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250.862.2377 907 Badke Rd | Kelowna BC | V1X 5Z5 office@heritagechristian.ca

2020-2021 STUDENT APPLICATION FOR ADMISSION - NEW PART TIME

1. Personal Information

Student Name __________________________________________________________________________ � M � F LAST FIRST MIDDLE

Street Address ___________________________________________ City __________________ P/C ________________ Student Birthdate ______________________ Parent Email _________________________________ Student Email _________________________________________ Mailing Address (if different) ____________________________________________________________________________ Present Grade ________ Grade Applied For ________ Requested Date of Admission __________________________

2. Parental/Guardian Information Mother ______________________________ Cell # _______________________ Home # ______________________ Workplace ___________________________________ Work # ________________________ Father _______________________________ Cell # _______________________ Home # ______________________ Workplace ___________________________________ Work # ________________________ Who does the child live with? ��Both Parents �� Both Parents - Shared Custody ��Mother Only

�� Father Only �� Legal Guardian �� Parent & Step-Parent ��Other Please communicate below any issues relating to legal guardianship or custody of your child.

___________________________________________________________________________________________________

3. Requested Part-Time HCS Courses Semester Course(s) 1 ___________________________________________________________________________________________

2 ___________________________________________________________________________________________ School of Record ____________________________________________________________________________________

*NOTE: Please present your Driver’s License, student Birth Certificate and Care Card (or legible copies) to the office when submitting this application form.

Phone Number for Family Directory:

heritagechristian.ca

OFFICE USE ONLY Date Received: __________________________ Date Accepted: __________________________ Registration Fee Receipt #_____________________ Received Copies: Completed/Sent Out: � Birth Certificate � PAD Form ��Educational Support ��Schoo l Calendar � Care Card Number ��Void Cheque � Finance ��Students Achieve ��Guardian Driver’s Licence ��Perm./Release of Liability ��Interview � Supply List � Home Contact Card ��Legal Residency Form ��MyEd � Welcome Letter � ��Latest Report Card Issued ��Tuition Form ��Learning Commons

��No Previous Course(s) with HCS

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4. Citizenship Information Canadian Citizen ��Yes ��No Landed Immigrant ��Yes ��No Legally admitted to Canada ��Yes � No If not a Canadian citizen, attach a copy of the appropriate documents. Foreign students must attach a copy of the Student Visa. Does your family/child reside in B.C.? � Yes � No If “No”, when do you expect to move to Kelowna?___________________________________________________________

5. General Information How did you learn about HCS? ___________________________________________________________________________ What are your reasons for enrolling your child in HCS? ________________________________________________________ ____________________________________________________________________________________________________ What are your child’s interests and hobbies? _______________________________________________________________ ____________________________________________________________________________________________________ What are your child’s areas of strength and weakness? _______________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Has your child ever been assessed for, and/or diagnosed with, ADD, ADHD, Anxiety, � Yes � No Emotional Distress, Autism, ODD, etc? If “Yes,” please explain and attach the most recent copy of the assessment. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Is there an assessment in progress? � Yes � No Do you suspect any of the above? � Yes � No Will it be important for our school to take special steps to assist with the integration � Yes � No of your child into the school community? If “Yes”, please explain. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Is there anything else you’d like us to know about your child? ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

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4. General Information (cont’d) Name of the church your family regularly attends _____________________________________________________ We believe that children can place their trust in Jesus as their Personal Savior at any age. It is important for us to know if your child has done so. Please comment on your child’s Christian journey and response to Christian teaching. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ As a family, we support the Biblical values of HCS and embrace these values in our home. � Yes � No Please comment on your family’s Christian journey and response to Christian teaching. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ *Please include the completed Pastor’s Reference form when submitting this application.

