Author: Teresa

Kingsview Christian School
accredited through Northwest Association of Accredited Schools, Association of
Christian Schools International, and the Nazarene International Educators Association
2021-2022 ENROLLMENT APPLICATION

REGISTRATION ________________________________________________________
to be completed by the parent or legal guardian and returned to the office with the following:
[ ] Completed Application
[ ] Non-Refundable Enrollment Fee
Preschool & PreKindergarten $150.00
Kindergarten - 6th Grade $200.00
[ ] Copy of Birth Certificate
[ ] Copy of Current Immunization Records
TUITION ______________________________________________________________

Class	Annual Tuition	Monthly Payment / Option
Preschool / Half Day (Mon-Fri)	$2,625.00	9 monthly payments / of $291.67	Must be 3 years old by Sept. 1
Pre-Kindergarten / Half Day (Mon-Fri)	$2,625.00	9 monthly payments / of $291.67	Must be 4 years old by Sept. 1
Pre-K thru 6th Grade / Full-Time Student / 1st Child	$5100	10 monthly payments / of $510.00
2nd Child	$3,950	10 monthly payments / of $395.00
3rd Child	$3,450	10 monthly payments / of $345.00

Early Withdrawal: Because Kingsview Christian School offers a payment plan as a courtesy, there may be a balance or refund due if you to withdraw your child before payments are complete.
Financial Aid: If you feel you need to apply for financial aid in order to keep your student at Kingsview, it is your responsibility to request the application from the office each year.

Kingsview Christian School | 1850 Clark Street | North Bend, Oregon 97459
phone 541-756-1411 | fax 541-756-0105 | email kingsviewchristian@gmail.com | www.kingsviewchristian.com

ADDITIONAL SERVICES _____________________________________________________
KCS After-Care: Kingsview Christian School offers an After-Care program for the convenience of working parents. This program is billed separately from tuition payment and is expected to be paid monthly.
After-Care is held every full school day and runs from 2:30 p.m. to 5:30 p.m. Cost is $3.00 per hour and is billed by the quarter hour. Your promptness at 5:30 pick-up is greatly appreciated.
Children using this program will be signed in and out, and persons eligible to pick up must register their phone number with After-Care Supervisor.

FAMILY INFORMATION ________________________________________________
The following pages of this application must be completed by the parent or legal guardian and returned to the office with
enrollment fees for valid enrollment. Copies of birth certificates and immunization records are also required.
Student full name ___________________________________________________ 2021-2022 grade _______ DOB____________
Student full name ___________________________________________________ 2021-2022 grade _______ DOB____________
Student full name ___________________________________________________ 2021-2022 grade _______ DOB____________
Student full name ___________________________________________________ 2021-2022 grade _______ DOB____________
Father/Guardian full name _________________________________________ Relationship to student____________________
Home address ______________________________________ City_________________________ State______ Zip___________
Mailing address _____________________________________ City_________________________ State______ Zip___________
Home phone __________________________________ Cell phone __________________________________
Email ______________________________________________________
Employer______________________________________________ Business phone_____________________________________
Mother/Guardian full name ________________________________________ Relationship to student____________________
Home address ______________________________________ City_________________________ State______ Zip___________
Mailing address _____________________________________ City_________________________ State______ Zip___________
Home phone __________________________________ Cell phone __________________________________
Email ______________________________________________________
Employer______________________________________________ Business phone_____________________________________
**Current legal documents must be kept on file in the student’s records if one or more of the parents is not allowed
unsupervised visits.
If applicable, who has legal custody?_______________________________________________________________
If applicable, who has physical custody?____________________________________________________________

Office Use Only: Entered in Computer/Date ______________ Entered in QuickBooks/Date _____________________
Immunization Records ______ Birth Certificate ______ Enrollment Fee(s) $ ___________________________________

