Admission Information - Whitesburg Christian Academy

Admission Information
Dear Prospective Families,
Thank you for your interest in Whitesburg Christian Academy. It is our purpose to help students
recognize and answer God’s call on their lives, and to prepare them spiritually, emotionally, and
academically to go wherever God leads them and to be whatever God wants them to be. God has
blessed our school with a quality staff and faculty who share that vision and have prepared themselves to work alongside you and your church in developing students into passionate followers of
Christ and well trained servant leaders. We operate under the educational philosophy that when
love motivated teachers have high academic and behavior expectations of students, the students
will rise to the level of those expectations.
The mission of Whitesburg Christian Academy is to assist Christian parents by providing students
an academically excellent and Christ-centered education for life-long service to Christ. We accomplish this through a classical approach, in challenging, exciting classrooms, with devoted, caring
and exceptional faculty. Our emphasis on strong academics never compromises our core values:
God’s word, wisdom, honor, integrity, service, truth, love, and excellence.
What makes the Academy unique is the strong partnership between parents, the Academy, and the
church embodied committed to Kingdom Education. As we strive to provide a Biblical worldview
for our students, the key verse we look to is Luke 5:11 “…they left everything and followed Him”.
This serves as a prelude for the key results and outcomes we are seeking for our students: followers of Christ, leadership development, people of passion, faithful stewards, and reaching one’s
maximum potential. All of these are embodied in our ends statement, Students are passionate followers of Christ and well-trained servant leaders.
I hope that the website answers many of your questions, but I realize that it may generate many
new ones. Finding the right educational environment for a child is one of the most important decisions that a parent has to make and I want to make sure that we provide you all of the information
needed to make the right choice for your family. If you have additional interest or questions, I
would like to invite you to call or visit the Academy. Our dedicated faculty and staff welcome the
opportunity to tell you more about what makes us unique.
May God bless your search for the right educational choice for your child.
In His name,
Jerry Reeder
Headmaster
Whitesburg Christian Academy
Admissions Information
Whitesburg Christian Academy desires to unite church, home, and
school in developing students who are passionate followers of Christ
and well-trained servant leaders.
Admission Policy
The Academy program is provided for Christian families who are interested in an education where both spiritual and academic qualities
are emphasized. Due to the importance of promoting a Christian
influence at home and at school, the Academy requires that at least
one parent be a born again Christian and that he or she regularly
attends church with his or her child. All enrollees are expected to
comply with the total course of study and policy. Space limitations
and/or the ability of the Academy to meet the needs of a child may
cause denial of admission to an applicant.
Children requiring special medical attention may be accepted upon
the approval of the Principal and the Headmaster. Although the
Academy provides a high-quality education for enrollees, it does
not have special education classes or programs for those who have
learning disabilities.
Applications for transfer students will normally be denied for those
who have failed to accomplish acceptable work or who have been
subject to repeated disciplinary actions at previous schools. Upper
school students who do not have a cumulative 2.0 GPA or have received an “F” in any core subject the previous two semesters will not
be eligible for acceptance. Initial applicants who do not test to a level
commensurate with the grade applied for will be counseled on test
results and available courses of action.
Final admission is based upon the parent/guardian completing the
admissions process and acceptance by the Whitesburg Christian
Academy Admissions Committee.
Non-Discriminatory Policy
Whitesburg Christian Academy admits students of any race, color,
sex, national or ethnic origin to all the rights, privileges, programs,
and activities generally accorded or made available to students at
the school. The school does not discriminate on the basis of race,
color, sex, national or ethnic origin in administration of its education,
admission policies, tuition assistance, athletic and other school administered programs.
Priority
Admissions
Deadline
In order listed:
Families Currently Enrolled,
Whitesburg Weekday Education, Members of Whitesburg
Baptist Church
Application Deadline
Applications will be accepted
from January 1- February 1
for our Priority Admissions
process at Whitesburg Christian Academy.
Failure to
submit a completed application (all required paperwork
and forms) by the February 1
deadline may result in the applicant losing his/her priority
status.
Decision Notification
For the Priority Admissions
applicants, the Admissions
Committee will offer a contract that must be returned
within 10 days from the date
of the contract.
Rolling Admissions
Timeline
(New Applicants)
Beginning February 2, applications will be processed as
received and as openings by
grade levels are available.
Applicants must have all required paperwork and forms
submitted to the Admissions
Office before the enrollment
process can begin.
1
How to Apply
Frequently Asked
Questions
Applicants for Grades K – 12
To apply, complete and return the following to the Admissions Office
What about Wait Lists?
If an applicant is qualified to
attend the Academy, but there
are no openings in that grade
level, the applicant’s name will
be placed in a “wait pool.” The
wait pool is made up of qualified applicants available to fill
a specific opening in a specific
grade. When and if an opening
becomes available, the Admissions Committee will convene
and select a candidate for the
opening.
(Applicants must have all required paperwork and forms submitted to the Admissions Office before the enrollment process can begin.):
Do priorities exist?
In a desire to keep families together, the Academy reserves
the right to give priority consideration to qualified sibling applicants.
What about
financial aid?
Applications for financial aid
are available through the Finance Office. Deadline for application is April 30.
What are our
accreditations?
affiliations?
ACSI
Association of Christian
Schools International
SACS
Southern Association of Colleges & Schools
AHSAA
Alabama High School Athletic
Association
SBACS
Southern Baptist Association
of Christian Schools
2
Application with $250 application fee
(International Students I-20 $750 application fee)
Parent/Guardian Commitment Forms (School & Spiritual)
Parent/Guardian Kingdom Education Commitment Form
Emergency/Medical Authorization Form
Confidential Teacher Recommendation Form
(Mailed directly to the Admissions Office)
Confidential Character Recommendation Form
(Grades 5-12 mailed directly to the Admissions Office)
Parent/Guardian Volunteer Screening Form
Student Corporal Punishment Release Form
Copies of standardized test scores
Copies of report cards (past 2 years)
Copy of current official high school transcripts
Copy of Birth Certificate
Immunization record
Whitesburg Christian Academy will complete the following:
Testing – Applicants will be notified by the Admissions
Office concerning required testing.
Student/Parent Interviews – Applicants/Parents will be
contacted by the Admissions Office for an interview.
