Attached you will find the Re-Registration Packet for 2017-2018.

This year we have a new contest. The first classroom in which every student turns in a COMPLETE packet (on or before January 25th) will enjoy a free DRESS DOWN DAY & PIZZA PARTY on Friday, January 27th!

We are hoping you will join us for the Annual Pasta Registration Dinner on Thursday, February 9th at 5pm to socialize, ask questions, enter to win a $50 Gift Certificate to Cheryl’s Uniforms and enjoy the meal without the stress of paperwork. Of course, our staff will be available to process your re-registration on the 9th if that is the most convenient date for your family to return the packet. We look forward to seeing you there!

Edgar on

856-697-7300 Fax 856-697-7303 [email protected] P.O. Box646, 212 Catawba Ave., Newfield, NJ 08344 www.edgartonacademy.com

STUDENT RE-REGISTRATION INFORMATION GRADES PRE-K THROUGH 8 2017-2018 Attached please find registration papers for the 2017-18 school year. Open registration for new and current students has begun and will run through Friday, February 24th. Please fill out all appropriate forms completely. If you have any questions regarding these forms, please call the school office. Completed forms and a $150 per child registration fee (non-refundable) are due back in the office by Friday, February 24th. In order to guarantee a spot for your child for next year, please register by the above date. Please make checks payable to Edgarton Academy. Registration will not be considered complete until all paperwork is filled out and returned with payment.  If you are enrolling a new student, please obtain a new student registration packet online or call the office.  This packet includes one of each form. If you are registering multiple children please visit our website to print the additional forms you need. Forms Included That Need To Be Completed And Returned To School:     

Re-registration Form  Local Field Trip Permission Form Tuition Agreement Form  Textbook Loan Form (1 per student) Office Emergency /Before-Aftercare Form Emergency Form for Nurse (1 per student) B6T – All PK4-8 students for all municipalities (1 per student) Proof of Residency is required for ALL Vineland students. Send a copy of your current tax bill or lease agreement (rates crossed out) as proof of residency for submission with the B6T form.

 Student’s Grade: Please use student’s upcoming grade on all documents.  Uniforms: Can be purchased at Cheryl’s Uniform, 2100 N. Delsea Dr., Vineland, 856-696-0141.  Custodial Issues: A copy of legal documentation must be supplied to the office each year.  Not Returning: Please complete the section at the bottom of the re-registration form and return by Friday, February 24th. ALL OF THE ABOVE MUST BE PRESENTED TO COMPLETE REGISTRATION

RE-REGISTRATION FOR 2017/2018 Family Name___________________________________ Father

Mother

Guardian

Name Address

Name Address

Name Address

Home Phone Work Phone Cell Phone Email

Home Phone Work Phone Cell Phone Email

Home Phone Work Phone Cell Phone Email

How would you like to be contacted for general announcements (check all that apply) ____Home _____Text _____Cell ____Email

Child’s Name________________________________ Grade (17/18) _____ Date of Birth ___________ Child’s Name________________________________ Grade (17/18) _____ Date of Birth ___________ Child’s Name________________________________ Grade (17/18) _____ Date of Birth ___________ Child’s Name________________________________ Grade (17/18) _____ Date of Birth ___________ If PRE-K Please list Days Attending: M___ T___ W___ Th ___ F___ (1st child) If PRE-K Please list Days Attending: M___ T___ W___ Th ___ F___ (2nd child) Method of Transportation

( ) car

( ) bus Public School District_________________________ (Municipality where taxes are paid)

Family Status: __Married __Divorced __Separated __Spouse Deceased __Single Parent

___Custodial Concerns (please provide documentation)

**For Office Use Only - Please Do Not Fill In** Re-Registration Fee ($150.00 Per Child) Amount $___________ Ck. #________ Cash_____ Date______ Copy to Adv. Dir. _____

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------My child/children will not be returning to Edgarton Academy in September, 2017.