5. Academic Information Please list previous schools attended School City Phone Dates Attended ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Do you give HCS permission to contact schools or evaluators named herein if deemed necessary? � Yes � No Is your child in need of, or has your child ever received, Learning Assistance in school? � Yes � No ___________________________________________________________________________________________________ What school subjects does your child love? _______________________________________________________________

Has your child ever missed school for an extended period of time due to illness, including personal reasons - social, emotional, or otherwise? If “Yes”, please explain. � Yes � No ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Has your child ever been referred for or ever attended counselling? � Yes � No Has your child ever been involved in unlawful and/or violent behavior? If “Yes”, please explain. � Yes � No ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Has your child ever been suspended or expelled from school? If “Yes”, please explain. � Yes � No ___________________________________________________________________________________________________ *Please attach a copy of your child’s most recent Progress Report or Report Card. Students in Grades 7 - 12: Please write a personal letter indicating why you want to attend Heritage Christian School. Be sure to tell about your relationship with God. Enclose your letter with this application.

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6. Conditions of Registration (please check each condition) A. ___ I/We have read the Student/Parent Handbook (Admission Policy, Elem. Pg 7 & Sec. Pgs 14-16) and understand the commitment we are making.

B. ___ I/We agree to abide by the school rules and guide our child to uphold the Code of Conduct and discipline of the school as outlined therein.

C. ___ I/We agree to support the elements of faith & practice taught at the school as outlined in the handbook.

D. ___ I/We am/are willing to assist as time allows in volunteer areas of the school (see Parent Participation Program form).

E. ___ I/We agree to attend parent meetings as stated in the school calendar.

F. ___ I/We certify that all information on this application is complete and correct.

G. ___ I/We authorize Heritage Christian School to verify any of the information submitted herewith.

H. ___ I/we agree that contact information may be included on secure, web-based documents.

I. ___ I/We agree that images taken of our child(ren) may be used for promotional purposes (no names will be used).

J. ___ I/We understand that HCS has a Privacy Policy based on the Personal Information Protection & Electronic Documents Act (PIPEDA), June 2015. I authorize the use of my personal information as listed in the HCS Personal Information Privacy Policy.

K. ___ I/We have enclosed a copy of the following documents: * Child’s most recent Progress Report/Report Card * Parent’s current Driver’s License * Student’s Birth Certificate * Student’s Care Card * Home Contact Card (enclosed in package) * Pastor’s Reference (enclosed) * Appropriate citizenship status documents * Personal student letter (for grades 7-12) * Parent Participation Form

7. Signatures Parent/Guardian ________________________________________ Date ___________________________ Parent/Guardian ________________________________________ Date ___________________________ 8. Protection of Personal Information In accordance with the Personal Information Protection & Electronic Documents Act (PIPEDA), June 2015 we are diligent to protect the information that you provide to us. For educational, Provincial funding, and school promotional reasons we may appropriately disclose selected information to the following: There may be times that we choose to use images of our students for promotional purposes. No private information will accompany these images unless you are notified. *If you wish to opt out of any of these uses, please notify the school office in writing. For further information, please refer to our school handbook.

Ministry of Education Community Health Clinic Sports Organizations

Other HCS Families via our School Directory Media for Sporting or Promotional Events

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9. Registration Fee and Tuition Registration Fee A fee of $100.00 must accompany the application form for first time applicants. This fee for application processing costs is non-refundable. Tuition The first month tuition amount is non-refundable after July 1, 2020 and will be processed on your first payment date as indicated on the enclosed Tuition Calculation form in order to guarantee a spot for your child. This ensures that when the class is capped, other students who apply will be placed on a waiting list and not replace students who have already been accepted. Tuition rates/payment options are on the enclosed form. This form is to be completed and handed in with this application. Tuition Assistance If you require one, a tuition assistance form is available online at https://goo.gl/zMfOm0 Regular tuition will be charged until the form is submitted and approved.

10. Parent Drivers

If you will be driving HCS students (other than your own children) to/from any field trips or school events at any time during the coming school year, we require that you apply for a volunteer Ministry of Justice criminal record check (no charge through the HCS Office) and submit to the office, a copy of your driver’s license and insurance showing a minimum of 2 million liability.

� I will be driving and have attached the required documentation

� I will not be driving

� I am uncertain of whether I will be driving

� I have applied for a Criminal Record Check through the HCS office I/We acknowledge the items in sections 8 through 10. Signature ________________________________________ Date ___________________________ Signature ________________________________________ Date ___________________________

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Hithere!