How To Apply
Former Students
Students who have attended the Academy previously and wish to
return must submit the following:
Application with $250 application fee
Parent/Guardian Commitment Forms (School & Spiritual)
Completed Teacher Recommendation Form
(as required by grade level)
Current official transcript and report cards (past two years)
Whitesburg Christian Academy will complete the following:
Required testing
Required student/parent interviews
Application For Admission Grades K – 12
Student Information
Application for Grade _________________ School Year_ ________________________________
Student’s Full Legal Name____________________________ Preferred Name________________
Student’s Address________________________________________________________________
City__________________ State___________ Zip______________ Phone _________________
Current Grade ________ Student’s Social Security Number_______________________________
Date of Birth__________________
Male
Female
Parent/Guardian Information
Father Information
Father’s Full Legal Name
Mr.
Dr.
Rev._ _______________________________________
Father’s Address______________________________________Preferred Name______________
City__________________________________ State_________________ Zip________________
Phone Home__________________ Business____________________ Cell__________________
Employer__________________ Occupation______________ Email _______________________
Business Address ________________________________________________________________
City__________________________________ State_________________ Zip________________
Mother Information
Mrs.
Dr.
Rev._______________________________________
Mother’s Full Legal Name
Mother’s Address______________________________________Preferred Name______________
City__________________________________ State_________________ Zip________________
Phone Home__________________ Business____________________ Cell__________________
Employer__________________ Occupation______________ Email _______________________
Business Address ________________________________________________________________
City__________________________________ State_________________ Zip________________
Stepfather
Stepmother
Guardian
Full Legal Name
Mr.
Mrs.
Dr.
Rev._________________________________________
Address______________________________________Preferred Name_____________________
City__________________________________ State_________________ Zip________________
Phone Home__________________ Business____________________ Cell__________________
Employer__________________ Occupation______________ Email _______________________
Business Address ________________________________________________________________
City__________________________________ State_________________ Zip________________
Stepfather
Stepmother
Guardian
Full Legal Name
Mr.
Mrs.
Dr.
Rev._________________________________________
Address______________________________________Preferred Name_____________________
City__________________________________ State_________________ Zip________________
Phone Home__________________ Business____________________ Cell__________________
Employer__________________ Occupation______________ Email _______________________
Business Address ________________________________________________________________
City__________________________________ State_________________ Zip________________
3
Application For Admission Grades K – 12
Family Information
Student lives with
Father
Mother
Guardian
Stepmother
Stepfather
Married
Divorced
Separated Father Deceased
Student’s Parents are
Mother deceased
Any legal custody situations of which the Academy should be aware?
Yes
No
If yes, please explain:
_ ______________________________________________________
_ ______________________________________________________
Joint
Sole
If divorced, please indicate type of custody ordered by the court.
Which spouse holds legal responsibility for school decisions?_ __________________________
To whom should correspondence be sent?
Father
Mother
Both Parents
(Please submit copies of all court documents regarding custody and educational decisions along with application.)
General Information
Previous School Name_ ___________________________________________________________
Address________________________________________________________________________
City__________________________________ State_________________ Zip________________
Dates at previous school:________________________________ Last grade attended_ ________
Ever retained?
Yes
No Grade _____ Reason_____________________________________
Yes
No
Ever suspended, expelled, or asked to leave any school?
If so, please explain:______________________________________________________________
Grandparent Information
Name__________________________________________________________________________
Address________________________________________________________________________
City__________________________________ State_________________ Zip________________
Phone Home__________________ Cell____________________ Email_ ___________________
Name__________________________________________________________________________
Address________________________________________________________________________
City__________________________________ State_________________ Zip________________
Phone Home__________________ Cell____________________ Email ____________________
Name__________________________________________________________________________
Address________________________________________________________________________
City__________________________________ State_________________ Zip________________
Phone Home__________________ Cell____________________ Email_ ___________________
Name__________________________________________________________________________
Address________________________________________________________________________
City__________________________________ State_________________ Zip________________
Phone Home__________________ Cell____________________ Email_ ___________________
4
Spiritual Commitment Form Grades K-12
Student’s Name:_ ________________________________________________________________
Parent’s Name (or guardian):_ ______________________________________________________
All information must be completed. Only one form per family is necessary even if you have applied for more than one student.
Whitesburg Christian Academy is in partnership with parents to support and nurture the spiritual
growth and maturity of each student; therefore, regular church attendance (both parents) is preferred. Regular church attendance is required of at least one parent (with custodial status) to meet
admissions criteria.
Parent Commitment
Has the student’s father accepted Jesus Christ as his personal Savior?
Yes
No
Has the student’s mother accepted Jesus Christ as her personal Savior?
Yes
No
If a guardian, has he/she accepted Jesus Christ as his/her personal Savior?
Yes
No
One parent or guardian, please give a brief statement of your salvation experience. Be specific
about your personal relationship with Jesus Christ and the difference He makes in your life.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Church Attendance
What church do you attend?________________________________________________________
Are you a member?
Yes
No Are both parents church members?_____________________
Please rate your attendance as Regular = 4 times/month, Occasional = 2 times/per month, Rare = 6 or less times/year
Weekend Worship
Bible Study/Sunday School
Mid-week study  Regular
 Regular
 Regular
 Occassional
 Occassional
 Occassional
 Rarely
 Rarely
 Rarely
In addition to attendance, what activities or responsibilities are you and your student(s) involved in
at your church?__________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5
Spiritual Commitment Form Grades K-12
Please describe the ways in which you integrate your faith into your family’s life.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Whitesburg Christian Academy Statement of Faith:
We believe the Bible to be the only inspired, inerrant, infallible, and authoritative Word
of God.
We believe there is one God, eternally existent in three persons: the Father, the Son
(Jesus), and the Holy Spirit. He is an intelligent, spiritual, and personal Being, the
Creator, Redeemer, Preserver, and Ruler of the universe.
We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life,
in His miracles, in His vicarious and atoning death through His shed blood on a cross,
in His bodily resurrection, in His ascension to the right hand of the Father, and in His
personal return in power and glory.
We believe that salvation is the gift of God through faith in Jesus Christ by grace bestowed on those who call upon His name. Salvation is neither deserved nor earned
but freely given to anyone who will turn from one’s sin and call upon Jesus Christ to
be his or her Savior.
We believe in the present ministry of the Holy Spirit by indwelling every born-again
believer, enabling him or her to live a Godly life.
