Maximizing Power & Grace in YOUth!

Student Application 2 Corinthians 12:9 English Standard Version (ESV) But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weakness, so that the power of Christ may rest upon me.

Admissions Pre-K4 - First

Thank you for your interest in Power And Grace Preparatory Academy. We appreciate the opportunity to introduce you to our academically challenging, Christ-centered school, where we are Preparing Tomorrow’s Leaders! Admission is open to students of any race, color, and national or ethnic origin who are looking for a Christian environment with an emphasis on teaching Biblical principles and truths along with strong academics. This admission packet has been prepared to answer many of your questions Please pay careful attention to dates and procedures listed in this packet. We understand the sacred responsibility with which you have entrusted us. We thank you for the privilege and opportunity to influence your children for Jesus Christ and to help them realize their potential. The student handbook is a valuable tool in evaluating our school (available online at www.powerandgraceacademy.com). Curriculum, policies, procedures, and information regarding the daily operations of the school are included in the handbook. Read it carefully and use it to assist you in making your decision. A PDF version is available for download. Please remember that we are is available to answer your questions and assist you in completing your student’s application. We can be reached at (931) 320-9862.

Katobwa Stallworth Principal

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Admissions Process

The following is a list of procedures that will guide new students applying for enrollment in Power And Grace Preparatory Academy 1. Obtain a New Student Packet from the Admissions Office. (Packet also available online at PowerAndGraceAcademy.com) New Student Packet includes Application and Handbook Acknowledgment Form. 2. Read all information carefully and return completed application form and information as indicated in the packet. • Current Application/Registration Form and $35 non-refundable fee. • • • • • •

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(Completed and signed by a Parent/Guardian) Copy of Current immunization Records Copy of past Report Card or Testing Scores State Certified Birth Certificate Include a recent photograph Parent’s personal testimony Two Character References (one from a friend or teacher and one from a pastor or Bible teacher). These are confidential and should be sent directly to Power And Grace Preparatory Academy by the person completing the form. Schedule a screening and interview Parent release of prior records Notification of acceptance or denial is mailed Upon acceptance - please remit the following: Student Handbook Acknowledgment Form, Registration Fee, Book/Technology Fee, Sign Tuition Contract Order uniforms and purchase supplies. (Complete supply lists can be found on the website: www.PowerAndGraceAcademy.com)

Please Note: An incomplete application file may result in a student not being considered for entrance.

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STUDENT’S FULL LEGAL NAME Last: ________________ First:__________________ Middle:____________ Student’s Home Address:________________________________________ City:___________________ State/Zip: ______________ Mailing Address (if different): ____________________________________ City:___________________ State/Zip: ______________ Home Phone: (____)__________ Cell Phone: (____)__________ Gender: M____ F ____ Date of Birth: ___/____/___ Place of Birth: City:___________________County:____________ State:___ Church Home:________________________________________________Pastor: _______________________________ Previous School: ______________________________________ Reason for transfer/leaving:_______________________________ Is this student toilet-trained (no pull-ups)? □ yes □ no Is this student able to use the toilet by him/herself with no assistance, including pulling up pants? □ yes □ no Has this student ever been a previous Power and Grace: Applicant: □ yes □ no Student: □ yes □ no If yes, grade_________ Persons, OTHER THAN PARENTS LISTED ON NEXT PAGE(S), to be contacted in case of emergency: List at least three, must be local and from separate households. Additional contacts may be listed on separate sheet. Name Relationship Cell Work __________________ ______________________ _______________ ________________ __________________ ______________________ _______________ ________________ __________________ ______________________ _______________ ________________

Medical Information

Does this student have any medical conditions? □ yes □ no If yes, please explain: __ ________________________________________________________________________ Does this student take any medication (prescribed or OTC) on a regular basis? □ yes □ no If yes, please explain: ______________________________________________ Does this student have any allergies? □ yes □ no If yes, please explain: ____________________________________

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Doctor’s Name:_________________________________ Phone #:(____)__________ Preferred Hospital: _________ Page 4

HOUSEHOLD ONE (Primary residence) INFORMATION: Household One defined as the PRIMARY residence of the student. This parent’s address will be linked with student’s address !

