corpus christi academy · please print clearly in black or blue ink. registration forms are to be...
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CORPUS CHRISTI ACADEMY
Sacred Heart of Jesus Parish Saint Clare Parish
Please print clearly in black or blue ink.
Registration forms are to be submitted to Corpus Christi Academy Office.
Parent Name: ______________________________
Student Name: _____________________________
K-8 Registration Agreement 2020-2021 School Year
Registering as Active Parishioner: ( ) Sacred Heart of Jesus ( ) St. Clare ( ) Holy Rosary
OR ( ) Non-Parishioner
Registering as: ( ) Catholic ( ) Non-Catholic
Registration is complete ONLY upon following:
(1) Tuition payments are current for 2019-2020 with Corpus Christi Academy.
(2) Payment of $100 per student must accompany this Agreement. Registration Fee is non-refundable.
(3) Corpus Christi Academy Business Office reviews for accuracy and completeness.
(4) New Applicants Only: Complete only after student is accepted to the Academy by administration.
Father/Guardian Information Mother/Guardian Information
( ) Custodial ( ) Non-Custodial ( ) Custodial ( ) Non-Custodial
Name __________________________________ Name ___________________________________
Address ________________________________ Address__________________________________
_________________________________ __________________________________
E-mail _________________________________ E-Mail___________________________________
Phone __________________________________ Phone___________________________________
(Please mark preferred phone) (Please mark preferred phone)
Student Information
Name (First & Last) Date of Birth Grade 2020-21 N (New) or R (Return)
____________________________ ________________ ________ _________
____________________________ ________________ ________ _________
____________________________ ________________ ________ _________
____________________________ ________________ ________ _________
____________________________ ________________ ________ _________
CORPUS CHRISTI ACADEMY
2020-2021 K-8 Tuition and Fees
Number of K-8 Students in Family 1 2 3 4
Non-Parishioner Tuition
5,900
5,900
5,900
5,900
Registration fee (per student)
100
100
100
100
Technology fee (per student)
150
150
150
150
Additional Child
--
6,150
6,150
6,150
Family Total $ 6,150 $ 12,300 $ 18,450 $ 24,600
Number of K-8 Students in Family 1 2 3 4
Active Parishioner Tuition 4,300 3,830 3,435 -
Registration Fee (per student) 100 100 100 100
Technology Fee (per student) 150 150 150 150
Additional Child -- 4,080 3,685 250
Family Total $ 4,550 $ 8,630 $ 12,315 $ 12,565
Active Participation and Parish Contributions
The full cost to educate each student is approximately $6,200.00 The difference between full cost tuition and
each student’s tuition is covered by subsidies from Saint Clare and Sacred Heart of Jesus Parishes funded through:
*Offertory contributions by active parishioners
*Full participation in fundraising activities
Your committed and consistent support of your parish and Corpus Christi Academy enable the reduced Active
Parishioner rate and demonstrates your appreciation for the support being provided by other members of
your parish.
Corpus Christi Academy
2020-2021 Tuition Payment Agreement
Family Name:
Student/Grade:
_________________________________ ________ ________________________________ ________
_________________________________ ________ ________________________________ ________
_________________________________ ________ ________________________________ ________
Total Family Tuition (prior to application of financial assistance):
$_____________________
Fees:
• $100.00 non-refundable registration fee per student
• $150.00 non-refundable technology fee per student
Total Family Tuition and Fees: $_____________________
I agree to pay Corpus Christi Academy the tuition and all fees for the attendance of my child(ren) as established by the school for the 2020-2021 school year. I elect to pay the tuition and fees as follows. Please mark
preferred payment method(s):
Preferred
Payment
Option
Payment Type Payment
Amount
Payment Guidelines and Due Date
One Full Payment by cash
or check
Make checks payable to Corpus Christi Academy.
Payment due July 20, 2020. ($100.00 discount if tuition
paid on or before July 5, 2020.)
Semi Annual Payment by
cash or check
Make check payable to Corpus Christi Academy.