We believe it is the responsibility of every Christian to share the good news of Jesus
Christ to unbelievers through the power of the Holy Spirit.
I have read and agree to support Whitesburg Christian Academy’s Statement of Faith.
Father’s Signature/Date_ __________________________________________________________
Mother’s Signature/Date___________________________________________________________
Guardian’s Signature/Date_ ________________________________________________________
6
School Commitment Form Grades K-12
Student’s Name__________________________________________________________________
Parent’s Name (or guardian)________________________________________________________
How did you learn about Whitesburg Christian Academy?_________________________________
______________________________________________________________________________
Why do you want to enroll your child at Whitesburg Christian Academy?______________________
______________________________________________________________________________
Share with us anything that might help us in understanding your child better.__________________
______________________________________________________________________________
______________________________________________________________________________
Please initial each of these commitments that apply:
_____ I (We) pledge cooperation with the teachers, staff, and administration.
_____ I (We) have read and accept the conditions of this application.
_____ I (We) agree to be actively involved in a local body of believers (local church).
_____ I (We) give permission to publish our address.
_____ I (We) give permission to publish our phone number.
_____ I (We) give permission to publish our email.
_____ I (We) give permission to transport our student to the ROC (South Campus).
_____ I (We) give permission to use our student’s photo (still or video) for publication/broadcast
and marketing purposes.
_____ I (We) certify that all statements provided by us are true.
Upon favorable acceptance of the student, I (we) agree to accept all rules and regulations of the
school and authorize the school to administer such disciplinary measures, as may be deemed necessary and proper by the administration.
My signature below is an acknowledgement that I understand the nature of the spiritual, behavioral,
and academic standards of Whitesburg Christian Academy, and that I agree to be held accountable
for any violations of these standards.
Father’s Signature/Date_ __________________________________________________________
Mother’s Signature/Date___________________________________________________________
Guardian’s Signature/Date_ ________________________________________________________
7
Kingdom Education Commitment Form Grades K-12
Student’s Name_____________________________________ Grade_______________________
Kingdom Education is defined as the uniting of church, home, and school in the rearing of Godly
offspring. (Deuteronomy 6:7) Kingdom Education exists when God reigns in the entire educational process of a young person.
Kingdom Education is built on the following ten principles:
1. The education of children and youth is the primary responsibility of parents. (Deuteronomy 6:4-9; 11:1821; Psalm 78:1-7; 127:3; Proverbs 22:6; Malachi 2:13-16; Ephesians 6:4)
2. The education of children and youth is a 24-hours-a-day, 7-days-a-week process that continues from
birth till maturity. (Deuteronomy 6:7; 11:19; Proverbs 22:6)
3. The education of children and youth must have as its primary goals the salvation of and the discipleship
of the next generation. (Psalm 78:6-7; Matthew 28:19-20)
4. The education of children and youth must be based on God’s Word as absolute truth. (Matthew 24:35;
Psalm 119)
5. The education of children and youth must hold Christ as preeminent in all of life. (Colossians 2:3; 6-10)
6. The education of children and youth must not hinder the spiritual and moral development of the next
generation. (Matthew 18:6; 19:13-14; Mark 10:13-16; Luke 18:15-17)
7. The education of children and youth, if and when delegated to others by parents, must be done by
teachers chosen with utmost care to ensure that they all follow these principles. (Exodus 18:21; 1 Samuel
1:27-28; 3:1-10)
8. The education of children and youth results in the formation of a belief system or worldview that will be
patterned after the belief systems or worldviews of the person’s teachers. (Luke 6:40)
9. The education of children and youth must have a view of the future that includes the eternal perspective.
(Colossians 3:1-2; 3:23-24; Matthew 6:19-20; 2 Timothy 4:6-8; Acts 20:24; Hebrews 11:13)
10. The education of children and youth must lead to true wisdom by connecting all knowledge to a Biblical
worldview frame of reference. (Romans 1:20; 1:28; 11:33; Psalm 19:1; 104:24; 136:5; Proverbs 4:5,7; 3:19;
9:10; Jeremiah 10:12; Luke 11:52; Colossians 2:3; 1 Corinthians 8:1; 13:8)
I agree to read Kingdom Education by Glen Schultz (which may be checked out from the Admissions Office at Whitesburg Christian Academy) and attend the training session.
Father’s Signature/Date_ __________________________________________________________
Mother’s Signature/Date___________________________________________________________
Guardian’s Signature/Date_ ________________________________________________________
8
Emergency/Medical Authorization Form Grades K-12
Student’s Full Legal Name________________________________________________________________ Grade_________
Emergency Contacts:
Parent’s Name___________________________________________________________________
Phone Home__________________ Business____________________ Cell__________________
Parent’s Name___________________________________________________________________
Phone Home__________________ Business____________________ Cell__________________
Additional Contacts: (To be used in the event parents cannot be reached)
Contact’s Name__________________________________________Relationship______________
Phone Home__________________ Business____________________ Cell__________________
Contact’s Name__________________________________________Relationship______________
Phone Home__________________ Business____________________ Cell__________________
Pick Up Information:
In addition to my emergency contacts, the following may pick up my child:
Name___________________________________ Name_________________________________
Name___________________________________ Name_________________________________
Medical History:
Does your child suffer from chronic or acute illnesses such as diabetes, epilepsy, asthma, or allergies, etc?
Yes
No If yes, please explain. _________________________________________
______________________________________________________________________________
Specific instructions for treating above:________________________________________________
______________________________________________________________________________
Does your child have any physical problems that require reasonable accommodations?
Yes
No If yes, explain. ________________________________________________________
______________________________________________________________________________
Does your child take daily medication?
Yes
No If yes, what?__________________________
For what?_______________________________________________________________________
(Please use the back of this form to list additional information.)
Emergency Medical Service Permission:
Should an accident or illness occur during the school day or on a school-sponsored activity which
in the opinion of Whitesburg Christian Academy personnel requires immediate treatment and the
school is unable to locate either parent or guardian, I authorize and empower the proper authority of
Whitesburg Christian Academy to act in our stead and obtain the required medical services for the
above named child.