Step Parent (if applicable): _________________________________________________ Relationship _____________________
Home address ______________________________________ City_________________________ State______ Zip___________
Mailing address _____________________________________ City_________________________ State______ Zip___________
Home phone __________________________________ Cell phone __________________________________
Step Parent (if applicable): _________________________________________________ Relationship _____________________
Home address ______________________________________ City_________________________ State______ Zip___________
Mailing address _____________________________________ City_________________________ State______ Zip___________
Home phone __________________________________ Cell phone __________________________________
EMERGENCY CONTACTS _____________________Please list at least one local contact______
Name ________________________________ Relationship _________ Home # _____________ Cell # ____________________
Name ________________________________ Relationship _________ Home # _____________ Cell # ____________________
Other than the above emergency contacts, who is authorized to pick up your student? Please notify the office when you need to add or delete from this list.
Name ________________________________ Relationship _________ Home # _____________ Cell # ____________________
Name ________________________________ Relationship _________ Home # _____________ Cell # ____________________
Name ________________________________ Relationship _________ Home # _____________ Cell # ____________________
Pediatrician/Physician ___________________________________________ Phone # _________________________________
Do you have a home church? [ ] Yes [ ] No Church Name _____________________________________________________
Minister’s Name ___________________________________________ Phone # _______________________________________
IDENTIFIABLE INFORMATION __________________________________________
[ ] Yes [ ] No My child may enter contests that require information such as name, address, and phone number
with the possibility of having his/her picture published.
[ ] Yes [ ] No My child’s first name only may be published on Kingsview’s website.
[ ] Yes [ ] No My child’s photograph may appear on Kingsview’s website.
Ethnicity ____________________________________________________________
Several of our yearly reports ask for this information.
[ ] Native American [ ] Asian/Pacific Islander [ ] African American [ ] Decline to answer
[ ] Hispanic [ ] Caucasian [ ] Other ________________________

STUDENT HEALTH ________________________________________2021-2022__
Student__________________________________________________________ DOB __________________ Grade __________
Please check all that apply:
[ ] Allergic reactions to _________________________________________________________________________
Epi Pen/Emergency medication needed?_________________________________________________________
[ ] Asthma Inhaler needed? _________ Instructions__________________________________________________
[ ] Wears glasses/contacts
[ ] Speech difficulties [ ] Emotional difficulties (anxiety, depression, etc.)
[ ] Hearing difficulties [ ] Endocrine disorders (diabetes, hypoglycemia, etc.)
[ ] ADD/ADHD [ ] Seizure disorder
[ ] Frequent nosebleeds [ ] Dietary restrictions [ ] Heart problems
[ ] Frequent headaches [ ] Physical restrictions [ ] Blood disorders
[ ] History of serious illness, injury or surgery
Other ____________________________________________________________________________________________
Additional information regarding conditions checked above: ______________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Medication: I authorize Kingsview Christian School personnel to give my child the following over-the-counter
medications as needed while under the school’s supervision.
[ ] Tylenol [ ] Tums [ ] Allergy Medication [ ] Do not give my child medication.
[ ] Ibuprofen [ ] Cough drops [ ] Other _________________________________________________
[ ] Please call parents before giving my child/children medication. Phone ___________________________________________
Prescription medications needed during school _________________________________________________________________
* All prescription medications taken at school must be in the original packaging with the student’s name and administration
instructions clearly marked.
I hereby certify that, to the best of my ability, the information supplied herein concerning my student’s health is accurate and complete. I agree to keep Kingsview Christian School apprised of any changes to this information that may occur
during the course of the school year.
Parent/Legal Guardian signature ____________________________________________________ Date __________________
*******************************************************************************************************
Illness: It is mandatory that any child showing symptoms of communicable illness be excluded from classes
until readmission is acceptable to school authorities. Your cooperation is greatly appreciated!
Immunization Record: Please submit current immunization information to the school office, and let us know if
additional immunizations are received throughout the school year.
Birth Certificate: A copy of the student’s birth certificate must be on file at the school. If the birth certificate is not available, please make arrangements with the school office to provide alternative documentation.

Consent to Emergency Treatment ___________________2021-2022___
Student__________________________________________________________ DOB ____________________ Grade ________
Address ______________________________________________ City/State __________________________ Sex [ ] M [ ] F
Doctor ___________________________________________________________ Phone ________________________________
Father ___________________________________________________________ Phone ________________________________
Mother __________________________________________________________ Phone ________________________________
Emergency Contact ________________________________________________ Phone ________________________________
Pastor’s Name ____________________________________________________ Phone ________________________________
Known Physical Problems and Allergies _______________________________________________________________________
_____________________________________________________________ Date of Last Tetanus ____________________
The undersigned, legal guardian(s) of _______________________________________________________, a minor, do hereby authorize the administrator of Kingsview Christian School, or designee, to act as agent for the undersigned to consent to any examination, X-ray, anesthetic, medical or surgical diagnosis, treatment, and hospital care which is deemed necessary for the protection and preservation of the aforementioned student’s life. It is given to provide authority and power on the part of our school representative to give specific consent to any and all such diagnosis, treatment or hospital care which any attending physician or surgeon, in the exercise of his/her best judgment, may deem advisable.
This authorization shall remain effective until the end of the school year or when revoked in writing by the undersigned and delivered to said agent.
I agree to be financially responsible for any accidental injuries to my child on school property or during school activities.
________________________________________________ ________________________________________________
Father/Guardian Signature Date Mother/Guardian Date
Insurance Company ________________________________________________________________________
Group Number _______________________________________ Policy Number ______________________________________
Name of Insured ___________________________________________________________________