Payment due July 5, 2020 and December 5, 2020.
St. Margaret & Gregory
Credit Union loan
Pre-approved, interest bearing loan. Eleven monthly
payments beginning July 20, 2020. Please contact the
Credit Union directly at 216-691-0242.
One payment and semi-annual payment may be completed by using FACTS.
One Full Payment
through FACTS No additional fee. Payment due July 20, 2020.
Semi Annual Payment
through FACTS
$10.00 additional fee. Payments will be made on July 5
or 20 and December 5 or 20.
Monthly payment plan set forth below must be completed
by using FACTS as applicable.
11 Monthly Payments
through FACTS*
$45.00 additional fee. Payments will be made on
the 5th or 20th of the month beginning July 2020 and
ending May 2021. Balance must be brought to zero
with the final payment due on the Friday before
Memorial Day
Ed Choice Scholarship
Parent is responsible for applying for funds, signing over
the funds to the school, and paying any remaining
tuition and fees. Please select one of the previously
listed payment options.
Total Payments:
Total Family Tuition & Fees Due as listed above:
__________________________________
*If you choose a payment plan to use FACTS, you must enroll in FACTS Tuition Management at the following web
address: https://online.factsmgt.com/signin/4KS7J. Please note that credit card fees may apply if you choose to pay by
credit card.
ADDITIONAL TERMS AND CONDITIONS
1. I agree that all payments owed under this Agreement will be paid by the due date corresponding to the
payment method(s) selected above. I understand and agree that, regardless of what payment option is
selected, I am personally responsible for the payments and for ensuring that the tuition and fees are paid in
full. Should I be late in making any payment, I understand that the following process will be followed:
a. I, and the other parents/guardians (if they are not me), will be notified of any payment not received. Notification will be via email from FACTS or Business Office
b. I will be given 30 calendar days to bring the account to current status or meet with school administration to have an adjusted payment agreement approved (not a guarantee and must be in writing and signed by the parish pastor or school president).
c. A $25.00 late fee will be assessed.
d. If, within 30 calendar days, the account is not brought to current status, and an adjusted payment agreement is not agreed upon and approved by school administration, the student enrollment will cease at the end of the current quarter, and the school may immediately take any action available and consistent with applicable law in order to collect unpaid tuition owed by me/us including but not limited to limiting access to field trips and extra-curricular activities, withholding academic transcripts, referral to a collection agency, and/or the institution of a civil lawsuit to recover the unpaid balance.
2. Any family with an unpaid Tuition and/or Fees balance for the current School Year will not be allowed to register for the following School Year and School records, diplomas or transcripts will not be released until the current year’s Tuition and fees are paid, unless special arrangements have been made in writing and signed by Parish pastor or School president.
3. Prepaid Tuition will only be refunded in full if written notice of cancellation is received by the School before the first day that classes for the School year are scheduled to start. The Registration Fee and Technology Fee are non-refundable.
4. Once the School year begins, Tuition refunds are made on a quarterly basis. Should a Student attend School during any portion of a quarter (one day or more), the full tuition amount for that quarter is owed and no portion of that quarter’s tuition will be refunded.
5. The Student(s) and Student's parents/guardians agree that they and their child(ren)/ward(s) will abide by the policies and guidelines as stated in the School handbook.
6. Returned checks: If two checks are returned for insufficient funds, the school will no longer accept personal checks and you will be required to pay in cash, with a certified check from a local bank, or through an approved electronic payment provider (such as FACTS) at the school’s discretion.
7. I understand that the School will not reserve a place for my child(ren) for the upcoming school year until after I have returned a completed and signed Tuition Agreement, plus the registration fee, and, if applicable, an agreement has been created in FACTS for selected plans. I further understand that my child’s/children’s eligibility for enrollment is conditioned upon (1) his/her/ successful completion of the current School Year; (2) full payment of all Tuition and fees owed for the current and/or prior School Years; and (3) acceptance by the school. I understand that the School reserves the right to deny admission or enrollment for any lawful reason.