Family Physician’s Name_______________________________________Phone_ _____________
Health Insurance Name____________________________________________________________
Insurance Policy No. ______________________________________Group No._ ______________
Parent’s Signature/Date_ __________________________________________________________
9
10
Teacher Recommendation Form Grade K
THE FOLLOWING PORTION TO BE COMPLETED BY THE STUDENT’S PARENT:
My son/daughter is applying for admission to Whitesburg Christian Academy. Please complete
the following and return directly to Whitesburg Christian Academy. I hereby authorize the release
of my child’s records and evaluative data to Whitesburg Christian Academy. I understand that this
completed form will not be available to students, parents, or guardians.
Name of Student_________________________ Parent’s Name___________________________
Parent’s Signature_____________________ Date__________ Phone_______________________
Return to: Whitesburg Christian Academy, Admissions Office, 6806 Whitesburg Dr., Huntsville, AL 35802
TEACHER: As a current teacher, please evaluate the candidate based on your direct knowledge of him or
her. Keep in mind that the student should be evaluated according to others of the same chronological age.
The members of the Admissions Committee thank you for your interest, cooperation, and honesty. Your
comments will be held in strict confidence. This student’s application cannot be processed until this form is
received by the Admissions Office. If additional space is required for any question, please continue on an
additional sheet. Also enclose with this evaluation form any checklists or reports that you may use with your
students.
Social adjustment with peers:
Relates poorly
Establishes relationships but has frequent problems
Healthy relationships
Follow directions:
Rarely
Needs much explanation
Occasionally needs help
Quickly and effectively
Attention span/level of concentration:
Easily distracted
Occasionally distracted
Usually good
Exceptionally good
Response to a conflict situation:
Gives up
Cries
Fights
Turns to adult
Tries to reason
Response to a new social situation:
Withdraws to watch
Participates with strain
Participates with ease
Tends to dominate others
Disrupts activity
Understands the concept of taking turns:
Always interrupts or pushes ahead
Has some difficulty waiting turn
Usually waits turn without difficulty
Always waits turn without difficulty
Classroom conduct:
Frequent disruptions
Occasional disruptions
Usually good behavior
Excellent behavior
Separation from parent:
Frequently difficult
Occasionally hesitant
Not an issue
11
Teacher Recommendataion Form Grade K
Student’s Name__________________________________________________________________
What form of discipline/behavior modification is used in your classroom?_____________________
______________________________________________________________________________
______________________________________________________________________________
Does your preschool include organized learning programs in pre-reading activities?
Yes
No
If yes, please explain._ ____________________________________________________________
______________________________________________________________________________
How would you evaluate this student’s small motor abilities (examples: using scissors, crayons,
etc.)?
______________________________________________________________________________
______________________________________________________________________________
To your knowledge, has this student had his/her vision or hearing tested? Has your experience
with this student indicated any visual or hearing difficulties?_ ______________________________
______________________________________________________________________________
How would you evaluate this student’s readiness for Kindergarten?_ ________________________
______________________________________________________________________________
Do you perceive this student to have any special needs? If so, describe._____________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
How would you describe the parent’s support of you, the teacher, in matters of discipline or school
work?__________________________________________________________________________
______________________________________________________________________________
Is there anything else about this student that you would like to relate?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Teacher’s Name__________________________________Phone_ _________________________
Address____________________________________________________Email_ ______________
Position or Occupation_ ___________________________________________________________
Signature/Date___________________________________________________________________
Thank You!
12
Teacher Recommendation Form Grades 1-6
THE FOLLOWING PORTION TO BE COMPLETED BY THE STUDENT’S PARENT:
My son/daughter is applying for admission to Whitesburg Christian Academy. Please complete
the following and return directly to Whitesburg Christian Academy. I hereby authorize the release
of my child’s records and evaluative data to Whitesburg Christian Academy. I understand that this
completed form will not be available to students, parents, or guardians.
Name of Student_________________________ Parent’s Name___________________________
Parent’s Signature_____________________ Date__________ Phone_______________________
Applying for Grade: _______
Return to: Whitesburg Christian Academy, Admissions Office, 6806 Whitesburg Dr., Huntsville, AL 35802
TEACHER: As a current teacher, please evaluate the candidate based on your direct knowledge of him or
her. Keep in mind that the student should be evaluated according to others of the same chronological age.
The members of the Admissions Committee thank you for your interest, cooperation, and honesty. Your
comments will be held in strict confidence. This student’s application cannot be processed until this form is
received by the Admissions Office. If additional space is required for any question, please continue on an
additional sheet. Also enclose with this evaluation form any checklists or reports that you may use with your
students.
Ability to work in a group:
Has great difficulty
Sometimes has difficulty
Usually effective
Always works well
Social adjustment with peers:
Relates poorly
Establishes relationships but has frequent problems
Healthy relationships
Ability to stay on task and work independently: Classroom conduct:
Needs frequent refocusing
Frequent disruptions
Needs help frequently
Occasional disruptions
Needs help occasionally
Usually good behavior
Always works well on own
Excellent behavior
Fulfills responsibilities:
Rarely
Sometimes
Usually
Always
Consideration of others:
Rarely considerate
Usually considerate
Considerate
Extremely considerate
Response to a new social situation:
Withdraws to watch
Participates with strain
Participates with ease
Tends to dominate others
Disrupts activity
Response to a conflict situation:
Gives up
Cries
Fights
Tries to resolve with peer
Seeks teacher’s help
13
Teacher Recommendation Form Grades 1-6
Student’s Name__________________________________________________________________
What do you feel are the student’s academic strengths and weaknesses?_ ___________________
______________________________________________________________________________
______________________________________________________________________________
Subject
above grade level
at grade level
below grade level
Reading
Spelling
Written Expression
Handwriting
Math
Overall
Briefly describe your reading program (methods used, approach, etc)._______________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Do you perceive this student to have any special needs? If so, describe._____________________
______________________________________________________________________________
______________________________________________________________________________
How would you describe the parent’s support of you, the teacher, in matters of discipline or school
work?__________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Is there anything else about this student that you would like to relate?_ ______________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Teacher’s Name__________________________________Phone_ _________________________
Address____________________________________________________Email_ ______________
Position or Occupation_ ___________________________________________________________
Signature/Date___________________________________________________________________
Thank You!
14
Character Recommendation Form Grades 5-12
THE FOLLOWING PORTION TO BE COMPLETED BY THE STUDENT’S PARENT:
My son/daughter is applying for admission to Whitesburg Christian Academy. Please complete
the following and return directly to Whitesburg Christian Academy. I hereby authorize the release
of my child’s records and evaluative data to Whitesburg Christian Academy. I understand that this
completed form will not be available to students, parents, or guardians.
