BCS 3-school and 4-school Online Enrollment Form
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TUITION & PROGRAM INFORMATION
3-school (Must be 3 by Sept. 1) - Tuesday & Thursday - 9:00 AM - 11:00 AM - *estimated annual tuition will be $1000 (actual cost will be determined in January)

3-Day PM 4-school (Must be 4 by Sept. 1) - Monday, Wednesday, & Friday - 1:00 PM - 3:30 PM - *estimated annual tuition will be $1400 (actual cost will be determined in January)

3-Day AM 4-school (Must be 4 by Sept. 1) - Monday, Wednesday, Friday - 9:00 AM - 11:30 AM - *estimated annual tuition will be $1400 (actual cost will be determined in January)
PARENT/GUARDIAN INFORMATION
Parent(s)/Guardians(s) First and Last Name(s): *
Address/City/State/Zip *
Home Phone/Best Contact Number: *
Email Address: *
Publish Email Address in School Directory: *
Church Affiliation: *
STUDENT #1 INFORMATION
**3-school students must be 3 by September 1, 2022. 4-school students must be 4 by September 1, 2022.
Child's Full Legal Name (First, Middle, Last): *
Child's Birthday: *
MM
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DD
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YYYY
Gender: *
2022/2023 Program: *
If the AM 4-school Program is at the maximum capacity of 18 students, would you like to be placed on a wait list to get into the AM 4-school Program? *
STUDENT #2 INFORMATION (Only if enrolling multiple students)
**3-school students must be 3 by September 1, 2022. 4-school students must be 4 by September 1, 2022.
Child's Full Legal Name (First, Middle, Last)
Child's Birthday:
MM
/
DD
/
YYYY
Gender:
Clear selection
2022/2023 Program:
Clear selection
If the AM 4-school Program is at the maximum capacity of 18 students, would you like to be placed on a wait list to get into the AM 4-school Program?
Clear selection
PHOTO PERMISSION
Borculo Christian School has permission to use photos and digital media of our child(ren) for publication in newsletters, on the school website, and promotional products current and yet to come. Additionally, I/we give consent for the use of digital media and images, including first names, for the purpose of archival media (i.e. end of year memories DVD's, etc). *
FIELD TRIP PERMISSION
*
Required
FERPA Consent
Sharing immunization and personally identifiable information including the students name, Date of Birth, gender, and address with local and state health departments will help to keep your child safe from vaccine preventable diseases.  The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g, requires written parental consent before personally identifiable information from your child’s education records is disclosed to the health department.  If your child is 18 or over, he or she is an “eligible student” and must provide consent for disclosures of information from his or her education records.
I authorize Borculo Christian School to release my child’s immunization record to the Michigan Department of Health and Human Services and Local Health Department. I understand this information will be used to improve the quality and timeliness of immunization services and to help schools comply with Michigan Law. This includes any immunization information and limited personally identifiable information from the school.  
Clear selection
Borculo Christian 3-school and 4-school programs both require a parent/guardian to help provide snacks for the classroom once every 6-8 weeks.
Emergency Information
Father's Employer: *
Father's Work # *
Father's Cell #: *
Mother's Employer: *
Mother's Work #: *
Mother's Cell #: *
Emergency Contact #1: *
Emergency Contact Phone #: *
Emergency Contact #2: *
Emergency Contact Phone #: *
Emergency Contact #3: *
Emergency Contact Phone #: *
Does your child(ren) have any allergies the school should be aware of?   *
If yes, please list the allergies and special instructions:
Do you give the school permission to give Tylenol (generic brand) to your child(ren)? *
Name of Child's Physician: *
Name of Child's Health Clinic: *
Phone # of Child's Health Clinic:   *
Please describe any health information you feel would be important for the school to know about: *
Please describe any behavioral concerns you feel would be important for our school staff to know about: *
Please describe any educational concerns you feel would be important for our school staff to know about: *
Please describe any other concerns about your child(ren) you feel would be important for our school staff to know about: *
Borculo Christian School Enrollment Contract Terms
It is necessary to establish an agreement upon payments made for tuition and that families adhere to the agreed-upon payment schedule.  The board must meet its monthly payments and therefore this necessitates each family doing the same.

1. I/We agree to make full payment of any prior commitment by June 1, 2022.  If unable to do so, I will request a meeting with the school’s Finance Committee to mutually resolve the matter.  Until these criteria are met, enrollment of the new school year is considered conditional.  
2. If I/We cannot meet the payment plan, I/We will contact the Finance Committee.
3. I/We understand that in the event tuition is not paid, legal means of tuition collection may be used.
4. Any child shall be permitted to enroll whose tuition is paid from the previous year.  If a balance remains, however, there must be a written agreement as to the tuition payment for the current year.
5. Families that no longer have children at Borculo Christian School are expected to have their tuition paid in full at the time of leaving Borculo Christian, the family and the finance committee must agree on a payment plan to pay the remaining amount owed to BCS.  This plan will be made in writing and signed by the parent or parents and a representative of Borculo Christian School.

*
Required
*$50 non-refundable deposit due at enrollment.  Deposit holds your spot and is credited towards your tuition.
Parent/Guardian Signature: *
A copy of your responses will be emailed to the address you provided.
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