discount is applied.
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**We cannot accept credit or debit cards. Late fees will be assessed after the 15 of each month on all past due accounts.
Registration: This $225.00 charge is due upon enrollment. It reserves your child’s spot and covers expenses such as processing,
achievement testing, furniture, equipment, campus maintenance and the like. This fee is non-refundable.
Book/Supply Fee: This fee covers student books, teachers’ materials, classroom instructional supplies, enrichment materials,
project supplies, copies, and the like.
Monthly tuition payments: The monthly tuition reflects the total tuition divided into ten (10) or twelve (12) monthly
payments. Tuition includes: student insurance, SCACS (SC Association of Christian Schools) membership, RenWeb Accessibility
and Technology fees, Parent Alert fees, etc.
Referral Credit: A $25.00 credit is available to currently enrolled, tuition paying families who refer new students to WCA. A
credit will be applied to the current student’s account upon a written referral from the new student’s family (on enrollment
form).
Nursery Information: The WCA nursery (ages 6 weeks-2 years) is open any day that students are in attendance for school.
Registration for the nursery is $100.00. The nursery rate is $120 per week. On weeks that WCA is closed, the rate will be
prorated at $24 per day. This ONLY applies when WCA is closed. You will be responsible for the weekly amount if your child is
absent.
Statement of Nondiscrimination: WCA admits 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 Westside Christian Academy. It does not discriminate based on race, color,
national or ethnic origin in administration of its educational policies, admissions policies, athletics, and other administered programs,
particularly in regard to employment and student admission policies, procedures, and practices.
Date______________
Enrollment Form 2015-2016
WESTSIDE CHRISTIAN ACADEMY
554 Pinewood Road Sumter, SC 29154
Student’s Name_______________________________________________________________________________________________
Last
First
Middle
Grade Entering ________ Any Grade Repeated? ___Yes ___No
Age _____
Goes By
Birth Date ____________
Gender _________
Student’s Address __________________________________________________________________ Phone ____________________
Street
City/State/Zip Code
Church where student attends _______________________________________________________
OFFICE USE ONLY
Date received ___________________
Student Lives With (check all that apply)
__ Both parents
__ Parents are divorced
__ Father is deceased
__ Student is adopted
__ Father has custody
__ Parents are separated
__ Mother is deceased
__ Student lives with grandparents
__ Mother has custody
__Grandparents have custody
__ Other (please explain) __________________________________________________________
**If someone other than parents has custody of student, WCA requires a copy of guardianship
papers. Likewise, WCA requires copy of custody agreements/court orders for divorced parents.
Father’s Name __________________________________________________________________
Last
First
Middle
Title_________ Email Address ___________________________________ Cell # ______________
Mr./Rev./Dr.
Payment $_____________________
Ck # __________________________
Staff Initials ____________________
******************************
____ Copy of Birth Certificate
____SC Immunization Record
____DSS Form
____Meds Form
____Transcript Requested
***Required
____Testing completed & testing fee
paid
Social Security # _____________________________ Work Phone ________________________
***Required
____ W letter
Employer _______________________________________________________________________
Address (if different from student) _______________________________________________________________________________
Street
___ Allowed to pick up student
City/State/Zip Code
___ Emergency Contact
Church _________________________________________________
Mother’s Name __________________________________________________________________________ Title ______________
Last
First
Middle
Ms./Mrs./ Rev./Dr.
Social Security # ___________________ Email Address _____________________________________ Cell # __________________
***Required
***Required
Address (if different from student) _______________________________________________________________________________
Street
City/State/ Zip Code
Employer ________________________________________________ Work Phone _____________________________
___ Allowed to pick up student
___ Emergency Contact
Church _______________________________________________
Student Academic Information
Last School Attended __________________________________________________________________________ Grade __________
Address __________________________________________________________________________ Phone ____________________
Street
City/State/Zip Code
Fax _______________________ Contact Name _____________________________________________________________________
Has student ever been referred for academic evaluation? ___ Yes ___ No
evaluation.