ThispageisneededsowecanscanandfileyourApplicationmoreeasily.

ThanksforincludingitwithyourApplication.

Cheers;)

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PERMISSION AND RELEASE OF LIABILITY

__________________________________________________________________________________________________________ Student Name Phone Number Emergency Number __________________________________________________________________________________________________________ Address City Postal Code Location and dates of off-property functions are as indicated in the school newsletter or by letter sent home from the teacher throughout the school year.

The undersigned represents to Heritage Christian School, (hereafter referred to as HCS), that he/she is the natural parent or the legal guardian of the above named child; and the undersigned does hereby consent to such minor child taking part in all field trip activities off of school property with the full understanding of its inherent risks insofar as such activity will involve learning and sporting activity and mingling with other individuals and groups, and there is always the risk of injury, illness, loss, or expense. The undersigned acknowledges and accepts the risk of such injury, illness, loss, or expense, and does hereby release and discharge HCS from any and all claims, demands or liability that may arise on account of such injury, illness, loss, or expense and the undersigned agrees to fully indemnify and hold harmless HCS from any and all demands, claims, actions, or proceedings that may be brought by or on behalf of the above named child for any injury, loss, damage, or expense, together with the costs associated with the defense thereof, in connection with participation in the field trip or off school property function. The undersigned fur-ther agrees to comply with the rules and regulations as established from time to time pertaining to supervi-sion and discipline of students during field trips and/or off school property functions.

AUTHORIZATION

I give permission for my son/daughter to attend HCS off-property functions. I have read the above Permission and Release of Liability and agree to its provisions. Signature ______________________________________________ Date _______________________ Relationship to Minor __________________________________________________________________

heritagechristian.ca

250.862.2377 907 Badke Rd | Kelowna BC | V1X 5Z5 office@heritagechristian.ca

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Hithere!

ThispageisneededsowecanscanandfileyourApplicationmoreeasily.

ThanksforincludingitwithyourApplication.

Cheers;)

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��Good ��Concern ��Good ��Concern ��Good ��Concern ��Good ��Concern

HOME CONTACT CARD 2020-2021

1. Student Information Student(s) Name Grade Care Card Number Health (also see below)

____________________________________ ________ _______________________

____________________________________ ________ _______________________

____________________________________ ________ _______________________

____________________________________ ________ _______________________ 2. Emergency Contact Information Persons to be contacted in emergency (other than parent, in order of preference): Name: ___________________________________ Relationship: ___________________________ ��May Pick Up Student(s)

Home #: __________________________ Work #: ___________________________ Cell #: ____________________________

Name: ___________________________________ Relationship: ___________________________ ��May Pick Up Student(s)

Home #: __________________________ Work #: ___________________________ Cell #: ____________________________ Other persons (and relationship) to whom we are authorized to release the student(s) from school: ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

3. Health Information

Doctor Name: _______________________________________________ Phone: ___________________________

Please list any chronic health conditions child has (asthma, diabetes, epilepsy, allergies, etc) Student(s) Name Description of Condition Medication Required ____________________________ ____________________________________ ___________________________

____________________________ ____________________________________ ___________________________

____________________________ ____________________________________ ___________________________

____________________________ ____________________________________ ___________________________ Will the school be required to administer medication? ��Yes ��No

If Yes, please see the school office for forms to be completed by Parent/ Guardian and Doctor.

Parent / Guardian Signature _____________________________________________ Date __________________________

All information on this card is kept strictly confidential

250.862.2377 907 Badke Rd | Kelowna BC | V1X 5Z5 office@heritagechristian.ca

heritagechristian.ca

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Hithere!

ThispageisneededsowecanscanandfileyourApplicationmoreeasily.

ThanksforincludingitwithyourApplication.