Name of Student_________________________ Parent’s Name___________________________
Parent’s Signature_____________________ Date__________ Phone_______________________
Applying for Grade: _______
Return to: Whitesburg Christian Academy, Admissions Office, 6806 Whitesburg Dr., Huntsville, AL 35802
CHARACTER REFERENCE: As a pastor or a character reference (non-relative of student), please evaluate the candidate based on your direct knowledge of him or her. Keep in mind that the student should be
evaluated according to others of the same chronological age. The members of the Admissions Committee
thank you for your interest, cooperation, and honesty. Your comments will be held in strict confidence. This
student’s application cannot be processed until this form is received by the Admissions Office.
Spiritual Development
CONSISTENTLY
SOMETIMES
SELDOM
NOT OBSERVED
Demonstrates a personal relationship with God
Demonstrates an eagerness to learn about God
and Biblical concepts
Seeks to apply Biblical standards to his/her life
Willingly memorizes Bible verses
Attends church
Attends youth group or church related activities
(Awana, GA, RA, etc.)
Participates in class or group discussions
Takes a leadership role in youth activities
Parental support is evident
Has the student accepted Jesus Christ as Lord and Savior?
Yes
No
Not Sure
15
Character Recommendation Form Grades 5-12
Student’s Name__________________________________________________________________
How long have you known the student?_______________________________________________
How supportive are the student’s parents of organizational policies and procedures?____________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
If you have additional information that would be helpful to the Academy Admissions Committee in
evaluating this candidate’s application, please comment. If needed, use another sheet of paper.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Select one:
Highly Recommend
Do Not Recommend
Recommend
Recommend with Reservation
If you selected “Do Not Recommend” or “Recommend with Reservation,” please explain:________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Recommended by__________________________________Phone_________________________
Relationship to Student____________________________________________________________
Email__________________________________________________________________________
Position or Occupation_ ___________________________________________________________
Church or Organization____________________________________________________________
Address of Church or Organization___________________________________________________
Signature/Date___________________________________________________________________
Thank You!
16
Teacher Recommendation Form Grades 7-12
THE FOLLOWING PORTION TO BE COMPLETED BY THE STUDENT’S PARENT:
My son/daughter is applying for admission to Whitesburg Christian Academy. Please complete
the following and return directly to Whitesburg Christian Academy. I hereby authorize the release
of my child’s records and evaluative data to Whitesburg Christian Academy. I understand that this
completed form will not be available to students, parents, or guardians.
Name of Student_________________________ Parent’s Name___________________________
Parent’s Signature_____________________ Date__________ Phone_______________________
Applying for Grade: _______
Return to: Whitesburg Christian Academy, Admissions Office, 6806 Whitesburg Dr., Huntsville, AL 35802
TEACHER: As a current teacher, please evaluate the candidate based on your direct knowledge of him or
her. Keep in mind that the student should be evaluated according to others of the same chronological age.
The members of the Admissions Committee thank you for your interest, cooperation, and honesty. Your
comments will be held in strict confidence. This student’s application cannot be processed until this form is
received by the Admissions Office. If additional space is required for any question, please continue on an
additional sheet. Also enclose with this evaluation form any checklists or reports that you may use with your
students.
Academic Skills
SUPERIOR
BELOW
GOOD
AVERAGE
AVERAGE
N/A
Listens to and follows teacher’s directions
Demonstrates an appropriate attention span
Exhibits good study habits
Completes assigned tasks
Expresses written ideas clearly
Expresses verbal ideas clearly
Social Skills
Responds positively to constructive criticism
Establishes friendships easily and is considerate
Demonstrates maturity level that is age-appropriate
Is respected by faculty and respects faculty
Respects others
Is respected by peers
Is a positive influence on peers
Demonstrates self-discipline
Takes responsibility for belongings
Demonstrates appropriate behavior
Participates in extracurricular activities
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Teacher Recommendation Form Grades 7-12
Student’s Name__________________________________________________________________
Is the student habitually tardy or absent?
Yes
No If yes, please elaborate._____________
______________________________________________________________________________
How long have you known the student?_______________________________________________
How would you describe the parent’s support of you, the teacher, in matters of discipline or school
work?__________________________________________________________________________
______________________________________________________________________________
How supportive are the student’s parents of school policies and procedures?__________________
______________________________________________________________________________
______________________________________________________________________________
If you have additional information that would be helpful to the Academy Admissions Committee in
evaluating this candidate’s application, please comment. If needed, use another sheet of paper.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Select one:
Highly Recommend
Do Not Recommend
Recommend
Recommend with Reservation
If you selected “Do Not Recommend” or “Recommend with Reservation,” please explain:________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Recommended by__________________________________Phone_________________________
Relationship to Student____________________________________________________________
Email__________________________________________________________________________
Position or Occupation_ ___________________________________________________________
Church or Organization____________________________________________________________
Address of Church or Organization___________________________________________________
Signature/Date___________________________________________________________________
Thank You!
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Student Corporal Punishment Policy Grades K-12
Student’s Name_____________________________________ Grade_______________________
In accordance with the Parent/Student Handbook of the Academy policies and procedures, including all subsequent revisions, I hereby authorize Whitesburg Christian Academy to administer corporal punishment (paddling). The parent/guardian will be contacted prior to the administering of
corporal punishment. The following are excerpts from the Handbook.
Grammar School: Punishment may include written assignments, in-house suspensions, or calling parents/guardians and requiring them to come to the school to administer corporal punishment
(paddling). Additional episodes may result in an Academy official administering corporal punishment for those parents/guardians that have given written permission for corporal punishment. The
corporal punishment permission slip must be on file in the Admissions Office. Academy administered corporal punishment may be administered by a school/church official of the same gender and
witnessed by one other adult.
Upper School: Upper school corporal punishment will be the exception rather than the rule; therefore, the Upper School will be systematic in its approach to discipline.
I (we) agree with the corporal punishment policy.
Father’s Signature/Date_ __________________________________________________________
Mother’s Signature/Date___________________________________________________________
Guardian’s Signature/Date_ ________________________________________________________
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Appendix
VOLUNTEER SCREENING DOCUMENT GRADES K-12
To volunteer at Whitesburg Christian Academy, the following pages of documentation must be read,
completed, and signed by each individual wishing to volunteer. The term volunteer is used for any
person wishing to help during or after school hours inside or outside the classroom. This includes
any activities involving any contact with students without the teacher or school official present at all
times.
