2019-2020 Student Enrollment Form

I would like to:* Re-Enroll Students Enroll New Students

Family Status:*

Your Information

My Name *

Relationship to Child(ren) *

My Email Address *

Street Address *

City *

State *

Zip *

School District in which you reside *

Home Phone

Cell Phone *

Work Phone

I authorize MCS to use the following contact number for automated messages. (Snow delays, cancellations, or other important messages) *

Occupation

Employer *

Church Presently Attending *

Church Attendance * Weekly Occasionally Never

Second Parent Information

Name

Relationship to Child(ren)

Email Address

Street Address

City

State

Zip

Home Phone

Cell Phone

Work Phone

Occupation

Employer

Church Presently Attending

Church Attendance Weekly Occasionally Never

Additional Authorized Contacts

When unable to reach parents/legal guardian in case of an emergency, please call one of these authorized pickup contacts.

Name *

Contact Number *

Name

Contact Number

Children Information

Number of Children *

Child 1
Child's Full Name *
Birthdate *
Grade 2019-2020 *
On Campus or Independent Study? *

Consent for Use of Photographs Media Release - 2019-2020 School Year

As the parent/legal guardian, I hereby authorize or refuse Mansfield Christian School, and any photographer, videographer, newspaper or other media source, to use photographic or other images of my children. *

Student Name	Authorize	Refuse

For Purpose of Publicizing and/or Promoting the School Operated By Mansfield Christian School *

I represent that I have authority to release, and understand that I may revoke this release at any time providing a signed and dated copy of the revocation below to the school office. A photocopy of this release may be used to the same extent as the original until such time as this release is revoked.

Student Activities Permissions

Permission is granted for my child to take part in all school activities, including sports and school sponsored trips away from the school premises (except as specifically listed below). I agree to relieve the school and any of its employees from any liability in connection with these activities and instructions.

Student Name	Agree	Exceptions (if any)

Emergency Medical Authorization

Purpose: To Enable Parents And Guardians The Provision Of Emergency Treatment For Their Children Who Become Ill Or Injured While Under School Authority, When Parents Or Guardian Cannot Be Reached. This Authorization Does Not Cover Major Surgery Unless The Medical Options Of Two Other Licensed Physicians Or Dentists, Concurring In The Necessity For Such Injury, Are Obtained Prior To The Performance Of Such Surgery. (Required By Section 3313.712 Of The Ohio Revised Code)

Treatment Options

Option I (Refusual to Consent): I do not give my consent for emergency treatment of my child. In the event of illness or injury regarding emergency treatment, I wish the school authorities to take no action.
Option II (Grant Consent): In the event reasonable attempts to contact primary Parent/Guardian have been unsuccessful, I hereby grant consent for (1) the administration of any treatment deemed necessary by your Family Physician or Pediatrician or in the event the designated preferred physician is not available by another licensed physician or dentist, or (2) Call 911 and transfer the child to any hospital reasonably accessible.

Student Name	Grant Consent	Refusal to Consent

Family Physician/Pediatrician *

Phone Number *

Family Dentist *

Phone Number *

Facts concerning each child's medical history including allergies, medications being taken, and any physical impairment to which a physicial should be alerted

Student Name	Medical History

MCS Student Expectations

As parents, you want God's best for your children. That is also our desire at Mansfield Christian School. The school's mission involves a loving, cooperative and committed partnership between the families and Mansfield Christian School. We ask that each family take a moment to familiarize the expectations of each MCS student as described in the Student/Academic Handbook and the Parent/Guardian Agreement.

Mission Statement

Assisting the Christian home and church by teaching solid academics rooted in a Biblical worldview

Lifestyle Statement and Agreement

Mansfield Christian's Lifestyle Statement Mansfield Christian School's biblical role is to work in conjunction with the home to mold students to be Christ like. Of necessity this involves the school's understanding and belief of what qualifies or characteristics exemplify a Christ like life. The school reserves the right, within its sole discretion, to refuse admission of an applicant or to discontinue enrollment of a student of the atmosphere or conduct within a particular home or the activities of the student are counter to or are in opposition to the biblical lifestyle the school teaches. This includes, but is not necessarily limited to, participating, supporting or condoning sexual immorality, homosexuality activity, bisexual activity, or transgender identity promoting such practices: or being unable to support the moral principles of the school. (See Lev. 20:13, Rom. 1:27 & I Cor. 6:9-20)As clearly stated in our admissions policy, our mission rests upon both the home and church. The standards in your home and church are important to us and we desire that they align with our Statement of Faith, Core Values, and Philosophy of Education.

Parent/Guardian Agreement

I/We support the goal of the Mission and Vision Statement to fulfill the MCS mission in the life of an MCS student.
I/We pledge that our child is not residing in a household in which adults are living together outside of legally sanctioned marriage.
We pledge to faithfully attend a church where our Savior, Jesus Christ, God's Son, is worshipped and the authority of the Bible is taught.
I/We pledge our loyal support to the school through praying for its programs and those involved in operating the school, contributing to its financial support as the Lord leads, and by making tuition payments regularly and on time.
I/We commit to pray for the school, faculty, administration, volunteers and school board.
I/We understand that the school reserves the right to dismiss or deny re-enrollment to any student who fails to comply with the established regulations, its spiritual standards or whose financial obligation remains unpaid. MCS reserves the right to withhold any academic records or transcripts for any unpaid tuition, fees, etc. (As stated in the student/academic handbook).
The Student/Academic Handbook - I/We acknowledge and agree to the, policies, procedures, and programs, the standards of the school, and that MCS will not tolerate a lifestyle that brings dishonor to God and the Word of God nor disrespect the personnel of the school.
I/We, as parents or legal guardian who are accepting the challenge to "train up a child in the way he should go," do state that this training will be carried on in the home. We shall place our trust in Mansfield Christian School to extend that training more completely.
Discipline - I/We authorize the school to discipline our child/children when necessary, as stated in the Student/Academic Handbook.
MCS Uniform Guidelines - I/We understand and agree to uphold the MCS Uniform Guidelines outlined in the Student/Academic Handbook.
Property Loss or Damage - I/We understand that we will be assessed for property damages caused by our child/children to MCS property (including breakage of windows, display cases and abusing personal property of others). MCS is not financially responsible for loss, damage, or injury to clothing or personal items brought to school. (Electronics such as iPods, cell phones, are not to be used during school hours).
Parent/Teacher Conferences - I/We acknowledge that MCS strives to maintain strong lines of communication. Parent/Teacher conferences are offered twice a year to discuss the academic progress of the child. Parents may contact the teacher via email throughout the year.
Matthew 18 Principle - I/We understand the steps are outlined in the Student/Academic Handbook on how to handle a conflict between our child and others in the MCS family. (Students, parents, faculty, staff and administration)
I/We pledge that if for any reason irreconcilable differences exist, we will not circumvent school rules and procedures, but will withdraw quietly and without delay.

Parent/Guardian Agreement *

I/We acknowledge that we have read and agree to abide by the conditions outlined in the above Parent/Guardian Agreement and to support the guidelines and policies of Mansfield Christian School, all of which are set forth and stated in the student/academic handbook.