Dr. John A. McKinney Christian Academy New Birth Baptist Church Cathedral of Faith International 2300 Northwest 135th Street  Miami, Florida 33167 

P/786.318.3818  F/305.685.6886 www.nbbcmiami.org/JAMCA 

Dr. Victor T. Curry, Founding Senior Pastor/Principal 

Application for Admission 2013‐2014 School Year 

STUDENT REGISTRATION CHECKLIST    Completed Application for Admission. Picture Identification of Parent or Guardian. Original Birth Certificate or Birth Card. Social Security Card of Parent/Guardian and Student. Completed DH 3040 Student Health Examination Form (yellow form). Completed DH 680 Florida Certificate of Immunization Form (blue form). Academic Report Card from School Last Attended (Grades 1 through 6). Completed Media Release Form. Completed Enrollment Agreement Form. Completed Tuition Payment Information Form. Completed Student Health Form. Completed Parent Notification of Disciplinary Policy. Registration Fee due with COMPLETED Application Packet. Pre‐admission Screening and Interview completed.

FOR OFFICE USE ONLY Date Received: ____________ Received By: ______________ Amount Received $_________  Cash    Receipt#______________  Check  #_______  Money Order # ______________  Cashier’s Check #_____________  All required documents received:  Yes   No (Indicated missing items on Front page.)   

APPLICATION FOR ADMISSION

STUDENT INFORMATION Please check the applicant’s grade level:

Kindergarten    First Grade  Second Grade     Third Grade      Fourth Grade    Fifth Grade     Sixth Grade 

Last Name:

Student Address: Apartment # (If applicable):

First Name: Middle Name:

Gender: Date of Birth: Present Age: Ethnicity:

City: State: Zip Code:

Telephone Number: Last School Attended: Last Grade Completed:

FAMILY INFORMATION Mother’s or Female Guardian’s Name: Father’s or Male Guardian’s Name:

Address (If different from student): Address (If different from student):

City/State/Zip: City/State/Zip:

Cellular Phone: Cellular Phone:

Home Phone (If different from student): Home Phone (If different from student):

Employer: Employer:

Work Phone: Work Phone:

Siblings presently attending Dr. John A. McKinney Christian Academy or will be attending (please list names and grades

ACADEMIC INFORMATION Name of school last attended: ____________________________________________________________________________ Address: ________________________________________ _________City ____________ State _______ Zip ____________ Has your child ever repeated a grade? Yes No If yes, list grade and year grade was repeated ___________________ Has student been in : Special Education Speech ESOL Other: ____________________________________ Has student been expelled or referred to an alternative program for disciplinary reason? Yes No Has your child been tested for or enrolled in a special program (gifted, learning disabled, special needs, etc.) ______ If yes, please give details ___________________________________________________________________________________

2013-2014 FINANCIAL INFORMATION

(For further information call 786.318.3818)

Non-Refundable & Non-Transferable: $200.00 Per Student (2) Siblings—$350 (3) or more Siblings—$500

ANNUAL SEMI-ANNUAL TRI-ANNUAL MONTHLY PAYMENTS August 1 August 1 & January 1 August 1, November 1 & 10 Payments beginning February 1 August 1—May 1 GRADES K—5th $4,400.00 $2,200.00 $1,466.67 $440.00 6th Only $4,500.00 $2,250.00 $1,500.00 $450.00

Prices are subject to change for the following school year. ***Scholarships Accepted: Step Up For Students/Florida Tax Credit 3% discount if tuition is paid in full for the year by August 1 5% discount for additional child from the same family. Discount is applied to the youngest child. 10% discount for Grandparents with guardianship and Military Parents 15% discount for the child(ren) of Senior Pastors if tuition is paid in full for the year by August 1 ***Discounts cannot be combined.

Payments received after the 5th of the month are considered delinquent and an additional charge of $15.00 will be added to the student’s account.

K-5 1st 2nd 3rd 4th 5th 6th $130.35 $280.45 $286.30 $269.15 $272.75 $256.85 261.70

(NOT INCLUDED IN THE TUITION) DAILY WEEKLY ANNUAL BREAKFAST $2.00 $10.00 $360.00 LUNCH $3.00 $15.00 $540.00 AFTERCARE** N/A $35.00 $1365.00 **(Note: There is a $15.00 non-refundable application fee for the Aftercare Program)

Your financial obligation is for the FULL YEAR’S TUITION. However, if you must remove your child from our school, you will be held accountable for the current month’s payment plus a $200.00 withdrawal fee per student.

REGISTRATION

TUITION

DISCOUNTS

LATE FEES

BOOK FEES

EXTENDED SERVICES

TUITION FINANCIAL OBLIGATION

TUITION PAYMENT INFORMATION

Name: ___________________________________ _________________________________ Person(s) responsible for student’s account Relationship(s) to student

*NOTE: If you opt to pay in two to three installments and payment is not received by the due date, a prorated portion of your discount will be recharged to you account.