Whitesburg Christian Academy is a ministry of Whitesburg Baptist Church; it falls under the policies
governing volunteer procedures. Whitesburg Christian Academy has the moral and legal responsibility to provide a safe and secure environment for all minors entrusted to our care. This child abuse
prevention policy includes screening all employees and volunteers. The process for current volunteers involves providing requested information and authorizing the Church/Academy to conduct a
criminal or sexual offender background check.
We recognize that the screening process may produce sensitive information. Accordingly, information provided by volunteers and the result of background checks will be reviewed in strict confidence
by authorized persons, and the confidentiality of all screening information will be preserved.
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Volunteer Screening Form
Student’s Name_____________________________________ Grade_______________________
1. All volunteers must fill out a background check form prior to volunteering at the Academy. All volunteers must have read the Whitesburg Baptist Church policies and procedures for child abuse prevention. All volunteers who wish to drive on field trips must have a copy of their up-to-date driver’s
license and car insurance on file in office of the principal in the school in which you are volunteering.
Upon expiration of your license or insurance, please provide the office with an updated copy.
2. Sign in at the office - name badges for volunteers are different than those for visitors. On the
days you come to volunteer in the classroom, you will be given a free lunch if you serve at least a
half day. You must order your lunch at the office before 9 a.m.
3. All library, office, computer, art, classroom, field trip volunteers and any other volunteers used by
the Academy must not touch a child in an inappropriate way. For example, frontal hugs are not acceptable. If you have any concerns about what that could involve, please ask. Do not put yourself
in a position to be criticized or misunderstood.
4. All library, office, computer, art, classroom, field trip volunteers and any other volunteers used
by the Academy must not discipline a child without referring the student to a teacher. Do not say
anything to students that you would not say to the students in the presence of their parents. Do not
put yourself in a position to be criticized or misunderstood.
5. Confidentiality - What happens in the classroom, stays in the classroom. The teacher of the
class will decide if she needs to contact the office or parent.
6. Dress Code - We want to set a professional example for our students. All classroom volunteers
are asked to dress at least business casual and modestly. Do not wear short shorts, short dresses,
or short tops. Do not wear jeans unless it is a day/trip where students are allowed to wear jeans.
7. Do not try to leave early with your child unless you check them out at the office. This applies to
the entire school population. Students must be checked out if they are taken from school property
before the students are lined up in the hall to go downstairs for carpool.
8. While chaperoning/attending a field trip, please remain with the group at all times.
9. The use of alcohol, illegal drugs, or tobacco is prohibited on all field trips.
10. Violation of these practices may result in the parent not participating in the volunteer program.
Signature of Volunteer/Date_ _______________________________________________________
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Volunteer Background Authorization Form
Full Legal Name (first, middle, last)__________________________________________________________
Former Name(s) and Dates Used___________________________________________________________
Current Address_ _______________________________________________________________________
City__________________________________ State_________________ Zip_______________________
Previous Address_ ______________________________________________________________________
City__________________________________ State_________________ Zip_______________________
List each state you have lived in during the past seven years_ ____________________________________
Social Security Number________________________________Date of Birth_________________________
Telephone Number:______________________________________________________________________
Driver’s License Number/State_____________________________________________________________
Student name/Relationship________________________________________________________________
Have you ever been arrested for, charged with, under probation for, convicted of, or accused of sexual misconduct or physical abuse? Yes
No If yes, please explain.___________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Are there any unresolved issues such as alcoholism, rape, misuse of prescription or illegal drugs, sexual
abuse, etc. in your past that may impair your ability to effectively work with minors? Yes
No If yes,
please explain.__________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
The information contained in this application is correct to the best of my knowledge. I hereby give my
permission for Whitesburg Baptist Church/Whitesburg Christian Academy and their designated agents and
representatives to conduct a comprehensive review of my background causing a consumer report and/
or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to
the following areas: verification of social security number, credit reports, current and previous residences,
employment history, education background, character references, drug testing, civil and criminal history
records from any criminal justice agency in any or all federal, state, and county jurisdiction, driving records,
birth records, and any other public records.
I further authorize any individual, company, firm, corporation or public agency (including the Social Security
Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Whitesburg Baptist Church or Whitesburg Christian Academy. I further authorize the complete
release of any records or data pertaining to me which the individual, company, firm, corporation, or public
agency may have, to include information or data received from other sources.
Whitesburg Baptist Church, Whitesburg Christian Academy, and their designated agents and representatives
shall maintin all information received from this authorization in a confidential manner in order to protect the
applicant’s personal information, including, but not limited to, addresses, social security number, and date of
birth.
There is a $5.50 fee for the background check. All volunteers will be billed to cover this cost.
Signature of Volunteer/Date_ ______________________________________________________________
To be completed by Admissions Office
Information entered and submitted for processing
Initials_____________ Date_________________
23
24
the caring place
WHITESBURG
BAPTIST CHURCH
Policy and Procedure for Child Protection
WBC cares for its children!
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Child Sexual Abuse Prevention
A. Purpose
The Church insurance carrier considers the problem of child sexual abuse to be the number one catastrophic risk facing
churches today. Accordingly, it is the policy of Whitesburg Baptist Church to provide a safe and secure environment
for all children and youth (see definitions below.) entrusted to our care, and to protect innocent workers from unfounded
claims. All employees and respective volunteers are responsible for assuring that children and youth who are under the
purview of the Church are protected from sexual abuse. This policy has five specific purposes:
1. To strive for an environment in which children, youth and their families may be guided toward a saving
relationship with Jesus Christ and may grow in their relationship with Him.
2. To have confidence that children and youth are comfortable, secure and appropriately supervised while in the
Church environment (to include off-campus activities).
3. To assure that parents are comfortable and satisfied that their minor children will be in a safe and secure
environment when entrusted to the Church.
4. To abide by State law and meet respective guidelines set forth by insurance carriers.
5. To reduce the vulnerability, risk and liability of the church and key leaders regarding legal action stemming
from child sexual abuse or accusations thereof.
B. Definitions
For the purpose of this policy, the following definitions shall apply:
1. “Children and Youth” or “minor” includes anyone (infant, preschooler, child or youth) under the legal age of
18 or whose mental capacity is that of a minor.