Family Name____________________________________________________

Child is transferring to:

Address________________________________________________________

Name of School_______________________________________________________

Child’s Name________________________________________ Grade______

Address_____________________________________________________________

Child’s Name________________________________________ Grade______

Reason for Transfer_______________________________________________

Child’s Name________________________________________ Grade______

Parent’s Signature_________________________________________ Date_______________

Edgar on Christian Academy K-8 TUITION AGREEMENT SCHOOL YEAR 2017-2018

1st STUDENT'S NAME_______________________________________GRADE __________ (Please Print) Last First 2nd STUDENT'S NAME_______________________________________GRADE __________ (Please Print) Last First 3rd STUDENT'S NAME_______________________________________GRADE __________ (Please Print) Last First 4th STUDENT'S NAME_______________________________________GRADE __________ (Please Print) Last First

AMOUNT___________ AMOUNT___________ AMOUNT___________ AMOUNT___________

Other Fees: a) HSA Dues Per Family __$20.00___ b) Kindergarten Activity Fee $60 (per child) ___________ c) 8th Grade Graduation Fee $400 (per Child) __________ GRAND TOTAL AMOUNT___________ Registration/Re-registration Fee per child: $150.00 Non Refundable is due at time of registration/re-registration.

#of Students ______ X $150.00 equals total registration/re-registration Fees due:________ Office Use only: Amount Paid

$_________

Cash______

Check # ________ Date ________

**TUITION ASSISTANCE AVAILABLE For Grades K-8/ PLEASE APPLY ONLINE**

K-8 Tuition Rates 1st Student 2nd Student 3rd Student 4th Student

Tuition $5300.00 $4240.00 $3590.00 $3510.00

**Payment Plan (circle one)** Plan A 1 Payment Payment in full Due August 15 Remit to ECA

Plan B 2 Payments Due August 15th & January 15th Remit to ECA

Plan C 4 Payments Due Aug. Oct. Feb. & May 15th Enroll in FACTS by July 15th

Plan D 9 Payments Due Sept 15thMay 15th Enroll in FACTS by August 15th

Plan E 11 Payments Due July 1st May 1st Enroll in FACTS By June 1st

**Payments will be divided equally according to the payment plan you choose** I/we understand and agree to the following: that in the event any school obligation is in default the school reserves the right to hold all records including report cards until the outstanding fee/obligation is fulfilled; that in the event any obligation is not met, a student will not be permitted to participate in K or 8th graduation ceremonies or receive his/her diploma; that all school obligations for any prior school year must be fulfilled before any student will be permitted to return to Edgarton Christian Academy for the next school year and before any records can be released to another school; that Edgarton Christian Academy reserves the right to release any student and family for any noncompliance to any policy, procedure, or agreement that Edgarton Christian Academy has established; that I/we may not be eligible for the payment plan I/we choose because of previous non-payment; that it is my/our responsibility to make timely payments; that the school may, but is not obligated to, send reminders or other notices regarding outstanding bills; that there will be an automatic late charge applied in the amount of $40 for payments made after the 25 th of each month; that returned checks are subject to a $40 fee; that upon withdrawal of my/our student/s, if my/our account is in arrears and payment arrangements are not met, the matter automatically will be remanded for collection 30 days from date of withdrawal; that I/we will be responsible for an additional late fee of $40 per month assessed from the last month my/our account was paid up-to-date; that in addition to the tuition payment I/we will be responsible for any court cost, and any and all other fees associated with the collection of the debt.

Please Print Please Print Father’s Name_______________________________________ Mother’s Name_________________________________ Street/Town/St/Zip____________________________________ Street/Town/St/Zip______________________________ Home Phone ___________________Cell_________________ Home Phone ________________Cell_______________ Father’s Signature____________________________________ Mother’s Signature______________________________ Date: __________ SS# ________________________________Date: _________ SS#__________________________

Edgar on Christian Academy PK TUITION AGREEMENT SCHOOL YEAR 2017-2018 1st STUDENT'S NAME_______________________________________GRADE ________ (Please Print) Last First Days per week_____ 2nd STUDENT'S NAME_______________________________________GRADE _________ (Please Print) Last First Days per week______ 3rd STUDENT'S NAME_______________________________________GRADE __________ (Please Print) Last First Days per week______ 4th STUDENT'S NAME_______________________________________GRADE __________ (Please Print) Last First Days per week______

AMOUNT__________ AMOUNT__________ AMOUNT__________ AMOUNT__________

Other Fees: a) HSA Dues Per Family b) Pre-K Activity Fee $60(per child)

__$20.00___ ___________

GRAND TOTAL AMOUNT___________ Registration/Re-registration Fee per child: $150.00 Non Refundable is due at time of registration/re-registration.

