Thank you for your interest in HEART Christian Academy!

The following checklist will assist you in completing your family’s application.

Please make sure to enclose the following items with your Enrollment Package:

□ A completed copy of this Application (include one Student Information page per child)

□ $75 Application Fee

□ Family Photo

□ Any testing documentation regarding learning issues or IEPs

□ A copy of each child’s most recent report card

□ A copy of each child’s most recent standardized testing reports

You may return a completed application during school hours to our physical location:

32222 Del Obispo Street, Room 108 San Juan Capistrano, CA 92675

or mail it to: HEART Christian Academy Attn: Admissions Director

31495 Sundance Drive San Juan Capistrano, CA 92675

If you have any questions, please feel free to contact our Admissions Director

Lori Borden

(949) 412-4060 admissions@heartchristianacademy.org

Revised 1/15/2014

Affix Family Photo Here (so we can start getting to know you!)

2014-2015 Enrollment Application

Two Day and Home Satellite Program (HSP)

Application Date:

Family Information

Mother’s Full Name Father’s Full Name

Home Phone Mother’s Cell Phone Father’s Cell Phone Work/Other Phone

Mother’s Email Father’s Email

Address City, Zip

Who referred you to HEART Christian Academy?

List All Children You Are Interested in Enrolling in HEART Christian Academy

Student Name First name only unless last

name is different Birthdate

MM/DD/YYYY Gender

M/F

Age As of

9/1/14

Grade As of

9/1/14

Requested Program Two Day M/W, Two Day T/Th,

HSP-Lesson Plans or HSP-Records Only

Comments:

Revised 1/15/2014

New Enrollment, page 2 Family Name

Family Faith Background You may continue lengthy answers in Section A-1.

Name of home church Are you a member?

Describe your church attendance (regular, occasional, infrequent)

How long have you attended this church?

If less than 2 years, name of prior church Reason for leaving?

Please list ministries in which you are currently involved:

Mother’s faith background. Describe your relationship with Jesus Christ:

Father’s faith background. Describe your relationship with Jesus Christ:

Describe your family’s devotional life (prayer time, Bible study, missions, etc.)

Revised 1/15/2014

New Enrollment, page 3 Family Name

Student Information Please use a separate form for each student. Additional forms are available in the Appendix.

You may continue lengthy answers pertaining to this student on page A-1.

Student Name Grade Entering

Why are you interested in home schooling this child through HEART Christian Academy?

Describe your child’s character, strengths and personality:

List your child’s extracurricular activities:

Has the student ever been tested for ADHD, autism or any speech, language, physical, emotional or learning disability? Please include any testing documentation and explain outcomes:

Has your child ever been retained from promotion, suspended, expelled or had any other serious academic or disciplinary difficulty in school?

Is there anything else you would like to share about your child?

By grade level, please list all previous schools your child has attended:

School Name Starting Grade Ending Grade

Name and phone number of an adult not related to your child we may contact as a reference (family friend, coach, Sunday School teacher, etc.):

Revised 1/15/2014

New Enrollment, page 4 Family Name

2014-2015 New Family Financial Contract We understand and commit to fulfilling the following financial obligations commensurate with applying to and enrolling in HEART Christian Academy. We understand that the costs listed below are projections which may change slightly before school begins in the fall.

Projected Tuition and Fees

Financial Obligation Two Day Program Homeschool Satellite Program (HSP)

Application Fee Per Family Due with Application

$75 $75

Application Fees are not refundable, but this amount will be applied toward the Registration Fee when a family accepts a position with HEART Christian Academy. This fee will hold your position on a wait list should it be necessary.

Registration Fee Per Student Due with enrollment agreement

Before April 30

th

June 1st

to August 30

th

Sept 1st

&

Later

Before April 30

th

June 1st

to

August 30th

Sept 1st

&

Later

JrK & K: $125

1st

-8th

: $150

JrK & K: $150

1st

-8th

: $175

JrK & K: $200

1st-8th: $225

All Grades $75

All Grades $100

All Grades $150

Subtract the Application Fee from the total amount before submission.