2. “Adult” is any individual who is at least 18 years of age (and not mentally handicapped).
3. “Worker” is any adult who serves as an employee or volunteer and who is given the responsibility of working with children or youth.
4. “Teenage worker” is any worker who is at least 14 years old, but under the age of 18, enlisted to assist with
the care of minors.
5. “Child Sexual Abuse” is any sexual related activity with a minor. The abuser may be an adult, youth or
another child provided the child is at least four years older than the victim. The abuse may be violent or nonviolent and may involve touching or non-touching activity. Sexual child abuse is criminal behavior.
C. Scope
This policy to prevent child sexual abuse applies to current and future personnel (ordained and non-ordained full-time
and part-time employees and volunteers) who will have the responsibility of supervising the activities of preschoolers,
children, youth and mentally handicapped persons within the purview of Whitesburg Baptist Church, including: Education ministries, Mission organizations, Weekday Education, Mother’s Day Out and other child care activities, Whitesburg Christian Academy, music programs including Excel and choirs for minors, Bus Ministry, Recreation Outreach
Center activities, counseling of minors, on-campus lock-ins and Church sanctioned off-campus activities including
those in private homes and those involving travel.
D. Overview
The policy calls for attention in four areas that is necessary for the protection of our children, our employees and our
church: the employee and volunteer selection process, the protection policy and guidelines, the reporting procedures,
and responding to allegations. The paragraphs below provide an overview of the Church policy to prevent child sexual
abuse.
1. All current employees, as of September 1, 2004, will undergo a national criminal background search.
2. After September 1, 2004, Church employees (paid and unpaid) including ordained and non-ordained fulltime and part-time positions will undergo thorough screening as a part of the hiring process. The screening
shall include:
a. Completing a written application
b. Completing reference checks
c. Conducting a personal interview and recording the results
d. Obtaining a national criminal background search
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4. After October 1, 2004, volunteers who work with minors will be screened, to include:
a. A written application
b. Reference checks
c. A personal interview
d. Being subject to a background investigation
5. All who work with minors will receive training regarding the prevention of child sexual abuse.
6. A minimum of two adults, who are not related by blood or marriage, will normally be assigned to lead activities involving minors (“the two-adult rule”).
7. Procedures have been established for reporting and responding to known or suspected cases of child sexual
abuse.
E. Protection Guidelines
In addition to the screening of workers, the following guidelines are set forth to help assure the safety of minors and the
protection of workers from unfounded allegations. Unusual, urgent or emergency circumstances may arise that necessitates the need to deviate from this policy. For such infrequent situations that are not classified elsewhere in this policy
document, the standards and spirit of this guidance shall be recognized as being in force. Any decision to temporarily
deviate from this policy will normally be made only by age group ministers or persons above in the supervisory chain.
1. Never allow a minor to be alone with one adult (or two related adults) on Church premises or in any sponsored activity unless it’s a counseling, Academy educational or special situation as described below.
a. In counseling sessions with minors, parental permission shall be obtained prior to a minister or
teacher meeting privately with a minor, or the two adult rule shall be used in that instance. Prior permission may be granted by parents to cover a particular time period (e.g., a school year) for their child
to receive counseling from a particular minister.
b. In special situations where leaving a minor alone with one adult is considered to be acceptable and
necessary (e.g. Academy teacher or worker), parental permission must be granted in writing; the activity and time period must also be specified. Such special situations must be approved by the Senior
Associate Pastor or his designated representative.
2. A minimum of two adults, who are not related by blood or marriage, will normally be assigned to lead activities involving minors (two-adult rule). Weekday Education and Whitesburg Christian Academy are exempted
from the two adult rule in classroom settings.
3. Related adults may teach, lead or supervise minors together in the same room or in the same activity where
there is a large group setting such as Sunday School or Sunday extended session and when hall monitors are
present and doors without glass are open; otherwise another adult should be present. Such related adults should
have a background investigation.
4. At least two unrelated adult leaders will be required for all trips and outings; related adults may participate
in such activities when another adult is present.
5. Adult leaders must respect the privacy of minors in situations such as changing clothes or taking showers
during Church sanctioned activities. Adults should also protect their own privacy in similar situations.
6. One-on-one discussions between adults and minors in secluded locations are strongly discouraged. In those
situations where a one-on-one session is considered to be necessary to maintain the spiritual, emotional or
physical well-being of the child, adults are encouraged to take precautions to protect themselves and the minor
from compromising situations.
7. An identification system shall be adopted so that kindergarten-age children and younger are picked-up by
a parent or guardian or someone else who has been authorized to do so. Permission slips will be available for
adults to sign, authorizing the release of the child(ren) to another person.
8. A list of workers with minors who meet Church approval shall be posted or otherwise available near each
classroom or area where minors are located. Only persons who have been authorized by the Church to do so,
will be allowed to interact with minors during Church sponsored activities.
9. Doors, for rooms that cannot otherwise be viewed from the outside, should remain open when activities for
minors are occurring within.
10. Church staff members, age group ministers and volunteer directors shall supervise activities for minors on
a regular, on-going basis, and make unannounced visits into classes and other program sites from time to time
to assure adherence to the above guidelines.
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11. It is recognized that ministry leaders may invite guest speakers, who have not been screened by our Church,
to lead in worship services or other activities for minors. On those occasions a cleared volunteer or staff employee should be present throughout the activity.
F. Assessing Levels of Risk
Not all activities bear the same level of risk. As a result, the level of supervision should correspond to the level of risk.
Accordingly, it is necessary to have some means to assess risk with respect to specific activities and programs. One assessment approach is to examine the risk factors of isolation, accountability, and power and control. The interaction of
these three factors result in a risk environment.
1. Assessing the Risk
a. Isolation: As a general principle, risk increases as isolation increases. Four factors that affect isolation are: (1) the number of people present, (2) the time of the activity, (3) the location of the activity,
and (4) the physical arrangements. Evaluate the level of isolation by examining the number of people
who are present, plus the time, location and physical arrangements. ( Note: As a general guideline, we
should treat any activity that is located off Church property, or any activity that is located on Church
property, but at a time or location that is isolated, as higher risk.)
b. Accountability: Accountability involves justifying one’s actions. Activities for minors should occur
in settings where those present must give account of their activities. Three factors that affect accountability of supervisors in activities involving minors include: (1) the personal character and integrity of
the adult worker; (2) the number of people present for the activity; and (3) the degree of openness and
approval associated with the activity. Accountability increases when two or more unrelated adults are
present for activities that involve minors.
c. Power and Control: One reason that minors are so vulnerable to sexual predators is the imbalance of
power related to age, size, strength, and also control and authority. Once abuse occurs, perpetrators will
use their power, authority and influence to promote silence. Abuse is less likely to occur when a balance of power exists. That balance of power does not exist between a child and an adult abuser. Rather,
the balance of power must come from other adults or, to some extent, from other children, as well as
from policies that are designed to maintain a low risk environment. An imbalance of power may also
exist among minors when there is an age difference of five or more years.