#of Students ______ X $150.00 equals total registration/re-registration Fees due:________ Office Use only: Amount Paid

$_________

Cash______

Check # ________ Date ________

**TUITION ASSISTANCE AVAILABLE For Grades K-8 ONLY**

Pre-K Tuition Rates Days/Week 5 4 3 2

Tuition $6400.00 $5750.00 $5300.00 $4200.00

**Payment Plan (circle one)** Plan A 1 Payment Payment in full Due August 15 Remit to ECA

Plan B 2 Payments Due August 15th & January 15th Remit to ECA

Plan C 4 Payments Due Aug. Oct. Feb. & May 15th Enroll in FACTS by July 15th

Plan D 9 Payments Due Sept 15thMay 15th Enroll in FACTS by August 15th

Plan E 11 Payments Due July 1st May 1st Enroll in FACTS By June 1st

**Payments will be divided equally according to the payment plan you choose** I/we understand and agree to the following: that in the event any school obligation is in default the school reserves the right to hold all records including report cards until the outstanding fee/obligation is fulfilled; that in the event any obligation is not met, a student will not be permitted to participate in PK, K or 8th graduation ceremonies or receive his/her diploma; that all school obligations for any prior school year must be fulfilled before any student will be permitted to return to Edgarton Christian Academy for the next school year and before any records can be released to another school; that Edgarton Christian Academy reserves the right to release any student and family for any noncompliance to any policy, procedure, or agreement that Edgarton Christian Academy has established; that I/we may not be eligible for the payment plan I/we choose because of previous non-payment; that it is my/our responsibility to make timely payments; that the school may, but is not obligated to, send reminders or other notices regarding outstanding bills; that there will be an automatic late charge applied in the amount of $40 for payments made after the 25th of each month; that returned checks are subject to a $40 fee; that upon withdrawal of my/our student/s, if my/our account is in arrears and payment arrangements are not met, the matter automatically will be remanded for collection 30 days from date of withdrawal; that I/we will be responsible for an additional late fee of $40 per month assessed from the last month my/our account was paid up-to-date; that in addition to the tuition payment I/we will be responsible for any court cost, and any and all other fees associated with the collection of the debt. Additionally as the parent of a preschool student, I/we understand that while our tuition covers the number of days per week that we have opted to attend. I/we also understand that the school schedule may preclude attendance for the number of days that we have scheduled per week. I/we understand that we cannot make up those days during another week. I/we understand that if my/our child is absent for any reason, I/we may not schedule “make-up” days for the days that my/our child is absent. I/we understand that I/we will not be monetarily reimbursed for any missed days regardless of the reason. I/we also understand that if for any reason my/our child must be un-enrolled from the ECA program, there is no guarantee that my/our child can re-enroll at a later time during the school year due to the class size. I/we understand that the preschool classes have a daily student attendance limit which cannot be exceeded.

Please Print Please Print Father’s Name_______________________________________ Mother’s Name______________________________ Street/Town/St/Zip____________________________________ Street/Town/St/Zip_____________________________ Home Phone ___________________Cell_________________ Home Phone _______________Cell______________ Father’s Signature____________________________________ Mother’s Signature_____________________________ Date: __________ SS# _______________________________ Date: _________ SS#__________________________

FOR NEW AND RETURNING FAMILIES Online Enrollment Process for Payment of Tuition Welcome to the 2017-2018 School Year for Edgarton Christian Academy. Our school uses the FACTS Tuition Management Program to handle our payment plans. You can check on the status of your account, the schedule of payments still to be made, a listing of those payments already made, and a complete listing of all activity through your account. Please be aware that you must enroll/re-enroll in FACTS at least 20 days prior to the first due date of the payment plan you prefer. Also note that FACTS charges a fee for their service which will be added to your first payment. The fee is payable to FACTS and is separate from tuition. All users should visit our ECA website at: http://eca-pk8.org Under the main picture you will see a black and white box that says FACTS on the right side of the page. Click on it. This will connect you directly to FACTS website then follow the prompts on the screen. If you are enrolled in FACTS for 2016-2017, it is still necessary to update your information and create your payment plan for 2017-2018. Returning and existing users may visit the FACTS site directly at https://online.factsmgt.com  Enter your username and password  Create your payment plan for 2017-2018 If you have any questions regarding the set up process please contact FACTS Management at 866.441.4637.

