Today's Date *

MM

DD

YYYY

Student Name *

First Name

Last Name

Current IEP, EIP or 504 Plan? *

Yes

No

Pre-K Students Only

Full Day

Half

Date of Birth *

MM

DD

YYYY

Main Contact Phone # *

(###)

###

####

Father's Name *

First Name

Last Name

Father's Cell Number *

(###)

###

####

Father's Work Number *

(###)

###

####

Mother's Name *

First Name

Last Name

Mother's Cell Number *

(###)

###

####

Mother's Work Number *

(###)

###

####

Physician's Phone Number *

(###)

###

####

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Statement of Cooperation *

It is my understanding that the policy of the school is to make no refund on registration fees. I agree to pay tuition and other fees in accordance with schedule outlined by JTCS. Also, it is understood that no transcripts will be issued until all financial obligations are met. I also give permission for my child to take part in all school activities, including sports and school sponsored trips away from the school premises. Doing so, I absolve the school from liability due to any injury my child may sustain at school or during any school activity.

Please provide the school with the following documents

Immunization Form (all students)

7th Grade Immunizations - Tdap & Meningitis

Birth Certificate

Textbook Fee (see Tuition page for price per grade)

Registration Fee (not billed automatically)

as marked by my selection(s) below. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, newspapers, videos, and digital images such as those on the Jackson Trail Christian School Web site. *

GRANT permission for unrestricted usage: I give unrestricted permission for my child’s image to be used in print, video, and digital media. I agree that these images may be used by Jackson Trail Christian School for a variety of purposes and that these images may be used without further notifying me.

DENY permission to use my child’s image at all.

Date *

MM

DD

YYYY

*

After submitting the form above, you will receive a confirmation email from Mrs. Black. Next, you will need to create a FACTS account (located on home page). Once you have created an account, you will be billed for registration by an administrator. Current students will be billed through their existing FACTS account.

I have read the above statement.

IMPORTANT INFORMATION *

A birth certificate AND current immunization record MUST be on file BEFORE your child is able to start attending Jackson Trail Christian School.