Application Form

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Important Notes Before Filling Out This Form

1) This is a lengthy form and it is suggested that you fill this form out on a desktop or laptop computer as opposed to a phone to make it easier on you.

2) This Form Can Take Multiple Hours To Complete. To save your progress while filling it out, Click the “Save And Continue Later” button located at the very bottom of each page of the form to save your progress.

3) After clicking “Save And Continue Later”, you will be given a unique link which you can right-click on to copy. We suggest you save this link to a file on your computer so you can complete the form later. The link stays available for 30 days.

4) This form requires payment of $50 per student to be made using a debit or credit card in order to be submitted.

F.S.C.A. Enrollment Application 2023-2024 School Year

1Basic Information On Students

2Relatives In the school

3Contact List For Student(s)

4Parent/Guardian School Messenger Consent For General Messages

5Confidential Medical Information

6Handbook Statement of Agreement for Student and Parent/Guardian

7Financial Responsibility Form for Parent/Guardian

8Student Computer Use Agreement

9Application Fee

Future Scholars Christian Academy utilizes an automated parent notification system to quickly and efficiently notify parents of important school and district information. Such notices may include information regarding school closures/delays, security alerts, absence notifications and upcoming school information.

Due to recent changes to the Telephone Consumer Protection Act (TCPA). Parents are now required to provide prior express consent to receive automated communications on their mobile device. This means. parents must provide express consent to receive general messages through automated calls and/or SMS text messages on their mobile device(s). Consent is not required if the call or text is for emergency purposes or if made directly from a principal, teacher, or other staff member.

PALRENT/GUARDIAN SCHOOL MESSENGER CONSENT FOR GENERAL MESSAGE:

By signing below you consent to give Future Scholars Christian Academy permission to contact you via cellular device for automated phone calls or SMS text messages for general messages. You understand that emergency notifications are excluded from this permission and will be sent as normal. By signing, you are stating that you are the owner of the cellular device and its user contract. You also certify that you will notify the school immediately if you change or deactivate this number.

Your Name(Required)

First Last Suffix

Signature(Required)

Date(Required)

Cell Phone Number(Required)

STUDENT ENTRY FORM

NOTICE: You are required to complete the Emergency and Contact Information Form and update information annually or any time the information changes. School personnel will contact you to pick up your child if he/she is unable to remain in school due to illness or accident. If school personnel are unable to reach you, one of the adults listed on the Emergency and Contact Information Form designated to pick up your child will be contacted. School personnel will contact Emergency Medical Services in an emergency situation to take whatever action is deemed necessary for the health and safety of your child. Parents are financially responsible for any emergency care and/or transportation your child needs. It is the parent/guardian's responsibility to notify F.S.C.A. if changes to this form need to be made and to provide the school with information if there are any custody restrictions involving your child. Forms must accurately reflect your child's court order, if applicable.

I certify that the information provided on this Student Entry Form/Emergency and Contact Information Form is accurate, true and correct.

Date(Required)

Enrolling Parent/Guardian Signature(Required)

Your relationship to student(s)

(Parent, Guardian, etc.)

Handbook Statement of Agreement for Student and Parent/Guardian

We, the student and parent/guardian, have received and read the Future Scholars Christian Academy Parent/Student Handbook and agree to abide by and support the beliefs, procedures, duties, regulations, and responsibilities therein.

The student understands that he/she will maintain behavior which exemplifies courtesy, kindness, morality, and honesty. The student will also strive to be of unquestionable character in dress, conduct, and other areas of life and will abide by and support the school's mission, philosophy, and Statement of Faith. I have read and understand the requirements for Face-to-Face learning and Virtual Learning. I understand that the choice I make at this time is for the fall semester of 2023-2024. I will be able to change my decision for the spring semester in December.

MY CHOICE FOR INSTRUCTION FOR 23-24 FALL SEMESTER IS:(Required)

On-line - Working at home with parent/guardian assistance

Face-to-Face-Physically at FSCA, 222 East Central, Winter Haven, FL

As parent/guardian, I will work with the school from 8 a.m. to 3 p.m. and assist my child as needed to be sure they understand how to do their schoolwork. I will be responsible to read emails throughout the day with my child, print materials as needed, upload assignments to the teacher, and bring my child in for weekly assessments as requested.

Parent (Mother)/Guardian (Printed Name)(Required)

First Last

Parent (Mother)/Guardian Signature(Required)

Date Of Signature(Required)

Month/Day/Year

Parent (Father)/Guardian (Printed Name)(Required)

First Last Suffix

Parent (Father)/Guardian Signature(Required)

Date Of Signature(Required)

Month/Day/Year

(1) Student (Printed Name)(Required)

First Last

(1) is for the first student if more than one student.

(1) Student Signature(Required)

(1) is for the first student if more than one student.

(1) Date Of Signature(Required)

Month/Day/Year. (1) is for the first student if more than one student.

(2) Student (Printed Name)(Required)

First Last

(2) is for the second student if applying for more than one student.

(2) Student Signature(Required)

(2) is for the second student if applying for more than one student.

(2) Date Of Signature(Required)

Month/Day/Year. (2) is for the second student if more than one student.

(3) Student (Printed Name)(Required)

First Last

(3) is for the third student if applying for more than one student.

(3) Student Signature(Required)

(3) is for the third student if applying for more than one student.

(3) Date Of Signature(Required)

Month/Day/Year. (3) is for the third student if applying for more than one student.

(4) Student (Printed Name)(Required)

First Last

(4) is for the fourth student if applying for more than one student.

(4) Student Signature(Required)

(4) is for the fourth student if applying for more than one student.

(4) Date Of Signature(Required)

Month/Day/Year. (4) is for the fourth student if applying for more than one student.

(5) Student (Printed Name)(Required)

First Last

(5) is for the fifth student if applying for more than one student.

(5) Student Signature(Required)

(5) is for the fifth student if applying for more than one student.

(5) Date Of Signature(Required)

Month/Day/Year. (5) is for the fifth student if applying for more than one student.

Student Computer Use Agreement

We, the student, and parent/guardian, have received and read the Future Scholars Christian Academy Parent and Student Handbook, including the computer requirements, and agree to abide by the policies and procedures therein.

If student is checking this assigned computer out for Virtual Education, the computer is to be used only for the assigned instructional purposes. Should the computer be damaged in any manner, the parent/guardian is responsible for the financial cost of replacement. No course grades will be posted, nor will school records be released until the financial obligation is cleared.

(1) Student Name(Required)

First Last Suffix

(1) is for the first student if more than one student is being submitted in this application.

(2) Student Name(Required)

First Last Suffix

(2) is for the second student if more than one student is being submitted in this application.

(3) Student Name(Required)

First Last Suffix

(3) is for the third student if more than one student is being submitted in this application.

(4) Student Name(Required)

First Last Suffix

(4) is for the fourth student if more than one student is being submitted in this application.

(5) Student Name(Required)

First Last Suffix

(5) is for the fifth student if more than one student is being submitted in this application.

Parent/Guardian Name(Required)

First Last Suffix

Parent/Guardian Signature(Required)

Date Of Signature(Required)

Month/Day/Year