Tuition Per Student Payable Annually, Bi-Annually, or Monthly JrK: $2000.00 ($200 per month)

K-6

th: $2500.00 ($250 per month)

7

th -8

th: $2800.00 ($280 per month)

HSP with Lesson Plans (all grades): $500 ($50 per month) for all services

including lesson plans and curriculum lists

HSP Records Only (all grades): $300 ($30 per month) for all services

except lesson plans and curriculum lists

Shown as an annual amount with the option of paying over 10 months.

Tuition Due Dates (All Programs) 1st

of each month, August through May. If enrolled after August 10

th, last payment is June 1

st

Materials Fee Per Student JrK-8th

: $45 None

Due august 1st or upon enrollment if enrolled after August 1st.

Late Fees (All programs) 10% of overdue balance after the 10th

of the month.

HSLDA Membership (All Programs) Per Family: $95 per year payable to HSLDA (see attached information)

Unless previous arrangements have been made with the Financial Administrator, if an account is 60 days past due the student(s) will not be able to attend class or receive lesson plans until the account is brought current. Chronic failure to pay promptly may result in disenrollment.

Written notice must be given to the school at least 30 days prior to withdrawing a student or transferring a student between the Two Day and HSP programs. Tuition will continue to be assessed at the regular rate for 30 days after receipt of written notice of withdrawal or transfer between programs.

HEART reserves the right to withhold report cards, test scores or other documentation generated during membership in our organization if a balance is still owed at the time of withdrawal.

A $25 fine will be assessed for each check returned unpaid by the bank for any reason.

HEART Academy offers a third and subsequent student discount of 10% off the 3rd

(4th

, 5th

, etc.) youngest child’s tuition which will be calculated at a rate of 90% of the stated tuition.

Please indicate how you would like to pay your tuition (this preference may be changed at any time):

One Annual Payment (due August 1st)

Bi-annually (due August 1st and January 1st)

Monthly Payments (10 mos beginning Aug. 1st)

Mother’s Signature Date Father’s Signature Date

Revised 1/15/2014

New Enrollment, page 5 Family Name

State Required Data

As a private school, we are required to keep resume data and qualifications of our teachers on file. Since HEART Christian Academy is a home school cooperative where each student’s parents are their primary teacher, the following information is requested to ensure we are in compliance with state requirements.

Current Occupation/Employer Ethnic Background

(optional, for California State statistical purposes only)

Mother

Father

Education/Teaching Experience Check the Box Next to Each Level of Completed Formal Education or Teaching Experience for Each Parent

Mother Formal Education Levels Father

High School Diploma

Trade or Vocational School

Associates Degree

Bachelors Degree

Masters Degree

Doctorate Level Degree

Teaching Credential

(In Comments, note level/specialty of credential and if it is current)

Mother Teaching Experience Father

Experience Teaching Adults in a Secular Environment

(e.g., Work, Hobbies)

Experience Teaching Adults in a Church/Religious Environment

(e.g., Bible Study, Lay Leadership)

Experience Teaching Children in a Secular Environment

(e.g., Public School Teacher, Boy/Girl Scouts, Coaching, Tutoring)

Experience Teaching Children in a Church/Religious Environment

(e.g., Private School Teacher, Sunday School, VBS)

Comments:

