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Reenrollment
Please scroll down to complete the
form:
2023-2024 Re-Enrollment
1
Student / Parent Information
2
Medical Information
3
Pick-Up Information
4
Payment
Student Information
You may register
multiple students
at once by using the "plus" button next to the Grade Entering field below.
Student(s)
*
First and Last
Birthday
Grade Entering
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Parent Information
Father's Name:
First
Last
Father's Phone:
Father's Email:
Employer:
Work Phone:
Mother's Name:
First
Last
Mother's Phone:
Mother's Email:
Employer:
Work Phone:
If the parents are separated or divorced, with whom does the student live?
Non-Parental Emergency Contacts
Name:
*
First
Last
Relation:
*
Phone:
*
I assume all financial responsibility for my child’s tuition and fees at Lighthouse Baptist Academy and I understand the following:
All accounts must be kept current, and no student may attend classes if account is more than 15 days in arrears.
A $50 per family late fee will be added to my account if it is delinquent after the 10th of the month.
Book fees are due July 1st, and the first tuition payment is due August 1st and must be paid before the first day of school.
Report cards and other school records will be held until all accounts are paid in full.
The policy of Lighthouse Baptist Academy is to make no refunds on registration, book fees, or current tuition.
The policy at Lighthouse Baptist Academy is to make NO REFUNDS ON TUITION OR FEES after due dates.
In making application for my child, I desire to have him/her complete his school year at LBA. I also give permission for my child to take part in all activities of Lighthouse Baptist Academy. I further agree to indemnify and hold Lighthouse Baptist Academy harmless for any and all liability that may result from my child attending or participating in all activities of Lighthouse Baptist Academy. I believe that discipline is necessary for the welfare of each student. I give Lighthouse Baptist Academy permission for my child’s teacher and/or school representative to make and enforce classroom regulations in a manner consistent with Christian principles and discipline as set forth in our handbook. I hereby grant permission for Lighthouse Baptist Academy to use my child’s photograph and/or video recorded image for purpose of marketing or promotions. I understand that Lighthouse Baptist Academy does not discriminate on the basis of race, color, national or ethnic origin.
Parent / Guardian Signature:
*
Parent-Student Agreement
• To be read and signed each year by all parents who have children in K3-6th grade.
• To be read and signed each year by the parents and all students 7-12th grade.
• All students are required to read the entire handbook.
As a student of Lighthouse Baptist Academy, I will:
Do my best to have personal time with God each day through Bible reading and prayer.
Do my best to regularly attend a local Bible-believing church.
Protect my mind, body, and morals from evil companions by not making them my intimate associates.
Select wisely the television programs I watch and will turn from those programs that have vulgar language or scenes of immorality, profanity, or any other activities of which Christians should disapprove.
Refrain from listening to music that is not Christian. Specifically, music which suggests turning against authority, living to enjoy self and immorality, and living for the thrill of the present without thinking of the consequences.
Refrain from the use of alcohol, drugs, or tobacco products.
Seek to faithfully witness as a Christian by looking, acting, and talking like a Christian.
If during the school year, the school administration brings to my attention something that they deem too worldly for a Christian young person, I will respectfully submit to such authority, realizing their intentions are not to be hurtful but that they have only my best intentions in mind.
Take responsibility for my education by doing my best to actively listen, pay attention, participate in class, heed deadlines, complete all homework assignments/projects, prepare for quizzes/tests, and fulfill all course requirements.
I understand the LBA Student Handbook contains the information that I will be expected to know and to abide by at Lighthouse Baptist Academy. I intend to read the entire Handbook as listed above before the beginning of the school year and will abide by the rules and the spirit of the rules contained in the Student Handbook while a student at LBA.
Parent / Guardian Signature:
*
Student Health Update
Does the child(ren) wear glasses or contacts?
*
Yes
No
If yes, how often?
Does the child(ren) have a physical hearing impairment?
*
Yes
No
If yes, does the child(ren) wear a hearing aid?
Known allergies (Please specify which child for each):
*
Food restrictions (Please specify which child for each):
*
Other health related restrictions (Please specify which child for each):
Current doctor-prescribed medications taken on a regular basis and for what cause (Please specify which child for each):
*
Current medical conditions for which the child(ren) sees a doctor regularly:
*
Most common re-occurring medical ailment/issues your child(ren) deals with during the year:
*
Please notate if your child(ren) has had any of the following illnesses. If not, please select NONE.
*
NONE
Diphtheria
Whooping Cough
Red Measles
Tuberculosis
Mumps
Diabetes
Chicken Pox
Rheumatic Fever
Ear Infection
Asthma
Scarlet Fever
Pneumonia
German Measles
Other
None
Does your child have an inhaler?
*
Yes
No
If you marked any of the illnesses above, please specify which child(ren) contracted it and when it was contracted.
Medical History from January 2018 - January 2023 (If yes, please explain)
Any hospitalizations?
*
Yes
No
If yes, please explain.
Any surgeries?
*
Yes
No
If yes, please explain.
Any broken bones?
*
Yes
No
If yes, please explain.
Any psychological/psychiatric counseling?
*
Yes
No
If yes, please explain.
Date of last physical / well child visit:
*
MM slash DD slash YYYY
Date and nature of last illness:
*
Any other medical, well-being, or health-related issues that you would like us to know in order to better care for your child?
Doctor to call in case of emergency:
*
Doctor's Phone
Dentist to call in case of emergency:
Dentist's Phone:
I certify that the above history is complete to the best of my knowledge. I give the Academy permission to call the above names physician and dentist in case of an emergency when I, the parent/guardian, cannot first be reached. I also give the Academy permission to first call 911 in the event of a serious emergency as attempts are made to contact me.
Parent / Guardian Signature:
*
Additional Pick-Up Authorization
Will there be additional people authorized to pick-up your children from school?
*
Yes
No
Non-Parental Authorized Persons:
First and Last
Relation
Phone
All authorized persons picking up a student at Lighthouse Baptist Academy may be required to show a photo identification.
The persons listed above are all authorized to pick up my child from Lighthouse Baptist Academy.
Re-Enrollment
Number of students re-enrolling
*
Please enter a number greater than or equal to
1
.
CC Processing Fee
Price:
$0.00
Total due:
$0.00
Credit Card
*
Card Details
Cardholder Name
Upon clicking the button below, you will be redirected to our payment vendor Stripe.
Please note, your re-enrollment is not complete until the payment has been made in Stripe.
Parent / Guardian Signature:
By typing your name below you consent to this digital form of a signature.