FINANCIAL AGREEMENT __________________________________2021-2022__
Contract for the _____________________________________________________ family.
Student ____________________________________________________________ Grade ________________
Student ____________________________________________________________ Grade ________________
Student ____________________________________________________________ Grade ________________
Student ____________________________________________________________ Grade ________________
I (We) select the following Payment Plan (check one) from the Schedule of Tuition and Fees:
[ ] Payment in full: $________________ on or before September 1, 2021.
[ ] Nine (9) payments of $________________. Preschool and Pre-K must be paid in nine payments September thru May, unless you have older children in the school who are on an alternate plan.
[ ] Two (2) payments of $________________ each on or before September 1, 2021, and February 1, 2022.
[ ] Ten (10) monthly payments of $________________ beginning September 1, 2021 through June 1, 2022.
All accounts must be paid in full by June 30, 2022.
I /We have read and understand the financial policies. I /We do agree to pay all the fees, tuition and any incurred bank charges according to the terms and policies I /we have selected from the attached payment plans and set forth in this contract.
I /We understand that the tuition does not pay all the cost of educating my child(ren). In order to keep my out-of-pocket tuition and fees down, I understand that my family will be asked to participate in school fundraisers and volunteer hours.
Father/Guardian Signature ____________________________________________________ Date _________________
Mother/Guardian Signature____________________________________________________ Date _________________
Name of person responsible for bills, if other than parents. Bills will be sent to them as requested.
Name ____________________________________________________ Phone ________________________________________
Address_________________________________________________________________________________________________
Street City State Zip
**Past Due Accounts - If a student’s tuition becomes 30 days past due and satisfactory arrangements have not been made with the office staff, the student(s) will unfortunately be dismissed from school.

FINANCIAL Policies__________________________________________
Checks: Please make checks payable to Kingsview Christian School or KCS. Returned checks will be charged up to a $25.00 fee. Be sure to include the student’s name in the memo line.
Debit/Credit: Payments may be made using Visa, MasterCard, Discover and American Express.
Cash: Please get a receipt from the office personnel to ensure proper credit for cash payments.
Late Payments: Payments are due on the 1st of the month and considered late after the 10th of the month. (Note: The grace period will be extended to the next business day when the 10th falls on a weekend.) A $20.00 late fee will be charged to your account for payments made after the 10th of the month. Modifications to the due date may be made with prior arrangements at the beginning of the school year.
Statements: Monthly statements will be sent by email unless the account is paid in full.
Past Due Accounts: If a student’s tuition becomes past due one month and satisfactory arrangements have not been made with the office staff, the student(s) will unfortunately be dismissed from school.
Withdrawals: Kingsview hires staff expecting parents’ commitments to be for the full year. If you choose to make payments rather than full payment, there may be a balance due in the event of early withdrawal. The school incurs non-negotiable expenses — fees paid before the school year begins — and these expenses are not negated upon dismissal.
Special Notes: Monthly payments do not reflect a price per month but rather equal payments of the total tuition and fees. Tuition includes classroom equipment, book usage, and staff assistance. Books stay with the school.
Extra Blessing: We realize that for some families, it is challenging to make tuition payments. However, some families may be positioned to invest into the work at Kingsview. If you would like to make a tax deductible donation to any of the following ministries within Kingsview, your gift will be greatly appreciated and put to good use. Accounts of special Kingsview ministries are as follows: undesignated donations, Financial Aid Fund, School Expansion Fund, and Emergency Aid Fund.
I have read and understand the above financial policy. ________________________________________

Where every student is somebody, the staff is something special, and Jesus Christ is Lord!