Dear Parents,

FACTS Grant & Aid Assessment will be conducting the financial need analysis for Edgarton Christian Academy for the upcoming 2017-2018 school year. K- 8 families applying for financial aid will need to complete an application and submit the necessary supporting documentation to FACTS Grant & Aid Assessment by March 15, 2017. Applicants can apply online by clicking the FACTS link at www.eca-pk8.org. Once an online application has been completed, the following information will need to be sent to FACTS to complete the application process:   

Copies of your most recent Federal tax forms including all supporting tax schedules. Copies of your 2016 W-2 forms for both you and your spouse. Copies of supporting documentation for Social Security Income, Welfare, Child Support, Food Stamps, Workers’ Compensation, and TANF.

All supporting documentation can be uploaded in pdf format online. Documentation can also be faxed to 866-315-9264 or mailed to the address below. Please be sure to include the applicant ID on all faxed or mailed correspondence. FACTS Grant & Aid Assessment P.O. Box 82524 Lincoln, NE 68501-2524 If you have questions or concerns about the application process, you may speak with a FACTS Customer Care Representative at 866-441-4637. Sincerely,

Dr. Mary Alimenti

PLEASE PRINT ALL INFORMATION (B6T) APPLICATION FOR PRIVATE SCHOOL TRANSPORTATION

NEW JERSEY STATE DEPARTMENT OF EDUCATION OFFICE OF STUDENT TRANSPORTATION

Please submit a separate application for each child to the private school. SCHOOL YEAR

2017-2018

RESIDENT DISTRICT BOARD OF EDUCATION (district where you pay your property taxes)

STUDENT's NAME

DATE OF BIRTH LAST

FIRST

MIDDLE

PARENT OR GUARDIAN ________________________________________________

MONTH

DAY

YEAR

DAYTIME PHONE AREA CODE + NUMBER

2nd Phone # CITY OR TWP _________________

HOME ADDRESS

ZIP ______________________

NEAREST INTERSECTION TO STUDENT'S RESIDENCE MAILING ADDRESS

ZIP ______________________

FULL NAME OF SCHOOL TO BE ATTENDED

Edgarton Christian Academy

PHONE __856-697-7300

212 Catawba Ave. Newfield, NJ 08344 SHORTEST ONE-WAY MILEAGE BETWEEN HOME AND SCHOOL

(MEASURED VIA THE SHORTEST ROUTE ALONG PUBLIC ROADWAYS OR WALKWAYS IN MILES AND TENTHS)

ADDRESS OF SCHOOL (campus for next year)

STUDENT'S GRADE FOR THE COMING YEAR

MILES TENTHS DATE SCHOOL OPENS

September 2017

CLOSES

June 2018 SCHOOL HOURS FROM

8:00 AM

TO

2:40 PM

NAME AND ADDRESS OF LAST SCHOOL OF ATTENDANCE DATE

SIGNATURE DO NOT WRITE BELOW THIS LINE * FOR PUBLIC SCHOOL USE ONLY

YOUR APPLICATION HAS BEEN REVIEWED BY THE RESIDENT DISTRICT BOARD OF EDUCATION. THE FOLLOWING DETERMINATION HAS BEEN MADE:

TRANSPORTATION WILL BE PROVIDED

YOU ARE ELIGIBLE FOR PAYMENT IN LIEU OF TRANSPORTATION

INELIGIBLE

(REASON)

DATE ___________ SIGNATURE TITLE _____________________________ ================================================================================================================= INSTRUCTIONS FOR COMPLETING Proof of Residence: current tax bill or lease agreement (rates crossed out) must accompany this form. Distance from School: if not sure, please estimate. Do not leave blank. Please complete this form even if your child does not ride the bus. 1. *

