Heritage Academy

Student Online Form

Student Information

What year are you applying for?
  Date of first application
First Name
Middle Name
Last Name
Social security number
Birth Date
Gender
Home Phone
Parent/ Guardian Name: Parent/ Guardian Cell Phone
Parent/ Guardian email address
Home Address
Mailing Address (if different)
Grade Applying for
Place of Worship



Description of Your Child

Current School Name
Address
Grades Attended
 
Other Schools Attended
Address






Has the student had any discipline
problems at school?

If yes, please explain
Has the student been suspended or
asked to leave any school?

If yes, please explain
Has the student been recommended for
IEP, Special Services, Retention,
Speech Therapy, or Diagnostic Testing?

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

Who has legal custody of this child?

Parent/Guardian completing this application has legal responsibility for

FATHER
First Name
Middle Name
Last Name
Address
Home Phone #
Cell Phone #
Occupation
Employer
Business Address
Business Phone #
Father’s Email
MOTHER
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 ALL THAT APPLY
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:











Name of Parent / Guardian

Date



Statement of Philosophy

Parent / Guardian: Please read the following and sign below.
Heritage Academy

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.

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.


Name of Parent / Guardian
Date
“You will be expected to sign agreement during a parent interview a time of testing”
333 Greene Street, Augusta, GA 30901,
P: (706)_ 821-0034, F: (706) 821-0122,
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