RLCA Application RLCA Application Child's InformationName of Child First Middle Last SexAddress 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 Telephone NumberBirthplaceBirthdate MM slash DD slash YYYY AgeState the grade for which you are applyingSemesterHow Did You Hear About Us?Social MediaSearch Engine (Google, Bing, Yahoo)Word of Mouth (Family/Friend)RadioNewsletterChurch AnnoucementEventTVOtherFamily InformationIs the father permitted to pick up the child? Yes No Father's Name (or Guardian) First Last Address Street Address Address Line 2 City State / Province / Region TelephoneName of High SchoolName of CollegeOccupationBusiness TelephoneBusiness Address Street Address Address Line 2 City State / Province / Region Cell Phone NumberEmail Is the mother permitted to pick up the child? Yes No Mother's Name (or Guardian) First Last Address (if different from Father's) Street Address Address Line 2 City State / Province / Region TelephoneName of High SchoolName of CollegeOccupationBusiness TelephoneBusiness Address Street Address Address Line 2 City State / Province / Region Cell Phone NumberEmail Before & Aftercare Contract / School Age OnlyStudent InformationNameGradeAge Add RemoveParent InformationName of GuardianDL# Add RemoveList each parental figure and their driver license number.Primary Home Phone NumberPrimary Work Phone NumberPrimary Cell Phone NumberMother/Guardian's EmployerMother/Guardian's Employer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Father/Guardian's EmployerFather/Guardian's Employer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Emergency Contact's Name First Last Emergency Contact's Phone NumberEmergency Contact's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent/Guardian Signature I agree and sign this formI understand that before care begins at 7:00am and ends at 8:00am. Should I bring and leave my child on the premises of Resurrected Life Children’s Academy between the hours of 7:00am and 8:00am it shall be assumed that my child is attending before care and will be charged for that day. If I bring my child in before care for whatever reason I shall be charged for the full cost of (1) day. Likewise, I understand that after care begins at 3:00pm. Should I not arrive by that time my child will be sent to after care classrooms, where he/she will remain until myself or an authorized adult from my release form picks him/her up from RLCA. Should the authorized person or I not arrive to RLCA after care by 6:30pm, I shall be charged a late fee of ($5.00 at 6:31pm and $1.00every minute after per child). In addition, someone from my release form will be notified to pick up my child/ren. Should no one arrive to pick up my child/ren my child will be taken to the local police station. If I do not make payment arrangements as scheduled I will be charged a $10.00 penalty fee and $5.00 for each child per day my balance remains unpaid and or dismissal from the before and after care program for the remainder of the year. Failure to comply will also give subject to prompt dismissal for the remainder of the year. Code of ConductSTUDENT CONDUCT – students are expected to comply with the personal appearance and good hygiene standards as set forth by the Academy. It is the parents’ responsibility to see that their children adhere strictly to this code. Students are expected to be courteous and respectful to others and to their property. ⦁ It must be understood that any participation in the following anti-Christian activities will result in disciplinary action, with possible expulsion: smoking, drinking of alcoholic beverages, swearing, indecent language, indecent exposure, drug abuse, gambling, pornographic literature, and unacceptable entertainment improper behavior with a person of the opposite or same sex, dishonesty. PARENTAL SUPPORT – maintaining godly example in the home is essential in the process of Christian education. It is important to have daily family prayer and to worship together. ⦁ Students are expected to attend field trips, and to attend other social functions; unless they are ill or excused. Parents are encouraged to chaperon on field trips as space allows. The academy reserves the right to exclude any student from a field trip or school function for misconduct. ⦁ The Academy reserves the right to dismiss any student from school who does not comply with Discipline Code and standards set forth. ⦁ Students are accepted on a trial basis for one month after enrollment before their grade or placement becomes final. ⦁ The Administration and staff assume the responsibility for following the Discipline Code as given in the Parent Handbook. ⦁ We have read and agree to this Parent/Student Contractual Agreement. It is my/our desire as parents/guardians and students to be a part of the Academy, and to support the school and its activities.Parent/Guardian Signature I agree to the code of conduct.Dress CodeDear Resurrected Life Parents, God bless you today, and every day. The purpose of this letter is to inform you of the Resurrected Life Children’s Academy dress code. Please be aware that the dress code will be strictly enforced. It is our belief that one’s external appearance will reflect and encourage certain external attitudes that are essential to all students enrolled at Resurrected Life Children’s Academy. The guiding principle of having a dress code is to provide students with a visual, and physical structured learning environment. Therefore, please make sure that your child attends our academy daily with a clean uniform. Neatness reflects and encourages a sense of organization as an aspect of one’s personality, and cleanliness reflects and encourages a basic caring about oneself. Should a student arrive to school dressed inappropriately he or she will receive a uniform slip and the parent is expected to pay $2.00 per each uniform slip. The payment for uniform violations is expected to be paid on the next school day. Emergency Release/Authorized Pick-up InformationIf for some reason you are unable to pick your child up, if the person picking them up is on the list there is no need to send a note or call. If you know ahead of time that you will be unable to pick your child up and are designating a person who is not on your list, leave a written note with the teacher or secretary on the day you are unable to pick up your child. Unless it is a dire emergency, please do not call to make alternate pick-up arrangements. Individuals authorized to pick-up your childNamePhone Number Add RemoveSignature I authorize the above-named individuals to pick up my child/ren.Please submit a photocopy of Parent/Guardian or Primary pick up person’s Driver’s LicenseMax. file size: 32 MB.Primary pick up person's DL#Primary pick up person's License Plate #State IssuedCar ModelCar MakeCar ColorCar YearCAPTCHA resurreccion2023-10-15T15:03:02+00:00
