Enrollment Form

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New Student Application

By submitting this form, you are officially applying for admission to Columbia Academy. Your information will be reviewed and presented to our Board for approval.

If you are not yet ready to apply and would like to learn more about our campus and programs, we encourage you to request a tour first using our Inquire Form

Signature(Required)

I have read and agree to the above statement.

School Year(Required)

Enrollment Type(Required)

New Enrollment (Never Attended CA)

Re-Enrollment (Attended CA in the Past)

Grade Level(Required)

If K3, how many days will the student be attending?(Required)

Three days

Five days

Have You Toured Our School?(Required)

Yes

No

If No, Would You Like For Someone To Contact You About Scheduling a Tour?

Yes

No

Student's FULL Name(Required)

First Middle Last Suffix

Preferred Name(Required)

Home Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Age(Required)

Please enter a number from 2 to 20.

Birth Date(Required)

Gender(Required)

Male

Female

Most Recent Grade Attended at CA(Required)

Previous School Information

School Attended Last Year(Required)

Phone Number of School(Required)

Address of School(Required)

Street Address City State ZIP Code

Parent / Guardian

FATHER'S Name(Required)

First Last

Employer(Required)

Business Phone(Required)

Cell Phone(Required)

Email(Required)

MOTHER'S Name(Required)

First Last

Employer(Required)

Business Phone(Required)

Cell Phone(Required)

Email(Required)

If Parent's are separated or divorced, with whom does the child live?

Please List 3 References From Families At CA

(If You Do Not Have Any Please Skip)

Emergency Information

NOT LISTED ABOVE

Emergency Contact Name(Required)

First Last

Cell Phone(Required)

Relationship to Child(Required)

Payment Plan(Required)

Ten Month (Aug 1- May 1)

Twelve Month (June 1- May1)

Bus Registration(Required)

Yes

No

Bus Route Choice

Count of Students for Bus

Please enter a number from 0 to 5.

Is your child a legacy of Columbia Academy(Required)

Yes

No

If yes, name of alumni and relationship to child

Do You Currently Have Any Children Attending CA or Going Through the Enrollment Process?(Required)

Yes

No

If Yes, give the other students name and grade

Please list your child's talents, gifts and hobbies

All applications are made to COLUMBIA ACADEMY Board of Directors who shall have the right to accept or reject any application. Students if accepted are enrolled for the entire school year and must abide by all rules and regulations in order to remain in school or to maintain priority for readmittance.

All tuition and fees are due at the time of enrollment and are not refundable. With the Board of Director’s approval, a monthly payment schedule Is available and payments are due promptly by the 1st of each month as stated in the payment schedule. Late fees are assessed in accordance with the Financial Policy of COLUMBIA ACADEMY published on the Fee Schedule, the Student Handbook, and on the website, www.cacougars.com.

The signature of the parent or guardian on this application form constitutes the acceptance of the above conditions and stipulations and is a commitment to make payment o tuition and other fees by the prescribed methods. Any failure to adhere to payment policies will be just cause for penalties to be imposed as deemed feasible or the requirement of payment in full for the school year. It is my understanding that the policy of the school is to make no refunds on any school fees. I also give my permission for my child to take part in all school activities, including sports and school sponsored trips, away from the school premises, and absolve the school from liability to me or my child because of any injury to my child at school or during any school activity. I also give permission for the school to drug test my child at any time during school year with full knowledge and understanding of its consequences.

NONDISCRIMINATORY POLICY – COLUMBIA ACADEMY admits students of any race, color, nationality, or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at the school. Columbia Academy does not discriminate in administration of its educational policies, admissions policies, athletic or other school-administered programs based on race, color, nationality, or ethnic origin. However, the Board of Directors reserves the right to deny admission to or continue admission of any student where it is reasonably calculated that such an admission or continued admission might create adversity, conflict, or opposition to the school’s adopted Purpose, Mission Statement and Beliefs, and educational and extra-curricular policies.

MANDATORY FUNDRAISERS: From time to time, the Board of Directors may deem it necessary to approve mandatory fundraising activities in order to raise money for school operations. Whenever the need arise and such fundraisers are approved, all patrons will be required to participate.

Signature

New Student Application

Previous School Information

Parent / Guardian

Emergency Information

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