Revised 1/15/2014

New Enrollment, page 6 Family Name

Legal Acknowledgments

I understand that failure to complete these forms as required or any missing documentation will result in unnecessary delays in processing this application. I (we) declare under penalty of perjury and the laws as set forth in the State of California that I (we) are the legal parent(s) or guardian(s) of the child(ren) listed above. I (we) hereby release HEART Christian Academy, its administration, teachers, and any designee(s), or members from any and all liability which may result from injury incurred or caused by my child(ren) while in attendance on the campus, during interviews, field trips, parties, socials, special events or classes, assemblies or any other function related to HEART Christian Academy. I agree that the safety of my child(ren) during any school activity or home activity is entirely my responsibility and promise not to bring any legal action against the school, its administration, teachers, designees, members or any other person involved in or with the school. I also agree to take full responsibility if my child(ren) injures another or causes property damage during any school function. I give permission for my child’s name and/or photo to be electronically displayed on the schools’ website or other school-related materials and release HEART Christian Academy from any liability resulting from or connected with the publication of such information. I understand this application does not ensure final enrollment but provides information that will assist in a decision. I understand my application and registration fees are non-refundable. HEART Christian Academy is a membership-based private organization. As such, admission is not guaranteed to all. Families who apply for membership understand they must agree to and sign our Statement of Faith and may be removed from membership for non-compliance with HCA policies or for behavior that is not in line with our Statement of Faith or discipline guidelines.

Mission Statement

The mission of HEART Christian Academy is to build a system which fosters both spiritual growth and academic excellence. We desire to come alongside parents in their effort educate their children at home. Our parents and staff work together to choose a distinctive curriculum, rich in both Christian worldview and solid scholastic emphasis. We hope to inspire students to become Godly leaders in their home, church, community and work place.

Statement of Faith

We believe that there is only one God who eternally exists in three persons: the Father, the Son (Jesus Christ) and the Holy Spirit. Man is sinful and therefore separated from God who alone is holy and perfect. Jesus Christ paid the penalty for our sin through His death on the cross. Jesus also bodily resurrected, ascended into heaven and will return one day to establish His Kingdom. Our salvation from eternal punishment comes through faith in Jesus Christ and His provision of salvation. This salvation allows us to enter into God's family and receive eternal life. The Bible is the inerrant and authoritative Word of God and is the supreme source of truth for the Christian faith and life. Marriage is a union between one man and one woman.

The signatures below constitute an understanding of and agreement with the statements above and attest to the verity of the information provided throughout this application

Father’s Printed Name Father’s Signature Date

Mother’s Printed Name Mother’s Signature Date

Revised 1/15/2014

Appendix

The following areas are supplementary, and need only be completed as applicable. One Student Information Page* must be completed per new incoming student.

A-1: Additional Space for Answers (as needed) Family Faith Background, cont’d

Student Information (1st Student), cont’d

A-2: Student Information (*required, for 2nd Student as applicable)

+ Additional Space (as needed)

A-3: Student Information (*required, for 3rd Student as applicable)

+ Additional Space (as needed)

A-4: Student Information (*required, for 4th Student as applicable)

+ Additional Space (as needed)

A-5: Student Information (*required, for 5th Student, as applicable)

+ Additional Space (as needed)

Revised 1/15/2014

New Enrollment, additional answer space. Family Name

Family Faith Background (cont’d) Continued from page 2

Please list ministries in which you are currently involved (cont’d):

Mother’s faith background (cont’d):

Father’s faith background (cont’d):

Describe your family’s devotional life (prayer time, Bible study, missions, etc.) (cont’d):

A-1: Family Faith Background

Revised 1/15/2014

New Enrollment, First Student Additional Space Family Name

Student Information: First Student (continued) Continued from page 3.

Student Name Grade Entering

Complete any answers you needed more room for below. Please indicate which question(s) you are answering prior to completing each answer.

A1 – Student Information – 1st Student (cont’d)

Revised 1/15/2014

New Enrollment, Second Student Family Name

Student Information: Second Student Please use a separate form for each student. You may continue lengthy answers on the next page.

Student Name Grade Entering

Why are you interested in home schooling this child through HEART Christian Academy?

Describe your child’s character, strengths and personality:

List your child’s extracurricular activities:

Has the student ever been tested for ADHD, autism or any speech, language, physical, emotional or learning disability? Please include any testing documentation and explain outcomes:

Has your child ever been retained from promotion, suspended, expelled or had any other serious academic or disciplinary difficulty in school?

Is there anything else you would like to share about your child?

