2516 West Oakland Park Blvd, Oakland Park, Florida, 33311Phone: (954) 440-2900 / Fax: (954) 652-1268

Email: theembassyacademy@gmail.com / Website: www.embassysoar.com

Admission Application Please complete each section using Black Ink

Section 1: CHILD’S PERSONAL DETAILSChild’s Name Last: First: Date of Birth

County of Birth Nationality

Male Female

Mother’s Name Father’s Name

Address

Parent’s Telephone Numbers

Home: Mobile: Office:

Name and classes of any brother(s)/sister(s) already attending the school ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Language(s) commonly spoken at home: (1): ________________________ (2): ______________________

Section 2: ACADEMIC DETAILS

Class in which admission is sought: __________________________________

Name(s) of school(s) attended in the past and dates of attendance:

Name of School (Any City/Country) Class From To

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Section 3: PERSONALITY AND HEALTHPlease provide details of any special aspects of your child’s personality: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please provide information if your child has any health problem requiring special attention:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section 4: PARENT / GUARDIAN DATAFather’s NameProfession DesignationOrganization

Office Address

Office Telephone Fax No:Email:

Mother’s Name

Mother’s Occupation House Wife Professional

Profession

Organization

Office Address

Office Telephone

Email: Section 5: DECLERATION

I confirm that, to the best of my knowledge, the information provided in this form is correct. I have understood and agree to abide by all school rules including school discipline, inter-school/city transfers and tuition fee payment and refunds. I also acknowledge that while the school does its best to ensure the safety of each child’s life, health and property, the school cannot be held responsible for any damage to these.

________________________________________ ______________________ Signature of Parent/ Guardian Date

Print Name: ________________________________________________________________

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Relation with the Child: __________________________________________________

Section 6: ADMISSION PROEDURE1. The completed admission form along with the copies of birth and health certificates, 3 passport size

photographs and the registration fee (non-refundable) must be submitted to the school office.2. After the admission form has been processed, a date is given for applicant’s assessment.3. Parents are informed of the outcome within one week of the written test date. If a place is offered, the

child’s admission / enrolment must be confirmed and all dues paid within 3 days of date of offer.4. If, within three days, enrolment is not confirmed, the child’s place is offered to another candidate.

FOR OFFICE USE ONLYForm Check By Yes or No Registration Fee Paid On:Birth Certificate Provided Yes or No Cash Photograph Provided

Yes or No Or Check No:

School Leaving Certificate Yes or No Admission Fee:Written Test Pass or

Fail Tuition Fee:

Date: Security DepositChild Interviewed By: Total Cash

Parent Interviewed By: Acceptance / Rejection A R

Reason For rejection: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Office Personal Signature: ____________________________________ Date______________________

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Questionnaire

Students Name: _______________________________________ Grade: _________

1. Does your child know what it means to be a Christian? __Yes __No

2. Are you and/or your spouse a Born Again Christian? __Yes __No

If yes, which one is a born again? __Husband __Wife __Both

3. Students natural parents are: __Together at home

__ Separated

__ Legally divorced

Student’s Natural Mother is: __Deceased

Students Natural Father is: __Deceased

If parents are divorced or separated, who does he/she live with?

__ Natural Mother Only

__ Natural Father Only

__ Natural Mother and Stepfather

__Natural Father and Stepmother

__ Grandparents

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__ Other ___________________

4. Has student ever failed a grade? _ Yes _No

5. Has student ever been removed from school for academic reason? _Yes _No

6. Has student ever been suspended? _ Yes _No

7. Has student ever been expelled? _ Yes _No

If yes, explain:

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

8. Has your child, to your knowledge, used marijuana or narcotics? _ Yes _No

If yes, has he/she been delivered_________________________________________

9. Does your child, to your knowledge, drink any alcoholic beverages of any kind? _Yes _No

10. Has your child ever run away from home? _Yes _No

11. Has your child, to your knowledge, been a member of a gang? _Yes _No

If yes, are they still involved with gang members? _Yes _No

12. Does your child have any medical problems? _ Yes _No

If yes, explain:

__________________________________________________________________________________________

__________________________________________________________________________________________

13. Has your child ever been molested? _ Yes _No

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14. Has your child ever been abused physically/mentally? _Yes _No

15. Has your child ever been examined for medical problems? _ Yes _No

16. Does your child have a behavior problem? _ Yes _No

17. Has your child ever been arrested? _ Yes _No

If yes, please list any convictions or felonies:

__________________________________________________________________________________________

__________________________________________________________________________________________

18. Is your child on probation? _ Yes _No

If so, how long?