Parent/Guardian One (in Household One) □ Dr. □ Mr. □ Mrs. □ Miss □ Ms. □ Relationship to Applicant: □ Father □ Mother □ Grandparent □ Guardian □ Other: _________________________________________ Last Name:____________________First Name:________________________ Address: _______________________________________ City: ____________________________________ State/Zip:_____________ Gender: □ Male □ Female Marital Status: □ Married □ Divorced □ Separated □ Not Married □ Widowed Custodial rights? □ yes □ no Financially Responsible? □ yes □ no Receive Correspondence? □ yes □ no Email 1:_______________________@___________________________ Occupation:______________________ Job Title: ______________________ Employer: __________________________________________ Work Phone:(____)__________ Cell Phone: (____)__________ How did you hear about us? □ Friends □ Relatives □ Newspaper □ Radio □ Magazine □ TV Internet Search or Website □ other: explain ___________________________________ Parent/Guardian One Personal Testimony Please give a brief, but comprehensive, personal TESTIMONY of your relationship with Jesus Christ. (May be typed and attached if desired.) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ Signature: _______________________________ Page 5

Parent/Guardian Two (In household One - lives at same address): Parent/Guardian Two (in Household One) □ Dr. □ Mr. □ Mrs. □ Miss □ Ms. □ Relationship to Applicant: □ Father □ Mother □ Grandparent □ Guardian □ Other: _________________________________________ Last Name:____________________First Name:________________________ Address: _______________________________________ City: ____________________________________ State/Zip:_____________ Gender: □ Male □ Female Marital Status: □ Married □ Divorced □ Separated □ Not Married □ Widowed Custodial rights? □ yes □ no Financially Responsible? □ yes □ no Receive Correspondence? □ yes □ no Email 1:_______________________@___________________________ Occupation:______________________ Job Title: ______________________ Employer: __________________________________________ Work Phone:(____)__________ Cell Phone: (____)__________ How did you hear about us? □ Friends □ Relatives □ Newspaper □ Radio □Magazine □ TV Internet Search or Website □ other: explain ___________________________________ Parent/Guardian Two Personal Testimony Please give a brief, but comprehensive, personal TESTIMONY of your relationship with Jesus Christ. (May be typed and attached if desired.) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ Signature: ___________________________________ Page 6

Discipline Agreement

Discipline is an essential teaching part of the classroom and is not viewed as punishment. Discipline is used to help children learn self control, to help develop their self-esteem and a regard for and acceptance of others in the classroom. Discipline will be consistent and age appropriate. Discipline will include positive guidance, redirection, and clear limits that encourage the child’s ability to become self-disciplined. When redirection is not working at a particular time for a child, time out will be employed. (Time out is a non-solitary separation of one child from the group.) Discipline will guide the children to resolve conflicts and will model skills that help children to solve their own problems. Physical punishment, humiliation, fright or other coercive strategies are not permitted. Withdrawal of food, rest or bathroom privileges are not permitted. Any type of emotional manipulation is also strictly prohibited. I, the parent/guardian of the child named in this application, have read the above and agree to support Power And Grace’s program in its disciplinary policies. Signature of Parent/Guardian: ___________________________________________ Date: _____________________________ Print Name:_________________________________________

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Child’s Health History Checklist

Child’s Full Legal Name: __________________________________________________ The answer to these questions will help us to know if your child has any medical problems. We need this information in case they should become ill and we would be unable to reach you right away. Please circle the right answer. We will go over the checklist with you when you have finished.

Pregnancy and Birth Yes No Yes No Yes No

1) Were there any problems with pregnancy or your child’s birth? 2) Was his/her birth weight under 5 pounds? 3) Did the baby have any problems in the hospital?