IT IS THE OBLIGATION OF THE PARENT OR GUARDIAN OF PRIVATE SCHOOL STUDENTS TO: ANNUALLY OBTAIN THE APPLICATION FOR PRIVATE SCHOOL TRANSPORTATION FROM THE ADMINISTRATIVE OFFICE OF THE PRIVATE SCHOOL FOR EACH STUDENT FOR WHICH TRANSPORTATION SERVICES ARE BEING REQUESTED. SUBMIT A SEPARATE APPLICATION FOR EACH STUDENT. NOTE O IF THERE IS A CHANGE OF HOME ADDRESS, A NEW APPLICATION SHALL BE SUBMITTED TO THE PUBLIC SCHOOL DISTRICT OF RESIDENCE. O IF THERE IS A CHANGE IN THE NONPUBLIC SCHOOL OF ATTENDANCE, A NEW APPLICATION SHALL BE SUBMITTED TO THE PUBLIC SCHOOL DISTRICT OF RESIDENCE. * COMPLETE THIS APPLICATION AND RETURN IT TO THE PRIVATE SCHOOL ON OR BEFORE MARCH 1st PRECEDING THE SCHOOL YEAR IN WHICH TRANSPORTATION IS BEING REQUESTED. LATE APPLICATIONS-ANY APPLICATION RECEIVED AFTER MARCH 1 WILL BE A LATE APPLICATION AND MUST BE ACCOMPANIED BY A STATEMENT OF THE REASON FOR LATENESS. ELIGIBLE STUDENTS WILL RECEIVE TRANSPORTATION OR AID IN LIEU OF TRANSPORTATION BASED ON THE DATE THE APPLICATION IS RECEIVED BY THE PUBLIC SCHOOL. 2. IT IS THE OBLIGATION OF THE NONPUBLIC SCHOOL TO ANNUALLY COLLECT THE APPLICATION AND SUBMIT IT TO THE PUBLIC SCHOOL FROM WHICH 3.

TRANSPORTATION IS BEING REQUESTED PRIOR TO MARCH 1ST. IT IS THE OBLIGATION OF THE PUBLIC SCHOOL TO NOTIFY THE PARENT OR GUARDIAN AS TO THE DETERMINATION OF EACH APPLICATION BY AUGUST 1ST.

A DISTRICT BOARD OF EDUCATION SHALL PAY AID IN LIEU OF TRANSPORTATION TO THE PARENT OR GUARDIAN OF AN ELIGIBLE STUDENT ONLY AFTER RECEIVING A SIGNED "REQUEST FOR PAYMENT OF TRANSPORTATION AID" VOUCHER AS PRESCRIBED BY THE COMMISSIONER OF EDUCATION.

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EDGARTON ACADEMY STUDENT EMERGENCY FORM FOR OFFICE 2017-2018 Please Print All Information

STUDENT INFORMATION:

1st) Student’s Name __________________________________________ Date of Birth _____________Grade________ Allergies: ____________________________________________________________________________ 2nd) Student’s Name __________________________________________ Date of Birth ______________Grade________ Allergies: ____________________________________________________________________________ 3rd) Student’s Name___________________________________________ Date of Birth ______________Grade________ Allergies: ____________________________________________________________________________ 4th)

Student’s Name___________________________________________ Date of Birth ______________Grade________ Allergies: ____________________________________________________________________________

Mailing Address _________________________________________________Home Phone______________________ __________________________________________________________ PARENT/GUARDIAN INFORMATION:

Father’s Name _________________________________Home Phone _______________Cell Phone________________ Address__________________________________________________________________________________________ E-mail Address____________________________________________ Employer’s Name_________________________________________________________Phone____________________ Mother’s Name ________________________________Home Phone _______________Cell Phone________________ Address__________________________________________________________________________________________ E-mail Address____________________________________________ Employer’s Name__________________________________________________________Phone____________________ If parents are separated or divorced, with whom does the child reside?_________________________________________ Are there any custodial concerns of which the school should be aware?________________________________________ (Copy of legal documentation must be sent to office)

LIST ALL PERSONS WHO HAVE PERMISSION TO PICK UP YOUR CHILD/REN IN THE EVENT OF: ILLNESS, SCHOOL EMERGENCY, REGULAR OR EARLY DISMISSAL, SPECIAL FUNCTIONS, APPOINTMENTS OR ANY OTHER REASONS:

1. Name____________________________________ Phone: ___________________Relationship __________________ 2. Name___________________________________ Phone: __________________ Relationship__________________ 3. Name___________________________________ Phone: ___________________ Relationship__________________ 4. Name___________________________________ Phone: ___________________ Relationship__________________ IN CASE OF AN ACCIDENT OR SERIOUS ILLNESS, THE SCHOOL WILL ATTEMPT TO CONTACT ME. IF I CAN’T BE REACHED, I AUTHORIZE THE SCHOOL TO SEEK EMERGENCY MEDICAL ASSISTANCE FOR MY CHILD. YES____ NO____ NAME OF YOUR CHILD'S DOCTOR______________________________________________PHONE_________________________ PARENT'S SIGNATURE_____________________________________________________________DATE_____________________

