Heritage Academy

School Application



First Name
 Middle Name
 Last Name
Date of First Application Birth Date Gender
Home Phone Parent/ Guardian Cell Phone
Parent/ Guardian email address
Home Address Mailing Address (if different)
Place of Worship

Description of your child

Works Slowly Works Quickly Impulsive Thoughtful
Shy Frinedly Talkative Quiet
Sensitive Insenstive Routine Goes with the flow
Organized Disorganized Leader Follower
Follow Directions: Easily With Difficulty Morning Person Evening Person
Active Passive Positive Attitude Negative Atttitude
Persistent Gives up easily Focused Easily Distracted
Cooperative Uncooperative
Current School Name Address
Grades Attended
Other Schools Attended Address
Grades have averaged Satisfactory Needs Improvement Average conduct grade Satisfactory Needs Improvement
Has the student been suspended or asked to leave any school? Yes No If yes, please explain
Has the student been recommended for IEP, Special Services, Retention, Speech Therapy, or Diagnostic Testing? Yes No If any please explain
Has the student had any discipline problems at school? Yes No If yes, please explain:
What is your primary reason for selecting Heritage Academy for your child?
Does the student have any special abilities or talents? (ie: athletic, artistic, musical, academic, etc)

Family Information
Student lives with :   Both Parents | Father Only | Mother Only | Mother/Stepfather | Father/Stepmother| Guardian| Other
Which parent has legal responsibility? School Related Decisions School Bills Custody of the Student Receiving School Communications
Father | NaturalStepfather
First Name Middle Name Last Name
Address
Home Phone # Cell Phone #
Occupation Employer
Business Address
Business Phone # Father’s Email
Mother | NaturalStepmother
First Name Middle Name Last Name
Address
Home Phone # Cell Phone #
Occupation Employer
Business Address
Business Phone # Mother’s Email
Guardian Information: If other than Father or Mother above
First Name Middle Name Last Name
Employer
Address Business Address
Home Phone # Business Phone #
Cell Phone # Occupation
Email

Medical History
Does the student have any illnesses, diseases, physical disabilities or special conditions, which either have affected or may affect the student’s general health, schoolwork or participation in athletics?
CHECK THE APPROPRIATE BOX
Health | Hearing | Eyesight | Attention Deficit | Memory | Learning Difficulties | Motor Difficulties | Other
If yes, please describe
Is your child referred for 504? If yes, please explain in detail
If student is on medication, indicate what medication and frequency of dosage.

Parent / Guardian Covenant
As a Parent / Guardian, if my student is accepted to attend Heritage Academy, I commit to:
Insuring that my child is in school EVERY DAY with necessary uniform, lunch, books, materials, and supplies except in case of serious illness.
Making sure my child arrives at school with ample time to organize books and supplies and be seated in class by 8:25am.
Attending two (2) report card conferences. If I am unable to attend at the designated time, I must call the school to arrange an alternative time.
Attending four (4) regularly scheduled Parent / Teacher meetings.
Facilitating communication with the school by responding promptly to phone calls, and notes home from the office or teacher.
Working with school staff to promote appropriate speech, behavior and social development in my child. Close cooperation and rapid response are particularly important when my child’s behavior is not in accordance with the standards of Heritage Academy.
Picking up my child within 15 minutes of the end of the school day.
Providing my child with a quiet, distraction-free environment for homework and studies. This area should be free of television, radios, video games and young children.
Providing my child ample time in evenings and on weekends to complete assignments and studies.
Providing my child with ample rest for the following day’s activities.
Meeting all my financial obligations to the school in a timely manner.
Name of Parent / Guardian Date

Statement of Philosophy / Statement of Faith
Parent / Guardian: Please read the following and sign below.

Heritage Academy

Statement of Philosophy

Heritage Academy believes that the Holy Scripture is the Word of God and the only rule for faith and practice.

Heritage Academy believes that all people are created in the image of God. As such, they are to be treated with dignity and respect. We are to reflect the character of God in our lives and to reveal it in the way we carry out His work.

Heritage Academy believes that to carry out the mission of Christian education, the personnel and programs must reflect Biblical principles of holy living, truth and faith expressing itself through love.

Heritage Academy believes that the pursuit of excellence is glorifying to God. Students will be encouraged to achieve and to model godliness before school, family and community.

Heritage Academy believes that self-confidence of children comes from knowing the love of God and understanding His purpose for their lives. That purpose is to glorify God and to enjoy Him forever.

Heritage Academy believes in the Biblical design for family. We respect the home as the first and most significant classroom of the child. We expect parents and/or guardians to be involved in the life of the school and to be in partnership with the school for the success of their child.

Statement of Faith

We believe there is one God, eternally existent in three persons, God the Father, God the Son (the Lord Jesus Christ), and God the Holy Spirit.

We believe the Bible, the Scriptures of the Old and New Testaments, to be the infallible, inerrant Word of God and to be the only rule for faith and practice.

We believe that God created the world and all things and people in it. Each person is created in the image of God, giving him inherent worth and equality with all other persons.

We believe that our ability to carry out our purpose to love and honor God, serve our fellow man has been corrupted by the effects of sin that entered God’s perfect creation through our first parents, Adam and Eve.

We believe that because God loved the world, He sent Jesus Christ into the world to save us from sin and its consequences. By the death of Jesus Christ on the cross, the debt of sin has been paid.

We believe that salvation is a free gift to all people who receive this gift by faith in the work and person of Jesus Christ.

We believe the church to be made up of all persons who place their trust in Christ and obey Him, by living according to His word.
I have read both the Statement of Philosophy and the Statement of Faith of Heritage Academy. In agreeing to enroll my child at Heritage Academy, I agree to support the mission of the school as guided by these statements.
Name of Parent / Guardian Date

Tuition Assistance Form
Full tuition for one student at Heritage Academy is $6,000 per year. With the assistance of generous donors, the school is able to provide substantial financial aid to families based on need. In order to determine the amount of financial assistance for each family, the school requires accurate information regarding household income and the number of dependents living in the household. If you have any questions or concerns related to financial information, please contact the school at 706-821-0034 or email hcaga@knology.net.
Please complete the following information (please print)
Name of Parent / Guardian
The Internal Revenue Service defines a dependent as: “A person, other than the taxpayer or the taxpayer’s spouse, for whom an exemption can be claimed. You can generally claim an exemption for a dependent if the dependent:

• Lives with you or is related to you,
• Is a U.S. citizen, a U.S. resident, or a resident of Canada or Mexico,
• Does not file a joint return,
• Does not have a $3,100 or more of gross (total) income (does not apply to your child if under age 19 or a student under age 24.
• Is supported (generally more than 50%) by you, and
• Cannot be claimed on another tax payer’s return.”

When you visit the school, plan to bring a copy of your most recent Federal Tax Return (ie: 1040). If you did not file a 1040 Tax Return, bring one or more of the following documents available to support the reporting of your total household income:
TANF Award Letter
Social Security Benefit Notification Letter
Unemployment Compensation Letter

I hereby certify that the above information is a correct representation of my total household income and number of dependents per the IRS definition listed above.

 Name of Parent / Guardian Date
333 Greene Street, Augusta, GA 30901,
P: (706)_ 821-0034, F: (706) 821-0122,
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