By signing below, I agree that I have read and understand all of the terms and conditions contained in this
agreement, and I agree to be personally bound by those terms and conditions.
_______________________________________ ____________________________________ Parent/Guardian 1 Date Parent/Guardian 2 Date _______________________________________ ____________________________________ Print Name Print Name _______________________________________ ____________________________________ Telephone (Please mark preferred phone.) Telephone (Please mark preferred phone.)
_______________________________________ ____________________________________ Mailing Address Mailing Address (if different from Parent/Guardian 1)
_______________________________________ ____________________________________ City/State/Zip City/State/Zip
ALL FAMILIES MUST COMPLETE THIS FORM. REGISTRATION FOR THE 2020-2021
SCHOOL YEAR WILL NOT BE ACCEPTED WITHOUT THIS FORM AND THE $100.00 NON-
REFUNDABLE REGISTRATION FEE.
Corpus Christi Academy Catholic School
Tuition Rates and Scholarship Application for 2020/2021 School Year
Every K-8 student at Corpus Christi Academy Catholic School may apply for scholarships and financial
aid. Working in partnership with parents, who are the primary educators of their children, we want to
ensure that the young people in our school community have an opportunity to receive an affordable
Catholic education. Please apply for scholarships and financial aid for the school using this worksheet,
and additional forms as needed. Once you have completed the form, please return it to Corpus Christi
Academy, at the school office, or the business office for processing. Families will be notified of
scholarship and financial aid awards as soon as possible.
Family Name: Date:
_____________________________________________ ___________________
Please list student(s) and grade(s): if there are more than six students, please list additional students on
the back.
______________________________ ________ ______________________________ ________ ______________________________ ________ ______________________________ ________ ______________________________ ________ ______________________________ ________
TUITION RATE K-8
Please note that it costs Corpus Christi Academy Catholic School approximately $6,500.00 to educate per
pupil, at current enrollment levels. The Parishes covers the substantial financial difference between per
pupil cost and the actual tuition through its weekly offertory collection and otherwise through the
generosity of those associated with the Parishes.
Tuition Rates
Number of
Children
Tuition
Non Parishioner Parishioner
1 $6,150.00 $4,550.00
2 $6,150.00 $4,080.00
3 $6,150.00 $3,685.00
4+ $6,150.00 $ 250.00
SCHOLARSHIPS
Corpus Christi Academy Catholic School offers several scholarship opportunities that may be available to
help offset the cost of educating your child. Please indicate which scholarships and/or financial aid
options you are applying for by placing a checkmark in front of the appropriate option(s):
_______ 1. Parish scholarship: $1,600.00 per student
This scholarship is available to those families who are registered at Sacred Heart of
Jesus, Church of St. Clare or Holy Rosary Parishes, and who regularly participate
in the life of the Parish, including regular attendance at Mass as determined in the
Parish’s discretion and as evidenced by the use of offertory cards or envelopes,
regardless of whether a donation is made.
_______ 2. Catholic School needs-based financial assistance:
The application for assistance is online at https://online.factsmgt.com/aid and there
is a link on the CCA web site. This needs-based assistance is available through the
Diocese of Cleveland through the Diocese of Cleveland application process.
________3. Ed Choice Awards or Scholarship.
Ed Choice is available through the Ed Choice application process.
Complete the application and return it and all necessary documentation
back to the Corpus Christi Academy school office. All income information must
be sent directly to the state at the Columbus address
provided.
Please note final scholarship and financial aid award announcements will be made by the diocese and the
state and your financial aid / tuition package will be communicated to you. Prior to your student being
enrolled, you will be required to sign a tuition agreement. In addition, prior to your student being
enrolled, all required paperwork and forms must be submitted to the Corpus Christi Academy school
office and payment of the non-refundable registration fee must be received and tuition agreement
commitments must be implemented, such as FACTS registration, etc.