Edgarton Christian Academy Grades PK through 8 BEFORE/AFTER SCHOOL AGREEMENT 2017/2018 Regardless of whether or not you intend to use the program, all families must sign the form below acknowledging the charges that will be incurred should your children attend Before/After Care. Child’s Name_____________________________________________________________ Grade_________ Child’s Name_____________________________________________________________ Grade_________ Child’s Name_____________________________________________________________ Grade_________ Child’s Name_____________________________________________________________ Grade_________ Days enrolled in program (please check): Monday_____ Tuesday_____ Wednesday_____ Thursday_____ Friday_____ Drop Off Time:____________________ (If on regular schedule) Pick Up Time:_____________________ (if on regular schedule)

MORNING CARE: Children should be dropped off no earlier than 6:30 am. AFTER CLOSING FEE: The program closes promptly at 6 pm. If you are late, a staff member will stay with your child until you arrive. You will be charged $5.00 for each additional 15 minutes after closing time. SNACK: After-school snacks may be provided by parents or purchased at school for varying prices. SCHOOL HALF DAYS: The Before/After School Program will be in operation; however, parents must provide their child’s lunch. PAYMENT: Payment of $2.50 per half-hour is required of each student. Each half hour begins and ends with the minute hand of the clock reaching 12 and 6, not at the time your child is dropped off or picked up. Children who are enrolled on a daily basis should make payments on Friday. Children who are on an “as needed” basis should bring a note to school that morning stating that they will be attending the program with payment made at time of pick up. PLEASE NOTE THAT THERE IS NO CHARGE FOR PK STUDENTS. THIS FEE IS INCLUDED IN THE PK TUITION FEE. DAILY RELEASE: No one but the designated person(s) may pick up children. If anyone other than the designated person(s) will be picking up your child, a signed note from you, the parent, must be given to the school office that morning.

In consideration of acceptance into the Before/After School Program, I agree to make timely payments of required fees and to adhere to all the rules and regulations of the program. I understand that my failure to meet the conditions of this agreement may result in my child(ren) being dismissed from the program. I have read this form and agree to all the conditions stated above. Parent’s Signature__________________________________________________________Date___________________

SCHOOL YEAR 2017-2018 EMERGENCY MEDICAL FORM FOR NURSE Please Print Clearly Home Phone ______________________________ Date of Birth ______________________________ Grade ____________________________________ Student’s Name ___________________________________________________________________________ Last First Middle Mother/Legal Guardian _______________________________ Father/Legal Guardian ____________________________ Address ____________________________________________ Address _________________________________________ Town __________________________, St. ____ Zip _________ Town _________________________, St. ____ Zip _______ Cell# _______________________________________________ Cell# ____________________________________________ Cell# _______________________________________________ Cell# ____________________________________________ List Those Who Will Assume Temporary Care Of Your Child If You Cannot Be Reached 1. Name ___________________________________ Phone: ___________________Relationship __________________ 2. Name ___________________________________ Phone: ___________________Relationship __________________ 3. Name ___________________________________ Phone: ___________________Relationship __________________ 4. Name ___________________________________ Phone: ___________________Relationship __________________ List medication routinely given: 1. _________________ 2. _________________ 3. _________________ 4. _________________ 5. _________________ 6. _________________ Check If Student Has Any of the Following Conditions

_____ Heart Condition _____ Restrictions _____ No Restrictions _____ Diabetes _____ Asthma _____ On Medication _____ Seizure Disorder _____ Adverse Drug Reaction _____ Vision or Hearing Problems _____ Glasses _____ Contacts _____Allergies please list: ____________________________________________________________________

___________________________________________________________________________________ _____Severe Allergies/Anaphylaxis please list allergen: _______________________________________________ ____________________________________________________________________________________ _____ Other _______________________________________________________________________________ Please explain any of the above conditions if they are checked _______________________________________________________ Name of child’s physician/clinic facility__________________________________ Office Phone ____________________________ Hospital of choice ______________________________________ Town ________________________ Phone __________________ If there are any changes in the information provided, please notify the school and nurse as soon as possible. I hereby give permission to release information regarding my child’s health condition(s) to school personnel in order to best meet the medical and health needs of my child in the school setting. In case of accident or serious illness, I request the school to contact me. If the school is unable to reach me, the school may make necessary arrangements to treat my child. Signature of Parent or Legal Guardian ___________________________________________________________ Date _____________