_______________________________________________________________________

19. Would you like your child to graduate from The Embassy Academy? _ Yes _No

20. List your child's interest, talents and abilities.

__________________________________________________________________________________________

__________________________________________________________________________________________

21. Is student withdrawing f r o m another school? _ Yes _No

If yes, please explain why?

_____________________________________________________________________________

__________________________________________________________________________________________

_____________

22. Is your child respectful at home? _ Yes _No

23. Does your child get along with other children? _ Yes _No6

24. Describe your child's attitude and behavior toward adults.

__________________________________________________________________________________________

25. How often does your child attend church?

__ Weekly __ Frequently __Never

26. How often does your child attend Sunday school and Bible Study?

I have read and understood all the questions on the questionnaire form.

PRINT

SIGN

DATE

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DRUGS AND WEAPONS POLICY

DRUGS AND ALCOHOL

Students may not possess, use, sell, be under the influence of, or transmit any substance capable of modifying mood and I or behavior. Expulsion by the Principal is mandatory for students who sell mood altering substances, including alcohol or alcoholic beverages, and steroids. For the possession, use transmittal, or being under the influence of such substances the first offense shall result I suspension and may result in expulsion. Expulsion is mandatory for the second offense unless the student is enrolled, and attends, a state-licensed drug rehabilitation program.

WEAPONS

You may not bring a weapon on campus. If you possess, use, handle, or transmit any firearm, you will be referred to the Principal for expulsion. If a weapon is found in your possession, other than a: firearm or you pass one to someone else, or if you use any type of objects to threaten or harm someone, you will be suspended and expulsion proceedings may be started.

Weapons shall be defined as:

1. Firearms - any kind of gun, whether operable or inoperable, loaded or unloaded, including but not limited to, hand, zip, pistol, rifle, shotgun, BB gun, starter gun, explosive propellant or destructive device.

2. Knives - any kinds of knives, including, but not limited to pen, switchblade, or hunting knife.

3. Chains - any chain, not being used for the purpose which it was normally intended.

4. Pipe - any length of metal not being used for the purpose for which it was normally intended.

5. Razor - blades of any kind or similar instruments with a sharp cutting edge.

6. Ice picks, dirks, other pointed instruments.

7. Nunchakus, brass knuckles, Chinese stars, Billy clubs, machete.

8. Tear gas gun (chemical weapon or device/ m a c e ).

9. Electric weapon or device (stun gun).

10. Any instrument (or object) deliberately used, intended for use, to harm another person, or used to intimidate any person (e.g. pencil, pen, etc.).

Student's Signature _____________________________ Date__________________

Parent's Signature _______________________________ Date ________________

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The Embassy Academy Doctrinal Statement

-We believe the bible as God's written Word and revelation of His truths in which he reveals Himself to us.

-We believe the Bible is written to guide us to a way of holiness as God is Holy.

-We believe in the Old and New testaments in which we govern our church, Millennium Kingdom International Embassy, and The Embassy Academy.

-We believe there is only one God which functions in three different capacities the Father, Son , and Holy Spirit.

-We believe He is Holy, powerful, perfect, all-knowing, all-seeing, full of love, inerrant, a n d infallible.

-We believe that man, created in the image of God, sinned incurring n o t only physical death, but also spiritual death, which is separation f r o m god and which is inherited by every member of Adam’s race. (Romans 5:12-21; Romans 6:23: Psalms: 51)

-We believe by the miracle of the virgin birth, that the Lord Jesus Christ, eternal Son of God, became man without ceasing to be God, in order to reveal God and to redeem man.

-We believe Jesus Christ shed His Blood on Calvary as a Substitutionary sacrifice and rose bodily from the dead for our justification, a n d has ascended to the right hand of the Father, from whence He will personally return for His glorified Bride.

- We believe He (Jesus Christ) is now exalted at the right hand of God that He is the Head of the Church, the Lord of the individual believer, that He is ministering as our Great High Priest and Advocate and that we are awaiting His bodily return. (Isaiah 7:14, Matthew 1:23, Luke 1:35, Hebrews 4:15, 7:25, 9:12, Acts 1:11, John 2:11, 11:25 and Rev. 19:11-15.)

-We believe salvation is the free gift of God (neither merited nor secured in part or in whole by any virtue or work of man) to be received only by personal faith in the Lord Jesus Christ, in whom all true believers have, as a present possession, the gift of eternal life, a perfect righteousness, Sonship in the family of God, deliverance and security from all condemnation, eve ry spiritual r esource needed for life and godliness, and the divine guarantee that they shall never perish. (John 3:16-19, 5:24, Romans 3:19, Ephesians 2:18-19, Titus 3:5-6)

-We believe in the resurrection o f both, the saved and the lost, a literal heaven and a literal hell. All those who have received Jesus Christ as their personal Savior and Lord will inherit eternal life in Heaven. Those who have not accepted Him are lost unto eternal damnation. (John 5:28-29)

-We believe that the Holy Spirit convicts of sins, righteousness, and judgment, leading to repentance, and that Be regenerate, seals, indwells, teaches, guides, and comforts every genuine believer.