STATEMENT OF COOPERATION _________________________________
“I hereby pledge to pay my financial obligations to the school on the date due and understand that late fees will be assessed when payment has not been made in the agreed upon manner.”
“I agree to uphold and support the high academic standard of the school by providing a place at home for my child to study and give my child encouragement in the completion of any homework or assignments.”
“I appreciate the standards of the school and do not tolerate profanity in word or action, dishonor to the Trinity, the Word of God, or disrespect to the personnel of the school.”
“I understand that the school reserves the right to dismiss any child who fails to comply with the established regulations and discipline or whose financial obligation remains unpaid.”
“It is my understanding that the policy for the school is to make no refund of enrollment fees after June 30, 2021.”
“I give Kingsview Christian School permission for my child(ren) to take part in all school activities, including bus trips, sports activities, and school-sponsored trips away from the school premises.”
“I also believe that discipline is necessary for the welfare of each student, as well as for the entire school. I give permission for my child’s teacher and/or other agent of the school to make and enforce school regulations in a manner consistent with Christian principles and discipline as set forth in the Scriptures. (Hebrews 12:11) I understand no corporal punishment will be used.”
“I will help my child(ren) maintain the dress code that is listed in the Student Handbook.”
“I agree that if my child(ren) should become involved in any trouble at school or I disagree with any policy set by the school, I will not discuss with other parents issues that don’t relate to their children. I further agree to settle issues regarding my child(ren) by the Matthew 18:15-17 passage of Scripture. I will register my concerns with the teacher, principal, and Advisory Committee in that order. If necessary I will ask for a mediator if the issue has not been solved by administration or boards. Should legal action, for any reason, be taken against Kingsview Christian School or any employee or agent not be found at fault, I agree to pay any attorney fees, court fees, damages or other costs that Kingsview Christian School or its agent should incur to defend itself against such action.”
“I agree that we will abide by the policies and guidelines in the student handbook, and I have read and discussed the appropriate areas with my child(ren).”
By signing these enrollment forms, we signify that we have read, understand, and are agreeing to the above commitments for the length of time our child is enrolled.
SIGNATURES OF BOTH PARENTS ARE REQUIRED UNLESS A SINGLE PARENT HOME.
Father/Guardian Signature ___________________________________________ Date _______________
Mother/Guardian Signature __________________________________________ Date _______________

Where every student is somebody, the staff is something special, and Jesus Christ is Lord!

DOCTRINAL MATTERS ____________________________________________
Kingsview Christian School support the historic authority of the Bible. Many different denominations are represented by our school family. We have had very little doctrinal controversy among our parents or faculty. There is much more which holds the family of believers together than separates denominations.
We ask our teachers not to dwell upon any doctrine which could be divisive. We ask the same of our parents when participating in a school function. Sometimes children will say things at home which may indicate a controversial doctrine has been discussed in class. If you are concerned, please call the teacher and find out the context of the discussion.
Neither of these lists are exhaustive, but these suggested areas give direction to our school family.
BIBLICAL DOCTRINES THAT MAY BE FREELY TAUGHT AT KINGSVIEW
* God is a Trinity: Father, Son and Holy Spirit. (Matt. 28:19)
* God created all things supernaturally. (Hebrews 11:3)
* Man was created for God’s glory. (Isaiah 43:7)
* Man rebelled against God. (Genesis 3)
* Sin entered by rebellion. (Isaiah 43:27)
* Man can be restored only by atonement. (Romans 3:22-26)
* Old Testament atonements are symbols. (Hebrews 13:10-14)
* Christ made full atonement for our sins. (Hebrews 9:26-28)
* Justification is by grace through faith. (Gal. 2:16)
* Repentance toward God (Acts 20:21)
* Lordship and faith (Romans 10:9)
* Baptism (but not mode) (I Peter 3:21)
* Eternal life and everlasting death (Romans 6:23)
* Heaven and Hell (II Tim. 4:18, Matt. 10:28)
* Virgin birth (Matt. 1:23)
* God’s love and God’s wrath (Romans 8:39,
Romans 1:18)
* The Bible as the infallible Word of God (II Tim. 3:16)
* Christ is coming again (but not when). (John 14:1-4)
* All unrighteousness is sin. (I John 5:17)
* The Holy Spirit dwells in believers. (Romans 8:16)
* Missionary work and evangelism (Matt. 28:19-20)
* After death-judgment (Hebrews 10:26-31)
* Godly respect for all in authority (Hebrews 13:17)
* People are lost without Christ. (Luke 15:4-6)
* Christ, our power and wisdom (Jude 25)
* Man is born in sin. (Romans 5:12)
* Christ, our Righteousness (II Corinthians 5:21)