IMMUNIZATIONS REQUIRED Please use the guide below to make sure you child is up to date regarding required immunizations. Updated records must be sent to the school nurse on or before the first day of school. New Jersey Department of Health and Senior Services AGE-APPROPRIATE VACCINATIONS FOR LICENSED CHILD CARE CENTERS/PRE-SCHOOLS 18 Months-4 Years 4 doses DTaP 3 doses Polio 1 dose MMR (given on or after the first birthday) 1 dose Hib (given on or after the first birthday) 1 dose Varicella (given on or after the first birthday) 1 dose PCV (Pneumococcal) (given on or after the first birthday) 1 dose seasonal Influenza, to be given between September 1st and December 31st of each year, while in preschool

New Jersey Department of Health

MINIMUM IMMUNIZATION REQUIREMENTS FOR SCHOOL ATTENDANCE IN NEW JERSEY N.J.A.C. 8:57-4: IMMUNIZATION OF PUPILS IN SCHOOL Requirements for students entering Kindergarten (in addition to the above stated immunizations) 1 dose DTaP booster, given after the 4th birthday 1 dose Polio booster, given after the 4th birthday 3 doses Hep B Requirements for students entering 6th grade (in addition to the above stated immunizations) 1 dose Tdap 1 dose Meningococcal (Menactra)

********** Annual Flu vaccinations are required for Pre-K students!!!!!! *********

If your child receives any immunizations while visiting the pediatrician, please remember to ask for a copy of the documentation. Maintain a copy for yourself and submit a copy to the school nurse.

01/2016

PARENT PERMISSION FORM FOR FIELD TRIP PARTICIPATION 2017-2018 Dear Parent or Legal Guardian: Your son\daughter is eligible to participate in a school-sponsored activity requiring transportation to a location away from the school building. This activity will take place under the guidance and supervision of employees from Edgarton Christian Academy. A brief description of the activity follows: Name of Event & Destination:

Public Library, Walk to the local Municipal Buildings, Annual Frank Valla Walk-A-Thon

Designated Supervisor of Activity:

Principal and Faculty

Date and Time of Departure:

As scheduled on calendar or class schedule

Date and Anticipated Time of Return:

As scheduled on calendar or class schedule

Method of Transportation:

Walk

Student Cost:

None

If you would like your child/children to participate in this event, please complete, sign and return the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by the named student. I hereby consent to participation by my child/children (listed below) in the event described above. I understand that this event will take place away from the school grounds and that my child will be under the supervision of the designated school employee on the stated dates. I further consent to the conditions stated above on participation in this event, including the method of transportation. Print Parent's Name________________________________________________________________ Parent's Signature__________________________________________________________________ Child's Name____________________________________________________ Gr._______________ Child's Name____________________________________________________ Gr._______________ Child's Name____________________________________________________ Gr._______________

No child will be permitted to participate in school activities outside of the building without a signed consent form. Thank You.

K to 8th Grade only Individual Pupil Request for Loan of Textbooks

Today’s Date: ____________________________________ Public School District

Newfield (K-8)

(where nonpublic school is located)

Nonpublic School:

Edgarton Academy

Address

PO BOX 646 (212 Catawba Ave.)

City, Zip

Newfield, NJ 08344

Name of Pupil:

______________________________

Grade Level for 2017-2018 School Year:

____________

Name of Parent/Guardian: ________________________ Address ______________________________ City, Zip

______________________________

Under the provisions of N.J.S.A. 18A:58-37.1 et seq., I hereby request that either Newfield District Board of Education loan textbooks to Edgarton Academy in which my child is enrolled. I certify that my above named child and I are residents of the State of New Jersey. I understand that the Board of Education of the public school district in which the nonpublic school is located with state funding is responsible for providing the loan of textbooks to nonpublic school pupils pursuant to law and regulations.

Signature of Parent/Guardian:

________________________________________________

Date Signed:

________________

Rev: 1/2017