________________________________________________ _____________
Parent/Guardian Signature Date
________________________________________________ Print Name
Family Name:__________________________________________________________
Number of Students________________________ Grade Level (s)__________________________
Tuition Rate_______________________________ ( )Qualifies for Parishioner Rate
BALANCE OF THIS PAGE - OFFICE USE ONLY
(a)______________ Review Registration Agreement for completeness
(b)______________ Registration Fee ($100/student) Check No.________ Cash_________
(c)______________ Parishioner status checked
(d)______________ Current on tuition payments checked
(e)______________ Tuition Payment Preference Form completed
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Received by____________________________________ Date Received__________________
Registration Approved by ___________________________ Date Approved___________________
School Registration Checklist: K-8
Child’s Name: __________________________________________
Grade for 2020-2021: ________________
Items REQUIRED at the time of Registration:
_______ School Registration Packet with signed Tuition Payment Preference Form
_______ Registration Fee - $100 per student Cash _______ Check #_______
_______ Emergency Authorization Medical and Contact Form
_______ Legal Custody Agreement Form
_______ Permanent Record Card
_______ Birth Certificate (copy)
_______ Baptismal Certificate (copy) – If applicable
_______ *Kindergarten Medical Record & Physical Form with Immunization Records * (Only for incoming Kdg students)
Corpus Christi Academy 5655 MAYFIELD ROAD
LYNDHURST, OHIO 44124 (440) 449-4244
EMERGENCY MEDICAL AUTHORIZATION
2020-2021 SCHOOL YEAR
Family Name:___________________ First Name:__________________ Middle Name:______________
Sex: (circle) M F Grade Level:_____________ Date of Birth:________________
Business Phones: (Father):( )____________________ (Mother): ( )________________________
Cell Phones: (Father):( )_______________________ (Mother): ( )________________________
Address:___________________________ City:_______________ Home Phone: ( )_______________
Mother or Guardian:____________________ Occupation:___________________ With Family:____________
Father or Guardian:_____________________ Occupation:___________________ With Family:___________
IF I CANNOT BE CONTACTED and it is advisable to send my child home due to minor illness, injury
or emergency, my child can be released in the custody of: Name:________________________ Address:___________________________ Phone:____________________
Name:________________________ Address:___________________________ Phone:____________________
Name:________________________ Address:___________________________ Phone:____________________
*Must show proof of identification to be able to release said student.
Date:_________ Signature of Parent or Guardian:_________________________________
FACTS CONCERNING THE CHILD’S MEDICAL HISTORY INCLUDING ALLERGIES, MEDICATIONS BEING TAKEN, AND ANY PHYSICAL IMPAIRMENTS TO WHICH A
PHYSICIAN SHOULD BE ALERTED. PLEASE INCLUDE GLASSES/CONTACTS,
ORTHODONTIC APPLIANCES OR MEDICATIONS TAKEN AT HOME. _______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
Date:_________ Signature of Parent:___________________________________________
Transportation: (please check one) Bus_________ Walk________ Parent Pick-Up_________ If your child does not go directly home after school, please list where the child goes, on what days, with
phone numbers. Name_____________________________________________Phone Number_______________________ M T W TH F
*CONTINUE TO BACK OF THIS PAGE TO COMPLETE FORM*
Please provide your child’s medical-care provider information below: Doctor: Name:_________________________________________
Address:_______________________________________
Phone No.: ( )_______________________________
Dentist: Name:_________________________________________
Address:_______________________________________
Phone No.: ( )______________________________
PRIVACY ACT: It is understood that no student information will be given out without parental consent. However, we wish to inform you that your name and home phone number will be given
to selected adults who will keep the information confidential and will use it only to inform you of emergency situations. This procedure will replace our old method of informing parents of an
emergency school closing. If you have any problem with this policy, please call me in the school office at
(440) 449-4242. I have read the above statement regarding the Privacy of Student Information.
