Student Application

Enrollment Form

In the following pages you will find the Student Enrollment Application, Statement of Faith, Enrollment Policies, Admissions Procedures, and Health History Form.

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Enrollment Form

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Student's Legal Name

Last

First

Middle

Nickname

Home Address

Address

City

State

Zip Code

Home Phone

Date of Birth

Gender

Male

Female

Does your student have a current IEP?

Yes

Currently in Grade

Applying for Grade

Interested in after Preschool daycare at Loving Care Daycare

Previous School Attended (if applicable):

School Name

Phone

Address

City

State

Zip Code

Has student ever repeated any grade?

Yes

If yes, please explain:

Has student ever been dismissed or suspended?

Yes

If yes, please explain:

Are there areas (academic, social, citizenship, spiritual) where you feel that your student may need special assistance in adjusting to his/her new school situation?

We desire to enroll our child(ren) in Legacy Christian School because

Applicant's Siblings (if applicable):

Name

Age

Current School

Name

Age

Current School

Name

Age

Current School

Name

Age

Current School

Name

Age

Current School

Parents/Guardian Information

Father/Guardian 1:

Address (if different from child's)

Address

City

State

Zip Code

Occupation

Employer

Employer Address

Address

City

Work Phone

Cell Phone

Main Email

Mother/Guardian 2:

Address (if different from child's)

Address

City

State

Zip Code

Occupation

Employer

Employer Address

Address

City

Work Phone

Cell Phone

Main Email

Parents/Guardians are:

Please check all that apply

Married

Single

Separated

Divorced

Father Remarried

Mother Remarried

Father Deceased

Mother Deceased

If parents are divorced or separated, to whom should admission correspondence be sent and their address?

I (We) understand that should our address, marital status and/or custody arrangements change, it is my (our)
responsibility to notify the school and to have any necessary documents updated with the Legacy Christian offices in a
timely manner.

Father/Guardian 1 Initials

Mother/Guardian 2 Initials

If your student is not living with both parents, please answer the following questions.

A. Please explain the custodial arrangements and attach a copy of the most recent appropriate legal documents which clarify these arrangements.

Legal Document File Upload

Choose File

B. According to the most recent court order, who is allowed to make contact with the student at school or to pick the student up at school?

C. Please list who is authorized to receive mailings (newsletters, report cards, etc.)

Statement of Faith

1. The Bible
We believe the Bible to be the inspired, the only infallible, authoritative, inerrant Word of God, and the final authority in faith and life. (2 Timothy 3:16-17, 2 Peter 1:20-21)

2. The Trinity
We believe in One God, Creator and Redeemer, eternally existent in three persons- Father, Son, and Holy Spirit. (Genesis 1:1, Matthew 28:19, John 10:30)

3. Christ Jesus
We believe in the deity of Christ (John 10:33), His virgin birth (Isaiah 7:14, Matthew 1:23, Luke 1:35), His sinless life (Hebrews 4: 15, 7:26), His miracles (John 2:11), His vicarious and atoning death (1 Corinthians 15:3, Ephesians 1:7,Hebrews 2:9), His Resurrection (John 11:25, 1 Corinthians 15:4), His Ascension to the right hand of God (Mark 16:19), His personal return in power and glory (Acts 1:11, Revelation 19:11)

4. Salvation
We believe that the Lord Jesus Christ died as a representative and substitutionary atonement, fully justifying all those that repent of their sins and put their faith in Him. By God’s grace we are saved by faith alone. We believe believers have the presence of the Holy Spirit indwelling in them enabling them to live a Godly life. (John 1:12-13, 3:16; Ephesians 1:7, 2:8-10, 4:30; Romans 3:23, 8:13-14, 10:9-10; 1 Corinthians 3:16)

5. Eternal State
We believe in the resurrection of both the saved and the lost; that they are saved unto the resurrection of life (Heaven), and that they are lost unto the resurrection of condemnation (Hell). (John 5:28-29)

6. The Body
We believe in spiritual unity of believers in our Lord Jesus Christ. (Romans 8:9; 1 Corinthians 2:12-13; Galatians 3:26-28)

7. Gender, Marriage & Sexuality
We believe that God has established marriage as a lifelong, exclusive relationship between one man and one woman and that all intimate sexual activity outside the marriage relationship whether heterosexual, homosexual, or otherwise, is against God’s design and therefore sin. (Genesis 2:20-24; Matthew 19:4-6; Romans 1:18-31; 1 Corinthians 6:9-10, 15-20; Jude 1:7) We believe that God created the human race male and female and that all conduct with the intent to adopt a gender other than one’s birth gender is against God’s design and therefore sin. (Genesis 1:27; Deuteronomy 22:5)

8. Creation
We believe that God created the heavens, the earth and everything in them. (Genesis 1)

Father/Guardian 1: I have read Legacy Christian School’s Statement of Faith and I am willing to have my child
taught in accordance with it. In addition, I pledge my cooperation with LCS in encouraging my child to follow these
teachings.