I/We understand that: If a balance remains on the account after the 5th, a late fee of $15.00 will be added to the account. If a payment is not received by the 5th of the month, my/our child(ren) will not be allowed to attend classes. Report cards, transcripts and/or diplomas will not be issued if any family-related accounts are delinquent. Post-dated checks will not be accepted under any circumstances. Checks returned for any reason will not be re-deposited and a $35.00 service fee will be charged to the account. Only cash or money orders will be accepted as a replacement for returned checks. If I/we officially withdraw my/our child(ren) during the school year, I/we am/are responsible for all tuition through the withdrawal month and a $200.00 withdrawal fee per child.

I/We further understand that my/our failure to pay my/our child(ren)’s tuition does not relieve me/us of my/our obligation to pay the account in full. Should I/we default, I/we agree to pay all cost of collection, including but not limited to Collection Agency fees, court cost, and reasonable attorney fees, all of which my be paid or incurred by the Dr. John A. McKinney Christian Academy. I/we fully understand and agree to abide by the above information and desire to have my/our child(ren) enrolled in the Dr. John A. McKinney Christian Academy. Name: ____________________________________________ _____________________________ Signature of Person(s) Responsible for Student’s Account Date

11 Payments Beginning JULY 1 through MAY 1

10 Payments Beginning AUGUST 1 through MAY 1

4 Payments Due AUGUST 1, NOVEMBER 1, FEBRUARY 1, MAY 1

1 Payment Due AUGUST 1, with discount

GRADE

REGISTRATION

STUDENT NAME

1.

2.

3.

4.

Fill in student names and grades beginning with oldest OFFICE USE ONLY ANNUAL TUITION

ENROLLMENT AGREEMENT

PLEASE READ CAREFULLY BEFORE SIGNING 2013-2014 Academic School Year

Student Name: _________________________________ Grade Level: _______________ In consideration of the acceptance of the Enrollment Agreement by the Dr. John A. McKinney Christian Academy, the undersigned agrees to pay the required fees. Tuition payments begin August 1, 2013. I understand that my obligation is to pay tuition for the full academic year. However, if I must remove my child(ren) from school, I will be held accountable for the current month’s payment plus a $200.00 withdrawal-processing fee per student. The Dr. John A. McKinney Christian Academy reserves the right to hold all records until all family-related accounts are paid in full. All family-related accounts of students in grades K-6th must be paid in full two weeks prior to promotional exercise for students to participate in activities and receive a promotion certificate to the next grade. I understand that if my account becomes fifteen (15) days past due my child(ren) may not be allowed to attend classes, and if it becomes thirty (30) days past due, it will be sent to collections and may have an adverse effect on my credit rating. I understand that in signing this Enrollment Agreement for the 2013-2014 academic school year, I am agreeing to accept the rules and regulations of the Dr. John A. McKinney Christian Academy as stated in the current handbook and referred to above. I understand that enrollment as specified within this Agreement, may be formally canceled (in writing) without penalty, with the exception of the registration fee, prior to August 1. If my registered student is not formally withdrawn (in writing) by August 15, I will be responsible for the August tuition and a $200.00 withdrawal processing fee. Name: _____________________________________________ ________________________ Signature of Person Responsible for Student’s Account Date

OFFICE USE ONLY Accepted by Dr. John A. McKinney Christian Academy

Administrator: ______________________________________ Date: _________________ Signature/Title

MEDIA RELEASE FORM

PLEASE READ CAREFULLY BEFORE SIGNING 2013-2014 Academic School Year

I understand that the Dr. John A. McKinney Christian Academy’s website www.nbbcmiami.org/JAMCA is used to promote the school and give information about its programs, academics and other activities. I also understand that at times a student's picture and/or name may be used on the site as well as in the promotion brochures usually to promote an event or activity (personal information, such as address or age are not used). In addition, my child may be photographed or filmed at various school-sponsored events. With my consent, the photograph or video may be reproduced and released for use by the media (i.e. newspapers, brochures, videos, television and advertisement, etc.). I, therefore, grant permission to place my child on the website and in the above mentioned media advertisements without financial remuneration, and hereby release the New Birth Baptist Church Cathedral of Faith International and its ministries from any claims present or future, as well as from liability arising from the use of any pictures or names.. Please check the appropriate box: Permission granted Permission not granted Date: _____________________________________ Child’s Name: _________________________________________________________________________ Guardian/Parent’s Name: _______________________________________________________________ Signature of Parent/Guardian: ___________________________________________________________

Last Name First Name Middle Name

Gender Ethnicity Date of Birth

Student Address Apartment # (If applicable)

City State Zip

Telephone Number Grade Level Teacher

STUDENT INFORMATION

FAMILY INFORMATION Mother’s or Female Guardian’s Name Father or Male Guardian’s Name