Cheers;)

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PASTOR REFERENCE Parent/ Guardian on Application ________________________________________________________________________ Student Name Grade Student Name Grade ______________________________________ _______ _______________________________________ ______ ______________________________________ _______ _______________________________________ ______ To Be Completed By Pastor: Name _____________________________________ Church Name _________________________________________ Contact Info ________________________________________________________________________________________ 1. How long have you known this family? ________________________________________________________________ 2. How long have they attended your congregation? _______________________________________________________ 3. Does the family attend services and functions regularly? __________________________________________________ 4. Does the family have membership in your church? ______________________________________________________ 5. List areas/ways in which this family is involved with/contributes to the life and ministry of the church. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 6. How do you feel this family would benefit from attending Heritage Christian School? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Comments _________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________

Pastor Signature _________________________________________ Date _________________

heritagechristian.ca

250.862.2377 907 Badke Rd | Kelowna BC | V1X 5Z5 office@heritagechristian.ca

13

Hithere!

ThispageisneededsowecanscanandfileyourApplicationmoreeasily.

ThanksforincludingitwithyourApplication.

Cheers;)

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��New Family

I choose to participate in the PPP and have picked 3 or more activities from the list below.

Parent Participation Form 2020 – 2021 Name:_________________________ Phone #:____________________ Email:_______________________________

Children: Name:_________________________ Grade:_____ Name:__________________________ Grade:______

Name:_________________________ Grade:_____ Name:__________________________ Grade:______

��I choose not to participate in the PPP. I will pay the $200 fee through my family account in RYCOR.

****************************************************************************************

��Book Fair

��Cleaning/Janitorial

�� Grad

��Fundraising

��A-thons

��Car Washes

��Baking for Events (nut free)

��Locker Maintenance & Clean Up

��Lost & Found

��Maintenance (painting inside or outside, yard work/repairs

��Prayer Group (approx. one hour, one day per week)

��Parent Meetings (refreshments, greeting)

��Promotions

��Safety Patrol Supervision

� ��8:00-8:35am �� 2:50-3:20pm

��Secondary Textbook Room Maintenance

��September Family BBQ

��Bus Driving (requires license class 2 or 4)

��Classroom Helper - Grade(s) ___________

��Computer Room Supervision

��Drama (costume design, makeup, shopping, greeting, promotions)

��Elementary Playground Supervision Lunch Time (12:05am-12:50pm)

��Field Trips

�� Department Help

��Elementary Reading Programs ��Learning Commons ��Office ��Special Education ��Other

��Secondary Retreats

��Sports: Coaching (please check one)

� � ��Basketball ��Soccer ��Other

��Other ________________________________

_________________________________________

Options below require a Criminal Record Check (CRC). If you are choosing one of these areas, please fill in the attached CRC for any adult (18 & over) who may partici-pate (there is no cost to the applicant)

�� Home Stay (application forms available)

heritagechristian.ca

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Returned Payments Policy - There will be a $25 charge should any payment be rejected by the fi-nancial institute for any reason.

Part-Time Tuition Payment Calculation Form 2020-2021

Tuition Amount based on the number of courses being taken (see Course Fees on the reverse side of this form).

Secondary Tuition Supplement (____# of grade 8-12 students x $125)

Total (A+B)

Payments

One Course = One Payment (at time of enrolment—Sept or Feb)

Two Courses = Two Payments Line E above divided by 2 (one month apart—Sept, Oct or Feb, Mar)

Three Courses = Three Payments Line E above divided by 3 (monthly—Sept, Oct, Nov or Feb, Mar, Apr)

A

B

E

Office Use Only $100 Registration Fee (Non-Refundable) - Included with Application (For NEW Part-Time Registrants Only)

C

Less: $ Amt paid by HCOS, if applicable

Total Tuition Payment for 2020-21 (C-D)

D

� I have paid my registration fee � I would like to help sponsor an HCS student ($_______/year OR $________/month)

heritagechristian.ca

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1. Course Fees

Grades 8 through 12 The family is charged $600 per course up to a maximum of three courses in total. Once a student

enrolls in a fourth course, HCS becomes the student’s school of record, and the student becomes a full-time HCS student. FOR HCOS STUDENTS: If applicable, HCOS may cover $150 per course out of the student’s curriculum account. Costs for extracurricular activities are not included in the cost of the course. Extra charges will be billed for field trips, retreats, travel & lodging for any school event that the student participates in.

