Preschool Enrollment Application

2021-2022

For Office Use Only:

□ Registration Fees Paid □ Sent to Accounting Department

□ Entered in Full Class List □ Acceptance Letter Sent

Education with a God-given Purpose 37557 Hwy 2A, Red Deer County, AB, T4E 1S2 Phone: (403) 343-6510 ext 517 Fax: (403) 343-1963

Notice of Non-Discriminatory Policy

Destiny Christian School accepts students of all races, color, national and ethnic origin, who form part of the student body, to all rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate race, color, national or ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs. Section A – Family Information

Address City Province Postal Code Home Telephone

FATHER/GUARDIAN INFORMATION

* All volunteers must complete a volunteer application form, as well as submit a copy of their police record check, and child services intervention check. Record checks must be completed before September 1, 2021.

Section B – Student Information

CHILD 1

Legal Name Surname: First: Middle:

Also Known As Surname: First: Middle:

Birth Date (MM-DD-YYYY): Gender: Citizenship:

Allergies/Medical Alert:

Are your child’s immunizations up to date?

CHILD 2

Legal Name Surname: First: Middle:

Also Known As Surname: First: Middle:

Birth Date (MM-DD-YYYY): Gender: Citizenship:

Allergies/Medical Alert:

Are your child’s immunizations up to date?

Note: All children must be 4-years-old prior to December 31, to be accepted in the program.

Note: Parent involvement is essential to our Playschool program. We ask that all

Yes No

families volunteer in class on a rotating basis. Is a parent, grandparent, aunt, or uncle available to assist in this capacity?

Yes No

Yes No

Surname: First: Middle:

Email: Cell: Work:

MOTHER/GUARDIAN INFORMATION

Surname: First: Middle:

Email: Cell: Work:

Marital Status: Student(s) living with:

2021-2022 PRESCHOOL ENROLLMENT APPLICATION

Education with a God-given Purpose 37557 Hwy 2A, Red Deer County, AB, T4E 1S2 Phone: (403) 343-6510 ext 517 Fax: (403) 343-1963

Emergency Contacts In the event of an emergency, if a parent cannot be reached, contact the following person(s):

FIRST EMERGENCY CONTACT

Surname: First: Relationship to Student:

Home Phone: Cell: Work: SECOND EMERGENCY CONTACT

Surname: First: Relationship to Student:

Home Phone: Cell: Work:

Medical Consent

In the event I, cannot be reached to make arrangements for emergency medical care at the time of the incident, I hereby authorize Destiny Christian School to take my child to the nearest emergency or to call an ambulance to provide first aid and transportation, in the event of a serious accident. __________________________________ ______________________

Signature of Parent/Guardian Date Christian Faith

Church Attending: Pastor: Phone:

No. of Years Attending: If less than 1 year, list previous church: Family attends church

Born again Christian? Father Mother

Received the Baptism of the Holy Spirit? Father Mother

Has the student made a profession of faith in Jesus according to Romans 10:9-10? CHILD 1 - CHILD 2 -

Yes No At what age? Yes No At what age?

2021-2022 PRESCHOOL ENROLLMENT APPLICATION

Education with a God-given Purpose 37557 Hwy 2A, Red Deer County, AB, T4E 1S2 Phone: (403) 343-6510 ext 517 Fax: (403) 343-1963

Section C – Financial Information

Financial Policy

To process your child/children’s registration for the upcoming 2021/2022 school year, we require: Full payment of your registration fee of $50 per child. A monthly payment-plan. Payment options are:

Auto debit on the first or fifteenth of each month (void check required) 10 Post-dated checks (dated September 1, 2021 to June 1, 2022) Credit card number to be processed on the first of each month (3.5% service charge will apply).

Once all the above requirements have been met, your child’s placement for the coming year will be secured. Because of the high enrollments for certain grades we cannot hold your child’s place if another family applies and you have not met the registration requirements.

NSF POLICY A $20.00 service charge will be charged for any returned checks.

ACCOUNTS IN ARREARS Current account in arrears three months – the family will be asked to prepare a written payment report and plan to

be submitted to the school board for review. A meeting between the parent(s)/guardian(s) will be held with a board member to determine the family’s registration status.

All marks and transcripts will be held until current account is paid in full or suitable arrangements are made with school treasurer.

WITHDRAWAL If your child withdraws from the school, tuition will be refunded for the number of months remaining in the school

year, not including the month of withdrawal.

REENROLLMENT Students will only be reenrolled, and classroom space will be reserved if a family’s account is up-to-date or if

satisfactory payment arrangements have been made by the reenrollment due date.

Agreement __________________________________ ________________________________ Parent/Guardian School Administration __________________________________ Date

2021-2022 PRESCHOOL ENROLLMENT APPLICATION

Education with a God-given Purpose

37557 Hwy 2A, Red Deer County, AB, T4E 1S2 Phone: (403) 343-6510 ext 517 Fax: (403) 343-1963

Destiny Christian School Society 37557 Hwy 2A Red Deer County, AB T4E 1S2 Family: _________________________________________ 403-343-6510 info@desinyschool.ca

Registration Fees:

Preschool:

per year

TOTAL: $_____________

Due with submission of registration form

Monthly Society Fees:

per month

TOTAL: $_____________

Due on the first of each month

Payment Plan:

I wish to pay by: (choose one)

Payable to Destiny Christian School, dated for the 1st of the month

The undersigned hereby authorizes Destiny Christian School to draw monthly debits by paper or electronic entry in the amounts of: $_____________ plus a 3.5% service charge, on the 1st of each month beginning Sept. 2021 and ending June 2022 or until all applicable fees are paid.

Card #: ________________________________________ Expiry Date: ____/____ CSV: ____

Name as it appears on card: __________________________________________

Signature: _____________________________________ Date: _____________

NOTE: If this is your initial request for bank debit, please enclose a specimen cheque marked VOID or a pre-authorization form completed by your bank. For a joint account, all depositors must sign if more than one signature is required on cheques issued against the account.

1. All amounts payable to Destiny Christian School drawn or directed to you by a chartered bank, on behalf of Destiny Christian School. 2. Your treatment of each debit shall be the same as if the undersigned has personally directed you to pay as indicated and to charge the amount specified to that account of the undersigned. 3. This authorization may be cancelled at any time upon written notice or email. 4. Any delivery of this authorization to you constitutes delivery of the undersigned. 5. You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this pre-authorized debit agreement. To obtain more information on your recourse rights, contact your financial institution or visit www.cdnpay.ca. 6. If you have any concerns contact Destiny Christian School, 37557 Hwy 2A, Red Deer County, AB, T4E 1S2 Ph: (403)343-6510 ext 517 Fax: (403) 343-1963

Signature: _____________________________________ Date: _____________

Enclosed Post-Dated Cheques

Credit Card

Bank Debit 1st of the month 15th of the month

The auto debit withdrawals are from a Personal Account Business

The undersigned hereby authorizes Destiny Christian School to draw monthly debits by paper or electronic entry, in the amounts of: $_____________ on the 1st or 15th of each month beginning September 2021 and ending June 2022 or until all applicable fees are paid. If new enrollment registration fees are not paid by June 30th, they will be debited on July 1st or 15th, as indicated on your agreement.

Preschool Fees:

______ x /child = ________

______ x /child = ________

2021-2022 PRESCHOOL ENROLLMENT APPLICATION