Cellular Phone Cellular Phone

Employer Employer

Work Phone Work Phone

Name Relationship Phone Number

Name Relationship Phone Number

Name of Doctor Address Telephone Number

Hospital Preference Insurance Company Insurance Policy Number

Medical Condition Allergies

PARENTAL CONSENT FOR MEDICAL TREATMENT Occasionally, an accident or extreme illness of a student makes it necessary for school personnel to contract the parent/guardian for consent to administer emergency medical attention. By signing below, you are authorizing the school personnel to administer First Aid on your child as recommended by the Dade County Health Department. Should your child need emergency medical attention, these expenses are the responsibility of the parent/guardian of the child. In the event a parent/guardian cannot be contracted, signing below also gives school personnel the authority to secure appropriate medical treatment. Furthermore, I will not hold school personnel, Dr. John A. McKinney Christian Academy, and the New Birth Baptist Church Cathedral of Faith International liable for any injuries that may develop as a result of the delivery of First Aid and/or the decision to secure appropriate medical treatment for the child the question.

EMERGENCY CONTACT INFORMATION

EMERGENCY CONTACT INFORMATION

Parent/Guardian Signature Date

Individuals Authorized to Pick-up Student Individuals Unauthorized to Pick-up Student

Mother’s Email: Father’s Email:

STUDENT INFORMATION Student’s Name: ________________________________________________________________________________ 

Last         First           Middle Initial 

Address: ________________________________________City/State:___________________ Zip: ______________ 

Home Phone: (      )______________________________________________________________________________ 

Date of Birth: ___________________   Age: _________     Sex:  Male   Female          Grade: ______ 

AFTER CARE APPLICATION This service is made available for all students from 3:00pm until 6:00pm.  The cost of this program is $35 a week with a non‐refundable   application fee of $15.  The After Care program provides an opportunity for students to begin Home Learning assignments.  Please be mindful that all assignments are not guaranteed  to be  completed during  the program.   Additional activities may  include movies,  indoor and outdoor games, arts and crafts, computers and cultural activities.  After Care ends promptly at 6:00pm and there is a $5 a minute charge for any student picked up after 6:00pm. 

APPLICATION FEE AND FIRST WEEK PAYMENT IS DUE  UPON SUBMISSION. 

FAMILY INFORMATION Father’s Name: ________________________  Telephone Number: ____________________________________ 

Home     Cell 

Address (if different from above): _________________________City/State: _________________ Zip: _____________ 

Father’s Employer: _______________________________________ Work Phone: _____________________________ 

Father’s Email:___________________________________________________________________________________ 

Mother’s Name: ________________________  Telephone Number: ____________________________________ Home     Cell 

Address (if different from above): _________________________City/State: _________________ Zip: _____________ 

Mother’s Employer: _______________________________________ Work Phone: _____________________________ 

Mother’s Email:___________________________________________________________________________________ 

MEDICAL AUTHORIZATION Allergies: ___________________________________   Physical Handicaps: ____________________________ 

In the event that I cannot be reached or in case of an emergency, I authorize treatment of my child at the nearest 

medical facility. 

PICK UP AUTHORIZATION Persons permitted to pick up your child:   Mother  Yes   No    Father   Yes   No Others authorized to pick up your child:  Name: ____________________________  Telephone Number: (____)__________   Cell Number: (____)__________ Address: ______________________________City/State: ________________________________ Zip: ______________ Name: ____________________________  Telephone Number: (____)__________   Cell Number: (____)__________ Address: ______________________________City/State: ________________________________ Zip: ______________ 

POLICY ACCEPTANCE I have read the 2013‐2014 Dr. John A. McKinney Christian Academy After Care information outlined above and agree to the policies and financial terms as stated. ____________________________________ ___________________________________    _________ Signature            Print Name            Date   

ABEKA BOOK CURRICULUM INFORMATION

The ABeka Book is a Christian curriculum known for its high quality, lively learning standard of excellence. Endorsed by Christian schools world-wide, this curriculum has been around for over 50 years, which means it has stood the test of time in providing the necessary foundation for students enrolled at Dr. John A. McKinney Christian Academy. Product information for each grade level is listed below. Students must have their books prior to the first day of school. Orders made before Friday, June 7th, 2013 through Dr. John A. McKinney Christian Academy will receive a 5% discount. **Prices are subject to change. Grade Product Order No. Price Kindergarten K5 Student Kit 139351 $130.35 First Student Kit 139319 $280.45 Second Student Kit 139327 $286.30 Third Student Kit 104205 $269.15 Fourth Student Kit 151629 $272.75 Fifth Student Kit 160814 $256.85 Sixth Student Kit 170739 $261.70

UNIFORM INFORMATION

Uniform tops include purple, gold or white polo shirts for both boys and girls, khaki or black bottoms (shorts, long pants, etc.) and all white or all black sneakers.

For chapel, the boys uniform include khaki or black pants, white ox-ford shirt, khaki tie and black shoes. Girls uniform include khaki skirt or dress with a white top, khaki ascot and black shoes

Uniforms can be purchased from any location. The JAMCA embroidered logo is available for a nominal fee of $5. For more information please call 786.318.3818

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