- We believe that being born of the Spirit makes one child of God.

-We believe that the baptism of the Spirit is the possession of every believer whereby he is united to the body of Christ.

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-We believe that the filling of the Spirit is the continual opportunity and responsibility of every believer, which assures victory over sin, and joy and power in service. We do not condone the misplaced emphasis of the Charismatics a n d Pentecostals regarding t h e Holy Spirit’s ministry and their misuse of the gift of tongues, etc.

-We believe that the Church (ecclesia) "called out ones" in its universal form, the true body of Christ. The purpose of the church is to make Christ known to the whole world; sharing and communicating to the unsaved that God is reconciling the world unto Himself(Matthew 28:18-20; Mark 16:15; John 17:18-20; Acts 1:8).

- We believe that the Church is to build up Believers in the most Holy Faith, and to equip them for the work of the ministry (Ephesians 4:12.), teaching them to live in Unity and Harmony and Empowering them to live a Godly and Abundantly life according to the Word of God and to prepare for the Lord's return. Acts 2:42

I / We the parent(s) of _____________________________________ affirm that I/ We

(Child's Name)

Carefully read the doctrinal statement of purpose for The Embassy Academy and have thoroughly familiarized myself/ourselves with their contents. As a parent seeking enrollment in The Embassy Academy for my child, I /we do understand that the Academy will present the Gospel to my child in terms appropriate to his or her age level of maturity. I/ we also understand that my/our child may at times be invited to pray or receive Christ as their Lord and Savior. The school shall advise me of any decisions made by my/our child's faith by appropriate activities in the home.

___________________________________________ _________

(Mother’s Signature) Date

___________________________________________ _________

(Father’s Signature) Date

___________________________________________ _________

(Guardian’s Signature) Date

*Both parents signature are required that are living with the student

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Financial Agreement

Date: ______________________________

I the parent of ________________________________________ affirm that I agree to pay tuition according to the arrangements that shall be made and to conclude all required payments.

All payments are due on the I st of each month. After the 5th day there will be a late charge added to your account.

A late fee of$25.00 will be added to my account after the 5th day. When accounts are in the arrears The Embassy Academy will only accept money orders, debit card, or cashier checks, no personal check will be accepted when payments are late.

If your account is not current by 10th your child will not be allowed to take any quizzes, tests, and exams nor receive a report card or transcript. If your account is outstanding for a month your child will not be allowed to return to school nor receive any school work until the accounts are current.

I am obligated to pay off the account that is owed to The Embassy Academy and I understand that my account will be turned over to collections if not paid in full.

Parent's Signature: __________________________ Date: _________________

Soc. Sec. Number: ___________________________

Administrator Signature: ______________________

Date: _____________

Witness Signature: __________________________ Date: _______________

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Student Release Form

The Embassy Academy will not permit your child/ children to be picked up by any person that does not appear on this form. The person picking up your child will need a picture I.D. and will be required to sign the child out. This release will be granted if you (parent/guardian) call the school’s receptionist to inform the school of the arrangement of pick up for your child. Please call the school before the 2:00 pm hour.

Persons Permitted to pick up __________________________________________ from school

Your Child’s Name

Mother: Yes or No Father: Yes or No

1. Name: ___________________________________ Relationship: ______________

Address: ___________________________________ Phone: ___________________

2. Name: ____________________________________Relationship: ______________

Address: ___________________________________ Phone: ___________________

3. Name: ___________________________________ Relationship: ______________

Address: ___________________________________ Phone: ___________________

4. Name: ___________________________________ Relationship: ______________

Address: ___________________________________ Phone: ___________________

5. Name: ___________________________________ Relationship: ______________

Address: ___________________________________ Phone: ___________________

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Sick Child Care Policy

Students Name: __________________________________ Grade: _______________

Child’s Physician: ________________________________ Phone: _______________

Insurance: ______________________________________ Policy#: ______________

Does the school have permission to take your child to the emergency room? _ Yes _No

Hospital Preference: ____________________________________________________

List three emergency contact persons.