By grade level, please list all previous schools your child has attended:

School Name Starting Grade Ending Grade

Name and phone number of an adult not related to your child we may contact as a reference (family friend, coach, Sunday School teacher, etc.):

A-2: Student Information – 2nd Student

Revised 1/15/2014

New Enrollment, Second Student Additional Space Family Name

Student Information: Second Student (continued) Continued from previous page

Student Name Grade Entering

Complete any answers you needed more room for below. Please indicate which question(s) you are answering prior to completing each answer.

A-2: Student Information –2nd Student (cont’d)

Revised 1/15/2014

New Enrollment, Third Student Family Name

Student Information: Third Student Please use a separate form for each student. You may continue lengthy answers on the next page.

Student Name Grade Entering

Why are you interested in home schooling this child through HEART Christian Academy?

Describe your child’s character, strengths and personality:

List your child’s extracurricular activities:

Has the student ever been tested for ADHD, autism or any speech, language, physical, emotional or learning disability? Please include any testing documentation and explain outcomes:

Has your child ever been retained from promotion, suspended, expelled or had any other serious academic or disciplinary difficulty in school?

Is there anything else you would like to share about your child?

By grade level, please list all previous schools your child has attended:

School Name Starting Grade Ending Grade

Name and phone number of an adult not related to your child we may contact as a reference (family friend, coach, Sunday School teacher, etc.):

A-3: Student Information – 3rd Student

Revised 1/15/2014

New Enrollment, Third Student Additional Space Family Name

Student Information: Third Student (continued) Continued from previous page

Student Name Grade Entering

Complete any answers you needed more room for below. Please indicate which question(s) you are answering prior to completing each answer.

A-3: Student Information – 3rd Student (cont’d)

Revised 1/15/2014

New Enrollment, Fourth Student Family Name

Student Information: Fourth Student Please use a separate form for each student. You may continue lengthy answers on the next page.

Student Name Grade Entering

Why are you interested in home schooling this child through HEART Christian Academy?

Describe your child’s character, strengths and personality:

List your child’s extracurricular activities:

Has the student ever been tested for ADHD, autism or any speech, language, physical, emotional or learning disability? Please include any testing documentation and explain outcomes:

Has your child ever been retained from promotion, suspended, expelled or had any other serious academic or disciplinary difficulty in school?

Is there anything else you would like to share about your child?

By grade level, please list all previous schools your child has attended:

School Name Starting Grade Ending Grade

Name and phone number of an adult not related to your child we may contact as a reference (family friend, coach, Sunday School teacher, etc.):

A-4: Student Information – 4th Student

Revised 1/15/2014

New Enrollment, Fourth Student Additional Space Family Name

Student Information: Fourth Student (continued) Continued from previous page

Student Name Grade Entering

Complete any answers you needed more room for below. Please indicate which question(s) you are answering prior to completing each answer.

A-4: Student Information – 4th Student (cont’d)

Revised 1/15/2014

New Enrollment, Fifth Student Family Name

Student Information: Fifth Student Please use a separate form for each student. You may continue lengthy answers on the next page.

Student Name Grade Entering

Why are you interested in home schooling this child through HEART Christian Academy?

Describe your child’s character, strengths and personality:

List your child’s extracurricular activities:

Has the student ever been tested for ADHD, autism or any speech, language, physical, emotional or learning disability? Please include any testing documentation and explain outcomes:

Has your child ever been retained from promotion, suspended, expelled or had any other serious academic or disciplinary difficulty in school?

Is there anything else you would like to share about your child?

By grade level, please list all previous schools your child has attended:

School Name Starting Grade Ending Grade

Name and phone number of an adult not related to your child we may contact as a reference (family friend, coach, Sunday School teacher, etc.):

A-5: Student Information – 5th Student

Revised 1/15/2014

New Enrollment, Fifth Student Additional Space Family Name

Student Information: Fifth Student (continued) Continued from previous page

Student Name Grade Entering

Complete any answers you needed more room for below. Please indicate which question(s) you are answering prior to completing each answer.

A-5: Student Information – 5th Student (cont’d)