Signature

Sign Here

Date

Mother/Guardian 2: I have read Legacy Christian School’s Statement of Faith and I am willing to have my child
taught in accordance with it. In addition, I pledge my cooperation with LCS in encouraging my child to follow these
teachings.

Signature

Sign Here

Date

Enrollment Policies

Phelps County Christian, Inc. d/b/a Legacy Christian School admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It doesn't discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school administered programs.
Parents/guardians are required to sign all areas of the student application, including all consent and release forms.

 Parents have the ultimate responsibility for the decision regarding where their children should attend school.

 Each student should have a genuine desire (cooperative spirit) to attend.

 Each transferring student must be in good standing academically and behaviorally at their present school.

 Each family is expected to be in harmony with and supportive of the school’s position and spiritual goals.

 Each family is to understand their child will be taught according to the school’s Statement of Faith.

 Pre-Kindergarten students must be at least 3 years old (and potty trained) on or before July 31st.

 Kindergarten students must be at least 5 years old on or before July 31st.

 First grade students must be at least 6 years old on or before July 31st.

 A waiting list is established for qualified students after all openings are filled; you will be notified if placed on the waiting list.

 All new students (transferring mid-year) are put on a one quarter probationary period.

 Legacy Christian may be unable to adequately serve students with:

o An extremely low academic performance as indicated by achievement testing.
o A failed most recent grade level prior to application.
o Significant emotional or disciplinary problems at current school.
o A police, court or criminal record.
o A physical disability which would impair the learning process under normal educational conditions.
o A learning disability for which our school is not staffed.

Admissions Procedures

For each student applying, the following will be required:

 Completed Student Application Form

 $50 non-refundable Application Fee

 Copy of birth certificate

 Student immunization record and health history form

(State law requires a physical examination for children entering Kindergarten, and all students transferring from out of state. All students must be immunized as specifically required by Nebraska law or have a notarized exemption on file. No student will be allowed in school if all state health requirements are not satisfied).

 Parent/guardian in person review with school representatives

(Prior to formal enrollment, an admission interview will be required for first-time applicants. Parents/guardians will meet with school representatives for this interview.)

 Student transcripts and records from previous school

 Students may be tested prior to placement

Once a student is accepted to Legacy Christian School, families will receive a letter of acceptance.

Copy of Birth Certificate

Choose File

Student Immunization Record

Choose File

Health History Form

Last Name

First Name

Student Date Of Birth

Physician Name

Date of Last Exam

Allergy Statement

Student has life-threatening bee sting allergies or food allergies.

Yes

If yes, a written note from student’s physician stating
specific instructions for Legacy Christian is required.

Other Allergies

Conditions/Concerns

Does this student have: (please mark all that apply)

Cerebral Palsy

Asthma Diabetes

Heart Conditions

Kidney Problems

Ear Infections

Hepatitis

Epilepsy

Emotional Concerns

Orthopedic Concerns

ADD/ADHD

Other

Please provide information about the conditions/concerns and how it is managed:

Does student have any hearing or vision concerns?

Yes

Please Explain

Has student had recent injury or illness that might limit him/her in school?

Yes

Please Explain

Has student had any surgeries in the past year?

Yes

Please Explain

Please provide a list of any medication(s) your child will be taking at school:

Any medication taken at school must be in an original, correctly labeled container from the pharmacist with the child's name on the label, pharmacy name, physician's name, name of medication, dosage and time it is to be administered. Your doctor must also send a signed form to the school.

Please list any medication(s) your child will be taking at home:

Parents/Guardians Information – Emergency Contact Information

Parent/Guardian to Contact 1st

First Name

Last Name

Mobile Phone

Work Phone

Main Email

Parent/Guardian to Contact 2nd

First Name

Last Name

Mobile Phone

Work Phone

Main Email

If parent/guardian is unable to be contacted, please list at least two local emergency contact persons.