Date:_____________ Signature:_________________________________
PART I OR II MUST BE COMPLETED
PART I (TO GRANT CONSENT) In the event reasonable attempts to contact me at: ( )__________________ or _______________________ (phone) (other parent) at ( )_____________________ have been unsuccessful, I hereby give my consent for:(1) the administration of any treatment deemed necessary by Dr._____________________, or Dr.______________________ or in the (dentist) (physician) event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to:____________________________________ hospital or any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentist, concurring in the necessity for such surgery, are obtained before surgery is performed.
Date:_______ Signature of Parent or Guardian:___________________________________
PART II (REFUSAL TO CONSENT)
DO NOT COMPLETE PART II IF YOU COMPLETED PART I
I do NOT give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the school authorities to take no action
or:to:_____________________________________________________________________________________ _________________________________________________________________________________________
Date:_________ Signature of Parent or Guardian:_________________________________
CORPUS CHRISTI ACADEMY
2020-2021
INFORMATION REGARDING LEGAL CUSTODY
Date:_______________________
Student Name(s):________________________________________________ Grade:________
_________________________________________________Grade:________
_________________________________________________Grade:________
_________________________________________________Grade:________
Address of student residence:_________________________________________________
_________________________________________________
Student lives with: _____ both parents
_____ mother as residential parent
_____ father as residential parent
_____ grandparent(s) (with legal custody)
_____ other - Please explain:________________________________
Residential parent/guardian:
Name: _____________________________________________________________
Address:_____________________________________________________________
City, Zip: _____________________________________________________________
Phone: _____________________________________________________________
Is there a court order (or pending order) affecting the custody and/or residency of the student(s)?
_____YES* _____ NO
*If yes, please attach a certified copy of the entire court order including the case number and
those sections referring to visitation rights and contact with the school. Also include the page
bearing the judge’s signature and court seal. This copy should include any and all modifications
made as of the date of registration of the student(s) in this school. It is also the responsibility of
the parents to inform the principal of any subsequent modifications during the student(s) tenure
at the school.
Non-residential parent:
Name: ______________________________________________________________
Address: ______________________________________________________________
City, Zip: ______________________________________________________________
Phone: ______________________________________________________________
Does the non-residential parent have visitation rights?_____YES _____NO
Is there a court decision that states that the non-residential parent should NOT receive school
information or attend school activities?
_____YES _____NO
Is the non-residential parent responsible for paying tuition? _____YES _____NO
School Entrance Medical Record & Physical Form
Kindergarten
This form must be kept on file in the school clinic in order for your child to start
school in the Fall of 2020.
Name of Child:_______________________________________ Birthdate: _______________________ Month Day Year
Address: _____________________________________________________________________________
City, State, Zip_________________________________________________________________________
EXAMINATION
Date: _______________________________ Height: __________________________________
Weight: _____________________________ BMI: ____________________________________
Eyes: _______________________________ Vision: R: 20/___________ L:20/___________
Ears: _______________________________ Hearing Test: Type: __________R: ____ L: _____
Yes: ______ No: _______
BP: ________________________________
Nose: ______________________________ Throat: _________________________________
Mouth: _____________________________ Teeth: __________________________________
Is dental work indicated? Yes: ________ No: __________
If so, are plans being made? Yes: ________ No: __________
Posture: __________________________ General Condition: ________________________
Skin: _____________________________ Orthopedic: ______________________________
Neck: ____________________________ Nervous System: __________________________
Heart: ____________________________ Lungs: __________________________________
Abdomen: ________________________ Hernia: __________________________________
Genitalia: _________________________ Urinalysis: _______________________________
Remarks and Recommendations: _________________________________________________________
____________________________________________________________________________________
_________________________________________
(Signature of Physician)
Please attach a copy of the completed pediatrician’s immunization record.
Note:
If your child’s last physical occurred between January 1 and August 31, 2019, this form must be
completed with a physical administered after January 1, 2020.
If your child’s last physical occurred between September and December 2019, please have your
physician complete this form based on the results of that physical. An updated form will be
required at your child’s next doctor visit.