Medical Problems Yes No 4) Has your child ever been in the hospital overnight? Yes No 5) Is your child taking any medicine? Yes No 6) Any allergies or reactions to medicine, DTP or other shots or insects? Yes No 7) Has your child had asthma or wheezing? Yes No 8) Does your child have speech or hearing problems? Yes No 9) Has your child had more than two ear infections in a year? Yes No 10) Has your child had tonsillitis? Yes No 11) Does your child have trouble with his/her eyes or seeing? Yes No 12) Has your child had a bladder or kidney infection? Yes No 13) Does he/she have burning when urinating? Yes No 14) Does he/she have seizures, fits, or shaking spells? Yes No 15) Have you ever been told your child has a heart murmur? Yes No 16) Is your child able to play as hard as other children? Yes No 17) Has your child ever had a bumpy, swollen reaction to the TB skin test? Yes No 18) Has your child ever been with anyone who have TB? Yes No 19) Has your child ever had worms? Yes No 20) Does your child scratch his/her genital area? Yes No 21) Is your child a hemophiliac (free bleeder)? Yes No 22) Is your child on a heart monitor? Yes No 23) Does your child have tubes in his/her ears?

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Older Girls Yes No 24) How old was your daughter when she had her first period? _________ Yes No 25) Does she have any problems with her period?

General Development Yes No 26) Is your child in a special education class in school? Yes No 27) Does your child get along with other children? Yes No 28) Is he/she usually happy? Yes No 29) Does your child have any special problems not indicated above? ____________________________________________________ Yes No 30) When did your child last see a doctor? ____________________

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HOUSEHOLD TWO (Secondary) INFORMATION: Household One defined as the PRIMARY residence of the student. This parent’s address will be linked with student’s address !

Parent/Guardian One (in Household Two) □ Dr. □ Mr. □ Mrs. □ Miss □ Ms. □ Relationship to Applicant: □ Father □ Mother □ Grandparent □ Guardian □ Other: _________________________________________ Last Name:____________________First Name:________________________ Address: _______________________________________ City: ____________________________________ State/Zip:_____________ Gender: □ Male □ Female Marital Status: □ Married □ Divorced □ Separated □ Not Married □ Widowed Custodial rights? □ yes □ no Financially Responsible? □ yes □ no Receive Correspondence? □ yes □ no Email 1:_______________________@___________________________ Occupation:______________________ Job Title: ______________________ Employer: __________________________________________ Work Phone:(____)__________ Cell Phone: (____)__________ How did you hear about us? □ Friends □ Relatives □ Newspaper □ Radio □ Magazine □ TV Internet Search or Website □ other: explain ___________________________________ Parent/Guardian One (In household two) Personal Testimony Please give a brief, but comprehensive, personal TESTIMONY of your relationship with Jesus Christ. (May be typed and attached if desired.) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ Signature: _______________________________ Page 10

Parent/Guardian Two (In household Two - lives at same address): Parent/Guardian Two (in Household Two) □ Dr. □ Mr. □ Mrs. □ Miss □ Ms. □ Relationship to Applicant: □ Father □ Mother □ Grandparent □ Guardian □ Other: _________________________________________ Last Name:____________________First Name:________________________ Address: _______________________________________ City: ____________________________________ State/Zip:_____________ Gender: □ Male □ Female Marital Status: □ Married □ Divorced □ Separated □ Not Married □ Widowed Custodial rights? □ yes □ no Financially Responsible? □ yes □ no Receive Correspondence? □ yes □ no Email 1:_______________________@___________________________ Occupation:______________________ Job Title: ______________________ Employer: __________________________________________ Work Phone:(____)__________ Cell Phone: (____)__________ How did you hear about us? □ Friends □ Relatives □ Newspaper □ Radio □Magazine TV Internet Search or Website □ other: explain ___________________________________ Parent/Guardian Two (In household two) Personal Testimony Please give a brief, but comprehensive, personal TESTIMONY of your relationship with Jesus Christ. (May be typed and attached if desired.) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ Signature: ___________________________________ Page 11

Character References

I understand that I am required to have two (2) character references for my child to complete the application process. These references should be sent directly to the school. Approved references will come from teachers, friends, or childcare provider. Pastor, bible school teachers, or extra-curricular instructor/sponsors are also preferred. We prefer that family members not be asked to provide character references. I understand that information furnished by the individuals completing the Character References will become the property of Power And Grace Preparatory Academy. Furthermore, I waive all rights to examine the responses given. Signature of Parent/Guardian: ___________________________________________ Date: _____________________________ Print Name:_________________________________________

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