BCA Application Step 1 of 3 33% Date of Application(Required) MM slash DD slash YYYY Student InformationStudent's Full Name:(Required) First Middle Last Date of Birth:(Required) MM slash DD slash YYYY Gender:(Required)Age:(Required)Grade:(Required)Guardian InformationName of Guardian #1:(Required) First Middle Last Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Employer:(Required)Occupation:(Required)What is your relationship to the student?(Required) Father Mother Stepfather Stepmother Grandparent Other Cell Phone Number(Required)Home Phone NumberWork Phone NumberEmail Address(Required) Name of Guardian #2: First Middle Last Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Employer:Occupation:Cell Phone Number:Home Phone Number:Work Phone Number:Email Address: Are you a member of a Church? Yes No Name of Church:Academic Background InformationWhich factor(s) most influenced your decision to apply to Bethel Christian Academy? Check all that apply.(Required) Academic Quality Academic Need Behavioral Need Christian Atmosphere Location Safe & Secure Environment School Philosophy and Values Other Reasons Does the applicant have any learning difficulties?(Required) Yes No Has the applicant ever been recommended for testing?(Required) Yes No Does the applicant require modifications to meet academic needs?(Required) Yes No Has the applicant ever participated in a special needs program (including gifted, resource, special education, 504)?(Required) Yes No If you answered yes to any of the questions 1-4, please explain.(Required)Has the applicant ever been expelled, suspended, or asked not to return to a school?(Required) Yes No If yes, please explain(Required)Please state any chronic health, emotional, or physical concern(s) the student has and any medications required.Has the student ever repeated a grade? Yes No If yes, which one(s)?(Required)ReferencesPlease name two references for the applicant who can provide information relevant to his or her character.Reference #1 Name(Required) First Last Reference #1 Relationship to Applicant(Required)Reference #1 Phone NumberReference #2 Name(Required) First Last Reference #2 Relationship to Applicant(Required)Reference #2 Phone Number(Required)How did you find Bethel Christian Academy?(Required) A friend or relative School A court referral A counselor or social worker referred me Other Select all that apply.Please describe: Contract AgreementIn making this application, I understand that: 1. Since the fees do not cover the actual cost of educating my child, we recognize that our participation is needed in prayer, service, and gifts in order to properly share in his/her training. 2. The school reserves the right to dismiss any student who does not respect its standards or cooperates in the educational process. 3. After acceptance, a place will be held for my child when the Student Registration Form and the non-refundable registration fee have been submitted to the Business Office by the date indicated on the acceptance letter. 4. It is hereby understood that the guardians will pay tuition for the amount stated by the Business Office. No refunds will be made for fees. Tuition may be paid annually, bi-annually, or monthly. If paid monthly, automatic payments will be set up with a debit or credit card. 5. Students transferring to another school and having attended one day or more of any month will owe the full month’s tuition.Statement of Cooperation1. I pledge loyalty to the aims of the school and will bring any and all questions and criticisms directly to the administration so that they may be properly considered for resolution. 2. We will read the Statement of Faith and the Philosophy of Education and are willing to have our child taught in accordance with them. 3. We will read the Student Handbook and will cooperate fully in seeing that the rules and regulations laid down there are met. 4. I give Bethel Christian Academy permission for my child to take part in all school activities, including sports and school-sponsored trips away from the school premises. 5. The Coordinator of Education/Principal and teachers are hereby given full discretion in the discipline of our child. This would include the issuing of disciplinary referrals, detention, suspension and expulsion from the school program. Bethel Christian Academy will never use physical discipline with any student. 6. I agree to hold the school and its agents harmless for any liability to my child or any guardian or parent thereof because of any claims on behalf of my child against the school or any agent thereof because of any injury or alleged injury to my child. Should legal action, for any reason, be taken against Bethel Christian Academy or any employee or agent thereof, on my child’s behalf and the school or its agent not be found at fault. I agree to pay any attorney fees, damage or other costs that Bethel Christian Academy or its agent should incur to defend itself against such action, and would immediately withdraw my child from school as soon as such action had begun. 7. This statement of cooperation will be in effect for as long as my child/children attend Bethel Christian Academy. 8. The school reserves the right to dismiss any student who does not cooperate with the educational process. If a student is dismissed for any reason, the tuition will not be refunded or prorated.Name of GuardianElectronic Signature(Required) I have read and agree to Contract Agreement & Statement of CooperationDate MM slash DD slash YYYY School InformationPlease list each school the student has attended starting with the most recent.School #1Name of SchoolCity & StateGrades AttendedSchool #2Name of SchoolCity & StateGrades AttendedSchool #3Name of SchoolCity & StateGrades AttendedSchool Records Release: I hereby authorize the release of all educational records to and from Bethel Bible Village and the schools listed above for the child listed below.Child's Full Name(Required) First Last Child's Date of Birth(Required) MM slash DD slash YYYY This is my electronic signature as this child's legal guardian. With this signature I authorize the release of all educational records to and from Bethel Bible Village and the schools listed above.(Required) First Last This information includes special education records, if applicable. I understand the information released will be used to determine present and/or future needs for the well-being of this child. All information will be placed in the child’s private file and will only be available to appropriate personnel and/or agencies. This consent for release is given freely, voluntarily, and without coercion and is valid for one year from the date signed.Date of Signature(Required) MM slash DD slash YYYY This authorization is valid for one year from the date signed below.