Name

Phone

Relationship to Student

Name

Phone

Relationship to Student

Name

Phone

Relationship to Student

Name

Phone

Relationship to Student

In Case of an Emergency

I(We), as parent(s) or guardian(s) of the student named at above, give my (our) permission to take my (our) child to the hospital emergency room or doctor's office in the case of an emergency in the event I(we) am(are) not available. I(We) understand that all efforts will be made to contact a parent, guardian, or emergency contact before a school representative takes the student to the emergency room or to a physician's office unless it is an emergency situation.

In Case of an Emergency

Yes

Signature

Sign Here

Date

Student Application

Student's Legal Name

Previous School Attended (if applicable):

Applicant's Siblings (if applicable):

Parents/Guardian Information

Parents/Guardians are:

If your student is not living with both parents, please answer the following questions.

Statement of Faith

1. The BibleWe believe the Bible to be the inspired, the only infallible, authoritative, inerrant Word of God, and the final authority in faith and life. (2 Timothy 3:16-17, 2 Peter 1:20-21)

2. The TrinityWe believe in One God, Creator and Redeemer, eternally existent in three persons- Father, Son, and Holy Spirit. (Genesis 1:1, Matthew 28:19, John 10:30)

5. Eternal StateWe believe in the resurrection of both the saved and the lost; that they are saved unto the resurrection of life (Heaven), and that they are lost unto the resurrection of condemnation (Hell). (John 5:28-29)

6. The BodyWe believe in spiritual unity of believers in our Lord Jesus Christ. (Romans 8:9; 1 Corinthians 2:12-13; Galatians 3:26-28)

8. CreationWe believe that God created the heavens, the earth and everything in them. (Genesis 1)

Enrollment Policies

 Parents have the ultimate responsibility for the decision regarding where their children should attend school.

 Each student should have a genuine desire (cooperative spirit) to attend.

 Each transferring student must be in good standing academically and behaviorally at their present school.

 Each family is expected to be in harmony with and supportive of the school’s position and spiritual goals.

 Each family is to understand their child will be taught according to the school’s Statement of Faith.

 Pre-Kindergarten students must be at least 3 years old (and potty trained) on or before July 31st.

 Kindergarten students must be at least 5 years old on or before July 31st.

 First grade students must be at least 6 years old on or before July 31st.

 A waiting list is established for qualified students after all openings are filled; you will be notified if placed on the waiting list.

 All new students (transferring mid-year) are put on a one quarter probationary period.

 Legacy Christian may be unable to adequately serve students with:

Admissions Procedures

For each student applying, the following will be required:

 Completed Student Application Form

 $50 non-refundable Application Fee

 Copy of birth certificate

 Student immunization record and health history form

 Parent/guardian in person review with school representatives

 Student transcripts and records from previous school

 Students may be tested prior to placement

Once a student is accepted to Legacy Christian School, families will receive a letter of acceptance.

Health History Form

Allergy Statement

If yes, a written note from student’s physician statingspecific instructions for Legacy Christian is required.

Conditions/Concerns

Any medication taken at school must be in an original, correctly labeled container from the pharmacist with the child's name on the label, pharmacy name, physician's name, name of medication, dosage and time it is to be administered. Your doctor must also send a signed form to the school.

Parents/Guardians Information – Emergency Contact Information

Parent/Guardian to Contact 1st

Parent/Guardian to Contact 2nd

If parent/guardian is unable to be contacted, please list at least two local emergency contact persons.

In Case of an Emergency

1. The Bible
We believe the Bible to be the inspired, the only infallible, authoritative, inerrant Word of God, and the final authority in faith and life. (2 Timothy 3:16-17, 2 Peter 1:20-21)

2. The Trinity
We believe in One God, Creator and Redeemer, eternally existent in three persons- Father, Son, and Holy Spirit. (Genesis 1:1, Matthew 28:19, John 10:30)

5. Eternal State
We believe in the resurrection of both the saved and the lost; that they are saved unto the resurrection of life (Heaven), and that they are lost unto the resurrection of condemnation (Hell). (John 5:28-29)

6. The Body
We believe in spiritual unity of believers in our Lord Jesus Christ. (Romans 8:9; 1 Corinthians 2:12-13; Galatians 3:26-28)

8. Creation
We believe that God created the heavens, the earth and everything in them. (Genesis 1)

If yes, a written note from student’s physician stating
specific instructions for Legacy Christian is required.