2. High risk Church sponsored activities for minors include the following.
a. Any activity that occurs in a home.
b. Over night activities such as lock-ins, camping trips and staying in public lodging,
c. Any activity that involves changing clothes.
d. Events that involve age differences of five or more years.
e. Activity in an isolated environment: a building off by its self or a park that has secluded areas.
3. Use the following principles to guide child safety planning and efforts.
a. As risk increases, supervision should also increase.
b. Risk increases as accountability decreases.
c. Risk increases when there is an imbalance of power, authority, influence and control
between a potential abuser and a potential victim.
4. Maintain an awareness of risk that involves activities for minors; and make a reasonable effort to
reduce the risk.
G. Acts or Omissions in Violation of This Policy
The following acts or omissions are violations of this policy and will not be tolerated or accepted during any
activity or program and are to be immediately reported to the ministry or activity supervisor, after the safety
of the child, children, youth, or minor involved has been assured.
1. Any display or demonstration of sexual activity towards a minor.
2. Sexual advances or sexual activity of any kind between any person and a minor.
3. Physical neglect of a minor, including failure to provide adequate supervision in relation to the
activities of the Church.
4. The presence, possession or internet viewing of obscene or pornographic materials at any function
of the Church.
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5. The presence, possession, or being under the influence of any alcohol or illegal or illicit drugs while
leading or participating in a function for minors that is sponsored by the Church.
6. An adult who has not been cleared to do so, attempting to interact with minors involved in Church
sponsored activities.
H. Symptoms of Molestation
Church staff members and workers should be alert to physical signs of abuse and molestation, as well as to behavioral and verbal signs that a victim may exhibit. Some of the more common signs are summarized below.
The origin of these symptoms might be inside or outside (e.g., in the home) the Church community.
Physical signs may include:
1. Irritation, pain or injury to the genital area
2. Difficulty with urination
3. Discomfort when sitting
4. Torn or bloody underclothing
5. Venereal disease
6. Nightmares
7. Lacerations and bruises
Behavioral signs may include:
1. Anxiety when approaching the Church
2. Nervous or hostile behavior toward adults
3. “Acting out” sexual behavior
4. Exhibit inappropriate knowledge or interest about sex
5. Withdrawal from Church activities and friends
Verbal signs may include the following statements:
1. I don’t like (a particular Church worker or other person).
2. (A Church worker or other person) does things to me when we are alone.
3. I don’t like to be alone with (a Church worker or other person).
4. (A Church worker or other person) fooled around with me.
I. Child Sexual Abuse Prevention Reporting
An established reporting procedure is a critical component of the child sexual abuse prevention program.
Alabama law (Code of Alabama, Title 26, Chapter 14) requires that the Church (workers and leaders) render a
report regarding known or suspected victims of child abuse or neglect. Failure to make the report is a misdemeanor and is punishable by a fine or imprisonment. The State provides immunity from liability for anyone
who makes a good faith report required by the aforementioned law.
Reporting child abuse is a moral obligation as well as a legal one. All Church staff members and workers
need to know what constitutes an occasion for reporting, their obligation to make a report, and the reporting
channels they should use. A description of questionable or inappropriate worker behavior and the symptoms
of molestation are summarized in Paragraphs G and H, respectively. Child sexual abuse thrives when it goes
unnoticed or unreported. Reports may be classified as internal and external.
Internal reporting includes the institution of a chain of reporting that shall be followed in every case of suspected child abuse. The Office of the Pastor will designate a senior ministerial position within the Church
staff who will ultimately receive all reports related to child abuse and who will coordinate all further Church
actions regarding the reported incident.
1. Any worker having cause to believe that a minor has been abused or that an adult (or teenage worker) has exhibited behavior that might lead to child abuse, shall report their belief as follows:
a. Report the suspicion immediately to the Church minister or director that supervises the ministry or activity in which the incident occurred.
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b. Submit a written report after the verbal report.
c. Document the report by writing down the victim’s name, address, condition, location of
the incident (if appropriate), the name of others involved and exactly what action, omission or
behavior was observed.
d. Record what the child said but make no attempt to question the child about the incident;
leave that to State or law enforcement representatives.
2. The minister receiving the report is responsible for confirming (the same day) the reported information. The documented facts surrounding the incident will be routed (on the day of the incident) to
the Senior Associate Pastor or Business Administrator. In case an incident report, in accordance with
this policy, is necessary when Church offices are closed, the report will be submitted to the Church
emergency telephone number. The confidentiality of the victim and the alleged perpetrator shall be
considered and maintained throughout the reporting process.
External reporting includes any information provided to agencies or persons outside the Church campus and
is the responsibility of the Business Administrator. Reports will be provided to:
1. The Alabama Department of Human Resources (DHR), 2206 Oakwood Ave NW, Huntsville, AL
35810. A verbal report within 24 hours to 535-4500 (534-4940 evening and weekend) will be followed by a written report within 72 hours. Use DHR Form (DHR-DFC-1593) located in the Administration Office.
2. The victim’s family. Arrange for the family to be appropriately informed and keep the family advised of the steps that are being taken and the status of any investigation. (Church legal counsel should
assist in this determination.)
3. The Church Insurance carrier.
As an exception to the external reporting policy set forth above, the Weekday Education Director and the
Whitesburg Christian Academy Principal may submit reports directly to the DHR in accordance with Subparagraph 1, above; the Office of the Pastor and/or Business Administrator shall be kept fully informed. All
other external reporting shall be in accordance with the external reporting policy, above.
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Whitesburg Christian Academy
6806 Whitesburg Dr.
Huntsville, AL 35802
256-704-5678 ext 353
www.WhitesburgChristianAcademy.org
Lynn Lewis, Registrar
256-704-5678, ext 458
[email protected]