BIBLE DOCTRINES TO BE TAUGHT BY THE HOME AND CHURCH
AND NOT PRACTICED AT SCHOOL:
* Infant baptism * Speaking with other tongues
* Eternal security * Divine healing
* Falling from grace * Church authority
* Pre-, post-, or mid-trib. rapture * Church government
* Predestination * Mode of baptism
* Holiness (eradication)
* Manifestations of the Holy Spirit not mentioned in the Bible

Dear Parents, Teachers, Building Occupants, and Employee Organizations:
In the past, asbestos was used extensively in building materials because of its insulating, sound absorbing, and fire retarding capabilities. Virtually any building constructed before the late 1970’s contained some asbestos. Intact and undisturbed asbestos materials generally do not pose a health risk. Asbestos materials, however, can become hazardous when, due to damage or deterioration over time, they release fibers. If the fibers are inhaled, they can lead to health problems, such as cancer and asbestosis.
In 1986, Congress passed the Asbestos Hazard Emergency Response Act (AHERA) which requires schools to be inspected to identify any asbestos containing building materials. Suspected asbestos-containing building materials were located, sampled (or assumed) and related according to condition and potential hazard. Every three years, Kingsview Christian School’s has an inspector determine whether the condition of the known or assumed asbestos containing building materials (ACBM) has changed and to make recommendations on managing or removing the ACBM. At the last inspection conducted on January 29, 2016, all materials listed in the Management Plan as asbestos containing (or assumed to be asbestos-containing) were inspected and found to be in good condition.
The law further requires an asbestos management plan to be in place by July 1989. Kingsview Christian School developed a plan, as required, which has been continually updated. The plan has several ongoing requirements: publish a notification on management plan availability and the status of asbestos activities; educate and train its employees about asbestos and how to deal with it; notify short-term or temporary workers on the locations of the asbestos containing building materials; post warning labels in routine maintenance areas where asbestos was previously identified or assumed; follow set plans and procedures designed to minimize the disturbance of asbestos containing building materials; and survey the condition of these materials every six months to assure that they remain in good condition.
It is the intention of Kingsview Christian School’s to comply with all federal and state regulations controlling asbestos and to take whatever steps are necessary to ensure students and employees a healthy and safe environment in which to learn and work. You are welcome to review a copy of the asbestos management plan in the school district administrative office or administrative office of the school during regular business hours. Rick Wetherell is our designated asbestos program coordinator, and all inquiries regarding the asbestos plan and asbestos-related issues should be directed to him at 541-756-1411.
I have read the above asbestos information:
Father/Guardian Signature ________________________________________ Date_________________
Mother/Guardian Signature _______________________________________ Date_________________

Where every student is somebody, the staff is something special, and Jesus Christ is Lord!

Kingsview Christian School
1850 Clark Street
North Bend, Oregon 97459-1806
phone 541-756-1411
fax 541-756-0105

Our Mission
Equipping Students For Life:
Physically, Academically,
Socially, Spiritually

Permission to Release Information
For Educational Planning/Appropriate Placement Purpose
I hereby give my permission for the release of the following information from the education records of:
Student Name ___________________________________________________________ Grade ________________
Student Name ___________________________________________________________ Grade ________________
Student Name ___________________________________________________________ Grade ________________
Student Name ___________________________________________________________ Grade ________________
Name of Previous School _____________________________________________________________________________
Previous School Address _____________________________________________________________________________
City State Zip
INFORMATION REQUESTED
Please check education records that may be released.
[ ] Academic Record including transcript of grades
[ ] Health Card, Immunization Record
[ ] Individual Education Plans (IEP’s) or Special Education Records
[ ] Educational Evaluation Records, including psychological reports and/or test results
[ ] Current grades to date of withdrawal
[ ] An explanation of graduation credit requirements (secondary level)
Parent/Guardian/*Eligible Student Signature ________________________________________ Date ________________
*Student 18 years of age or older
Parent/Guardian/Student (Please Print) ____________________________________________ Date ________________
Please return records to:
Kingsview Christian School
1850 Clark Street | North Bend, OR 97459-2228

[ ] Mailed [ ] Faxed Date _______________________
Mailed _______ Faxed _______ Date _______________________

REGISTRATION _________