If so, please provide WCA with a complete copy of
Does student have any known learning disabilities or behavioral problems such as ADD or ADHD?
___ Yes ___ No
If so, please describe.
___________________________________________________________________
___________________________________________________________________
Has student ever been suspended or dismissed from school for academic, disciplinary or other reasons? ___ Yes ___ No
please explain:
If yes,
___________________________________________________________________
___________________________________________________________________
Emergency/Medical Contact Information (other than parents)
Name ______________________________________________________________________ Relationship _____________________
Address_______________________________________________________________________ Phone ________________________
Street
City/State/Zip Code
Cell # _________________________ Business Phone _________________________________
Name ______________________________________________________________________ Relationship _____________________
Address_______________________________________________________________________ Phone ________________________
Street
City/State/Zip Code
Cell # ______________________________ Business Phone _________________________________
Name ______________________________________________________________________ Relationship _____________________
Address_______________________________________________________________________ Phone ________________________
Street
City/State/Zip Code
Cell # ______________________________ Business Phone _________________________________
Name ______________________________________________________________________ Relationship _____________________
Address_______________________________________________________________________ Phone ________________________
Street
City/State/Zip Code
Cell # ______________________________ Business Phone _________________________________
Authorized Pick Up/Contact Information (the following people are authorized to pick my child from school)
Name ______________________________________________________________________ Relationship _____________________
Name ______________________________________________________________________ Relationship _____________________
Name ______________________________________________________________________ Relationship _____________________
Name ______________________________________________________________________ Relationship _____________________
Name ______________________________________________________________________ Relationship _____________________
Name ______________________________________________________________________ Relationship _____________________
Name ______________________________________________________________________ Relationship _____________________
Name ______________________________________________________________________ Relationship _____________________
Permission to Photograph/Video
WCA often uses student pictures in our various publications (i.e. ParentsWeb, WBC bulletin, yearbook and website). If you prefer
that your child NOT be photographed or videotaped, please inform the school in writing of your wishes.
Medical Information
Allergies____________________________________________________________________________________________________
If student has an allergy that requires an Epi-Pen or any medications that need to be taken at school, you MUST see the health room
attendant to complete the necessary forms.
Any physical health problems? ___Yes ___No
If yes, please explain _________________________________________________
____________________________________________________________________________________________________________
Is student on any medication? ___Yes ___No Type and dosage: ____________________________________________________
Physician _____________________________________________________Phone #________________________________________
Has student ever consulted, or been referred to a psychiatrist, psychologist, or psychiatric social worker for professional assistance?
___Yes ___ No
If yes, please explain___________________________________________________________________________
____________________________________________________________________________________________________________
Please provide the health room attendant and teacher with any additional information regarding health/well being that will
assist WCA in caring for your child. Any known fears/phobias, i.e. closed spaces, spiders, heights, etc.
Medical Consent
In the event of an emergency, and parents cannot be contacted or contact persons cannot be reached, I authorize and direct Westside
Christian Academy staff to send my child, (properly accompanied) to the hospital, doctor or medical facility deemed necessary.
___Yes ___No
Parent’s Signature__________________________________________________________ Date_______________
Parent’s Name ________________________________________ Student’s Name _________________________________________
Please print
Please print
How did you here about WCA: ____Radio ____ Sumter Living ____ The Item ____Shaw News ____Friend/Acquaintance
____Other: __________________________________________________________________________________________________
Referred to WCA by: ____________________________________________________________
Statement of Nondiscrimination
WCA admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded
or made available to students at Westside Christian Academy. It does not discriminate based on race, color, national or ethnic origin
in administration of its educational policies, admission policies, athletics, and other administered programs, particularly in regard to
employment and student admission policies, procedures, and practices.
**Please refer to cover letter for fees and documents that must accompany
student’s enrollment form.