Student Application

Bethesda Christian Academy

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Bethesda Christian Academy Student Application

GENERAL INFORMATION

* Indicates required field

Gender *

Student Name *

First

Last

[object Object]

Grade Applying To *

Preferred Name *

Date of Birth *

Select One *

Year *

Address *

Line 1

Line 2

City

State

Zip Code

Country

School Tee-Shirt Order *

Each student receives a free school tee-shirt.

How long at this address? *

Home Email *

Home Phone Number *

EMERGENCY MEDICAL INFORMATION

Name of Emergency Contact *

Phone Number *

Contact's relation to student: *

Relative Friend Guardian Other

Applicant's Doctor *

Doctor's Phone *

PARENT/GUARDIAN AND FAMILY INFORMATION

Father's Name *

First

Last

Employer's Name *

Mother's Name *

First

Last

Employer's Name *

Occupation *

Business Phone *

Cell Phone Number *

Work Email *

Cell Phone Number *

Work Email *

Church Attending *

Pastor's Name *

Church Member *

Yes No

Attendance *

Regular Seldom Never

Pastor's Email *

Upon completion of the online student application, we will send a link to your pastor to complete the Confidential Pastor Reference form. The pastor will click on the link in the email and complete the evaluation form online. The form will be submitted directly to BCA electronically.

FAMILY INFORMATION

Previous School Attended By Student *

Medication for diagnosed condition? *

Yes No

If yes, name of medication: *

Previous School Address *

Line 1

Line 2

City

State

Zip Code

Country

Does your child have any health concerns? *

Yes No

Are you aware of any spiritual, physical, emotional, or academic issues concerning your child? *

Yes No

If Yes, describe: *

If yes, describe: *

Please attach any diagnostic tests for ADD, ADHD, LD, etc. so we may better assist your child.

Upload File for any Diagnostic Tests *

Max file size: 20MB

Has your child ever repeated a grade? *

Yes No

If yes, which grade and why: *

If your child has had difficulties in school, please explain: *

Core Teacher Email *

Second Core Teacher Email (Middle School Only) *

Upon completion of the online student application, the teacher listed above will receive a link to the grade level specific Confidential Student Evaluation form. The teacher will click on the link in the email and complete the evaluation form online. The form will be submitted directly to BCA electronically.

PARENT STATEMENT OF FAITH

Briefly state your understanding of who Jesus Christ is. *

How would you describe your relationship with Jesus Christ? *

STATEMENT OF COOPERATION

It is required that parents or legal guardians pay tuition for each registered student in the amount stated on the Schedule of Fees for the current school year. The annual tuition is divided into eleven equal payments, due on the first of every month from July 1st to May 1st. I understand that in any month in which my tuition payment is not received by the 10th, a $25.00 late charge will be added to the amount due that month. I further recognize that if I fail to bring my account current by the end of the month, my student(s) may no longer attend class until I do bring it current, including late charge. *

I agree

I agree that the school may reserve the right to dismiss any student who will not cooperate with the educational process, or whose parents or legal guardians refuse their cooperation. *

I agree

In case of serious illness or other emergency, I ask that the school staff try to reach me. If the school cannot reach me or my child’s doctor, I give permission for the staff to take whatever steps they deem necessary. *

I agree

I understand that no refund will be made on registration fees. *

I agree

I hereby give the teachers and principal full discretion in the Biblical discipline of my child/children. I understand that corporal punishment will not be administered by school personnel. Likewise, I understand that if my student must be suspended, I will be called to take him/her home. *

I agree

I understand that I will be liable for any damages my child causes to school or church property. *

I agree

I give permission for my child to participate in all school activities, including school-sponsored trips away from the school premises (field trips). I further absolve the school of any reasonable liability - to me or to my child - for injuries while at school or during any school activity. I understand that the school has purchased School Time Accident Insurance for each student. *

I agree

I (we) have filled out the Enrollment Application, have read both the Statement of Faith found in the Handbook and this Statement of Cooperation, and have attached the fee for registration. I (we) hereby authorize Bethesda Christian Academy to process the completed application for acceptance.

Name *

First

Last

Date *

Additional Parent/Guardian Name *

First

Last

Date *

Please upload the necessary documents below. If you do not have digital copies of these records or capability to upload them, please bring hard copies to the school office or mail them to us at 1914 S. Miami Blvd.;
Durham, NC 27703

Upload birth certificate *

Max file size: 20MB

Upload Student Medical Immunization Record *

Max file size: 20MB

Upload most recent report card (Grades 1-8) *

Max file size: 20MB

Submit

Bethesda Christian Academy's Mission Statement
Bethesda Christian Academy partners with Christian families to inform the student’s mind, to affect the student’s heart, and to increase the student’s personal talents as they seek to be an Ambassador for Christ.

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Bethesda Christian Academy is a ministry of Bethesda Baptist Church. BCA is an accredited school with a state certified staff that provides a quality, Bible-based curriculum to students from K4 through twelfth grade.

Contact us:
1914 South Miami Boulevard
Durham, NC 27703

Contact us at: (919) 598-0190 between the hours of 8 AM to 4 PM.

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