For HCOS Students only: I authorize HCOS to release curriculum funds to pay for courses that ________________________

is taking at Heritage Christian School. (student name)

___________________________________ ___________________________________ _______________________

Parent Name (print) Parent Signature Date Other Potential Fees: Grad Fee $300 September Retreat $50 plus the student cost as determined by HCS for that trip Mid Winter Retreat $50 plus the student cost as determined by HCS for that trip Field trips Student cost as determined by HCS for that trip Sports Student cost as determined by HCS for that event/year Drama As set in September Yearbook (softcover) $ 20 2. Tuition

Tuition is received to supplement the cost of education for students. HCS is a Group 1 Independent School, and receives 50% of the per-student-funding given to School District #23. If you choose to withdraw your student(s) early from HCS, the first months tuition as well as 10% of the remaining tuition for the year will be held to cover administration costs.

3. Secondary Tuition Supplement

The Secondary tuition supplement of $125 per grade 8 to 12 student allows for many middle and secondary school programs (ie. reduced retreat costs, electives, field trips, chrome books, etc). It can be paid in full or built into the monthly tuition payments. This is non refundable.

4. Tax Information

Payee(s) are issued a charitable tax receipt in February for the portion of tuition paid that pertains to religious instruction (please note, any payments for which a charitable tax receipt has been is-sued are non-refundable). The receipt amount varies from year to year and is calculated in accord-ance with Canada Revenue Agency requirements. In recent years, on average, Heritage Christian School families have benefited by receiving a charitable tax receipt equivalent to approximately 60% of total tuition. This benefit may be used to reduce the amount of personal income tax paid and, consequently, reduce the total cost of tuition.

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TRANSACTION INFORMATION WE AUTHORIZE THE PAYEE TO DEBIT MY ACCOUNT (ATTACH VOID CHEQUE or equivalent banking information)

TYPE OF PAD: PERSONAL/HOUSEHOLD X BUSINESS Same as 2019-20 ACCOUNT TYPE: CHEQUING X CPA TRANSACTION TYPE AMOUNT: $_____________________ START_____________________ END ______________________ FREQUENCY: WEEKLY __________ BI-WEEKLY ____________ MONTHLY OTHER __________ The debit will be processed to your account on the 23rd day of the months associated with the above payments.

PAYOR INFORMATION:

NAME(S): _______________________________________________________________________________________________ ADDRESS: ____________________________________________________________ POSTAL CODE: ____________________ HOME: ____________________________________ BUS: ______________________________________

SIGNATURE

APPLICANT: _____________________________________________________ DATE: ________________________________

CANCELLATION (10 BUSINESS DAYS NOTICE IS REQUIRED) I may revoke authorization at any time, subject to providing notice of at least (10) business days before the next EFT debit is scheduled. I may obtain a sample cancellation form, or more information on my right to cancel a EFT agreement at my financial institution or by visiting www.cdnpay.ca. I have certain recourse rights if any debit does not comply with the agreement. For example, I have the right to receive reimbursement for any EFT that is not authorized or is not consistent with the EFT agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.cdnpay.ca.

CANCEL THIS PRE AUTHORIZED DEBIT (PAD) PLAN AGREEMENT EFFECTIVE ________________________, 20 _______ SIGNATURE: _____________________________________________________ DATE: _______________________________

I waive any and all need for signatures to change payment arrangements or withdrawal date as long as there is permission via telephone conversation or email instruction by the payor. The payee will provide 10 calendar days notification of a change. Initials: I have read and understand and accept the terms and conditions of this agreement for participation in the EFT plan. I warrant and guarantee that all persons whose signatures are required to sign on this account have signed this agreement below.

I authorize payments for Tuition and Additional Fees as indicated on the 2020-2021 Heritage Christian School Tuition Calculation form. (initials)

PRE AUTHORIZED DEBIT (PAD)

heritagechristian.ca

250.862.2377 907 Badke Rd | Kelowna BC | V1X 5Z5 office@heritagechristian.ca

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