Name: ______________________________________ Cell: _____________________

Work: ______________________________________ Phone: ___________________

Name: ______________________________________ Cell: _____________________

Work: ______________________________________ Phone: ___________________

Name: ______________________________________ Cell: _____________________

Work: ______________________________________ Phone: ___________________

List any physical difficulties your child may have.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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THE EMBASSY ACADEMY

HEALTH FORM

Dear parents:

In order for us to provide the safest and most beneficial program for your child we need you to please indicate any health problems which might limit his I her activities.

Allergies: _____________________________________________________________

Asthma: ______________________________________________________________

Heart Murmur: _________________________________________________________

Hernia: _______________________________________________________________

Severe Reaction to Bee Stings: ____________________________________________

Other (Please Explain: ___________________________________________________

Student Name: _________________________________________ Date: ________

Parent Name: __________________________________________ Date: ________

---------------------------------------------------------------------------------------------------------------------

Office Use

Teacher Name: _________________________________________ Grade: _______________

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Discipline Agreement

We invest authority in the school to administer discipline to your child/children in a loving way.

We understand if disobedience is severe other measures with a parent conference will follow.

(__)Yes, you have permission to discipline my child / children.

(__)No, I will come and discipline my child / children anytime the school calls.

Parent Signature: _______________________________________

Mother/ Guardian

Parent Signature: ________________________________________

Father/ Guardian

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PARENTS PLEASE BE MINDFUL OF OUR DRESS CODE, FOR IT

WILL BE STRICTLY ENFORCED.

It matters how you look at The Embassy Academy

1. UNIFORMS MUST BE WORN DAILY NO EXCUSES ACCEPTED.

2. UNIFORMS MUST BE CLEAN, AND NOT TORN AND TATTERED. (ALL STUDENTS MUST

HAVE 5-SHIRTS).

3. ALL BOYS MUST WEAR BELTS, AND PANTS ON THE WAIST; (NOT THE BUTTOCKS)!

4. NO TENNIS SHOES.

5. NO CARGO PANTS ALLOWED (BOYS MUST WEAR UNIFORM PANTS ONLY).

6. SHIRTS MUST BE WORN INSIDE PANTS OR SKIRTS.

7. THE FOLLOWING JEWELRY IS NOT PERMITTED: NOSE, TONGUE, NAVEL, and EYEBROW,

UP, TOE, BREAST, ANKLE, AND EARS - FOR BOYS.

8. BOYS NEED TO WEAR BRAIDS, DREDS AND ANY SORT OF TWISTS NEATLY AT ALL

TIMES.

9. SHORT SKIRTS ARE NOT PERMITTED {SKIRTS SHOULD NOT BE NO MORE THAN TWO

INCHES ABOVE THE KNEE CAP).

10. AFROS MAY BE WORN NOT BEYOND 2 INCHES IN HEIGHT AND MUST BE WELL

GROOMED ALL DAY, EVERDAY.

11. NO DRAWINGS (DESIGNS} ARE PERMITTED IN THE HEAD.

12. NO PULLOVER SWEATERS OR JACKETS OR HOODIES ARE ALLOWED.

13. NO GLOVES OR MITTENS ARE ALLOWED UNLESS IT'S 50' DEGREES OR BELOW.

Student Signature: ____________________________________ Date: __________

Parent Signature: _____________________________________ Date: __________

(Please sign and return with your application)

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The Embassy Academy

How to register for Admittance to The Embassy Academy

___ Transcript from previous school

___ Application fee ($10.00)

___ Non- Refundable registration Fee

___ Matriculation Fee

___ Health Records (Forms 682A or 3040)

___ Copy of Original Birth Certificate

___ Copy of Social Security Card

___ Submit updated Physical Form

___ Consent and Release Liability Form

___ Provide award letter for Step up Students (If Applicable)

___ Provide Matrix Number and IEP for McKay Student (If Applicable)

___ Interview with Principal or Designee

___ Purchase Uniform Shirts

___ Pastors Confidential Recommendation

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The Embassy Academy Student Financial Data

Students Name____________________________________ Grade: _______

Parent Name: ______________________________________ Work Phone: _______________

Email: ____________________________________________ Cell Phone: _________________

Address: ________________________________________________ Apt#_________________

City: ____________________________________ State: _______________ Zip: ____________

Tuition ___________________________

SUFS/ MCKAY ___________________________

Academy Discount: ___________________________

Balance: ____________________________

Months: _____________________________

Monthly Fees: ____________________________

Application Fees: _____________________________

Registration Fee: _____________________________

Florida Virtual School/ Night School: _________________________________________

Matriculation Fees: _____________________________

Payments

Weekly: ______________________________

Every Two Weeks: ______________________________

Monthly: ______________________________

_________________________________________ ______________

Parent Signature Date

_________________________________________ ______________

Administrator Signature Date18