Application for Admission

Print Form
Lanakila Baptist Schools
"Pursuing Christ and Academic Excellence"
APPLICATION FOR ADMISSION
This application does not assure final enrollment but provides information upon which a decision will be based.
The registration fee is payable with the application ($25.00) and is non-refundable. If your application is
accepted, it will be necessary to present a signed release form from the last school attended and to arrange
for the payment of the non-refundable Enrollment Fee. Tuition arrangements also will be arranged at
this time.
Academic Year: _____________________________
Applying for Grade:
KIN
1
2
3
4
5
6
7
8
9
10
11
12
PLEASE PRINT INFORMATION
Applicant Information
First Name:__________________ Middle Name:______________ Last Name: ____________________
Goes by: ____________________ Date of Birth:_________ Age:_____ Gender:
Male
Female
Parental / Guardian Information
Applicant lives with: ____Father ____Mother ____Guardian(s)
Father's First Name:_____________________ MI: ______ Last Name: ______________________
Wk Phone: _______________ Occupation: _______________ Employer: _____________________
Home Address: ______________________ City: ______________ Zip:______ Phone No.________
Emergency Phone: ________ Cell: _______ May we publish your home phone#? ____Yes___ No
Mother's First Name: ____________________ MI: ______ Last Name: ______________________
Wk Phone: _______________ Occupation:________________ Employer: _____________________
Home Address: ______________________ City: ______________ Zip:______ Phone No.________
Emergency Phone: ________ Cell: _______ May we publish your home phone#? ____Yes___ No
Legal Guardian Name: ____________________ MI: ______ Last Name: ______________________
Wk Phone: _______________ Occupation: _______________ Employer: _____________________
Home Address: ______________________ City: ______________ Zip:______ Phone No.________
Emergency Phone:________
Cell:_______
May we publish your home phone#? ____Yes___ No
If you are the Legal guardian, please provide custody documents or proof of legal guardianship.
Please include one primary email address for electronic notifications.
Email Address: ________________________________ ______________
Additional Information
Last school attended: _______________________________________________________________________
School Address ____________________________________________________________________________
Curriculum that was used at last school attended: ________________________________________________
Do you have outstanding tuition/fees at another school? ____ If so, where ____________How much _______
If child has repeated any grade, state grade and reason ___________________________________________
_________________________________________________________________________________________
Has the student had any disciplinary difficulty in school? _______ If so, state briefly ____________________
_________________________________________________________________________________________
Has the student had any difficulty with civil authorities? _______ If so, state briefly ____________________
_________________________________________________________________________________________
Physical Disabilities:
_________________________________________________________________________________________
Learning Disorders that we should be made aware of:
ADD
ADHD
ODD
Dyslexia
Other: ___________________________________
Is the student on any medication or in therapy for the above condition? _____
If so, state briefly _________________________________________________________________________
Subject's in which applicant is strong in: ________________________________________________________
Subject's in which applicant is weak: ___________________________________________________________
Religious Affiliation: ________________________________________________________________________
Number of other children in the family: _________
Name of others living in the same household ___________________________________________________
_________________________________________________________________________________________
Explain why you wish for your child to attend our school: __________________________________________
_________________________________________________________________________________________
If referred, please list the name of the person who referred you: ____________________________________
PARENTS ARE REQUESTED TO READ THE STATEMENT OF FAITH
AND PARENT AGREEMENT ON AND SIGN.
A BRIEF STATEMENT OF FAITH FOR LANAKILA BAPTIST SCHOOLS
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We believe that the Bible is the infallible, verbally inspired Word of God and that it is therefore, our final authority
in matters of faith and practice.
We believe in the eternally existing, Triune God: Father, Son and Holy Spirit.
We believe in the Deity of Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and
atoning death through His shed blood, in His bodily resurrection, and in His ascension to the right hand of the
Father, where He now acts as Mediator and Advocate.
We believe in the personal imminent return of our Lord Jesus Christ for His own, in His later return in power and
glory with His own to reign in righteousness over the earth, and in the resurrection of both the saved and lost -they that are saved unto the resurrection of life and they that are lost into the resurrection of damnation.
We believe that Heaven is the place of eternal blessedness for the saved and that Hell is the place of eternal
conscious punishment for the lost.
We believe that regeneration by the Holy Spirit is absolutely essential for the salvation of lost and sinful men and
that all who receive the Lord Jesus Christ by faith are born again and become the children of God.
We believe in the present ministry of the Holy Spirit whose indwelling in all believers enables them to live godly lives.
AGREEMENT
WE AGREE TO HAVE OUR CHILDREN TAUGHT IN THE CONTEXT OF LANAKILA BAPTIST SCHOOL'S STATEMENT
OF FAITH AND TO GIVE ENCOURAGEMENT TO THEM AS THEY SEEK TO ACT ON THIS INSTRUCTION IN THEIR
PERSONAL LIVES AND EXPERIENCES.
I hereby accept all regulations of the schools in the applicant's behalf.
I herewith authorize this school to employ such legal and reasonable discipline as it seems wise and expedient for
my child.
I give permission for my child's image or photo to be used in promotional material for Lanakila Baptist Schools.
I give permission for my child to take part in all school activities, including sports and school-sponsored trips away
from the school premises, and absolve the school, as applicable, from all liability to me or my child, because of
any injury to my child, at school or during any school activity.
I understand that the administration and faculty of Lanakila Baptist Schools will not tolerate profanity/obscenity,
any dishonor to the Holy Trinity or the Word of God, nor a disrespectful attitude toward school personnel. I will
quietly withdraw my child from school when I no longer support the program of Lanakila Baptist Schools.
I hereby pledge to pay my financial obligation to Lanakila Baptist Schools on or before the dates due.
I understand that if my child is expelled from school, there is no refund of tuition or fees.
I understand that there is a $25.00 fee for all returned checks.
I have read the terms stated on this application and agree thereto willingly supporting the educational goal of
creating the best possible atmosphere for the training of my child (ren).
___________________________________
____________________________
(PRINTED NAME OF PARENT OR GUARDIAN)
(SIGNATURE OF PARENT OR GUARDIAN)
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THIS SECTION FOR STUDENTS IN GRADE 7-12 ONLY
I, the undersigned, hereby agree to give my wholehearted cooperation as a student who has the privilege of attending
this great school and pledge to refrain from the following:
1. Actual violence and damage against the persons or the physical property of this institution.
2. Verbal threats or expressed acts of potential violence.
3. Smoking, drinking, gambling, illicit drugs.
4. Improper boy-girl relationship.
5. Fighting.
6. Profanity or filthy language.
7. Critical and uncooperative attitudes.
8. Conduct that will reflect unfavorably upon the testimony of Lanakila Baptist Schools.
I further understand that the privilege of attending Lanakila Baptist can be removed at any time if the above are violated,
or is the opinion of the administration, that my continued presence is considered not in the best interest of the school.
___________________________________
____________________________
(PRINTED NAME OF STUDENT)
(SIGNATURE OF STUDENT)
FOR OFFICE USE ONLY
Date application: rec'd: ______________
Amount paid: $_______________ Cash
Ck# _______ Receipt #:_________________
Interview Date: ___________________________
Date Accepted: __________________
Time: __________________
Date Denied: ___________________
Date Comprehensive fee paid: __________________
Amount paid: $_______________
Tuition: $_________________________
Payment Method:
Payment in Full
Half/Half
MAP
Date tuition payment or arrangements made: ______________________
Payment by:
Cash
Check
M.O.
Cashier's Check
Receipt #: ___________
If payment is MAP agreement, date agreement is sent to bookkeeper: __________________
Notes: