1. education
2. school

RegF:_______ Test Date: ______ TF: ________ Interview Date: ____________ Start Date:
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
New Student Application
Student’s Name _____________________________________________________Sex________ Age _______
Last
First
MI
Home address______________________________________________________________________________
Street
City
Zip
Home Phone ________________________________ Cell Phone (D)_______________(M)______________
Place of birth ____________________________________ Citizen_______ Immigration #_________________
Grade applying for____________ Last grade completed __________________Date of Birth________________
Last School Attended: _______________________________________ School Phone_____________________
School's Mailing Address_____________________________________________________________________
PLEASE CHECK APPROPRIATE BOXES:
Parents’ marital status
Student living with:
Married ____
Divorced ____
Mother & Father____
Mother & Step-Father____
Separated ____
Mother____
Widow ____
Father____
Father & Step-Mother____
Single ____
Guardian____
Grandparents____
Mother's Name ___________________________________Mother’s Occupation ________________________
Mother’s Employer ________________________________________ Phone ___________________________
Social Security # (required)) _______________
Father's Name ___________________________________Father's Occupation__________________________
Father's Employer _________________________________________ Phone ___________________________
Social Security # (required) _______________
If applicable:
Step-Mother’s Name ______________________________Occupation ________________________________
Employer _______________________________________________ Phone ____________________________
Step-Father's Name _______________________________Occupation ________________________________
Employer _______________________________________________ Phone ____________________________
Page 1 of 3
How did you learn about Cornerstone Christian School? ______________________________
State student's special interest, skills or hobbies ____________________________________
_____________________________________________________________________
List any difficulties your child may have had in school:
Behavior _______________________________________________________________
Academics ______________________________________________________________
Study Habits ____________________________________________________________
Physical Problems_______________________________ Allergies____________________
Is your child on medication _____ If yes, explain ___________________________________
Has he/she had outside testing (psychological, educational) ______Specify _________________
Does family attend church regularly? ____ Yes ____ No
Are you Looking for one ___Yes ___ No
Church family attends _________________________________ Member: ____Yes ____ No
Name of church _________________________ Denominational preference?_____________
Church address _____________________________ City_______________ Zip_________
Why have you chosen to enroll your child/children at Cornerstone Christian School:
How important is Christian Education to your family? ________________________________
Page 2 of 3
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Christian Commitment Form
(Please sign bottom of page and initial each commitment)
Philosophy
Cornerstone Christian School shall have high spiritual and academic standards and shall
include the development of the whole person spiritually, mentally, socially, physically, and
emotionally. Emphasis is placed on learning about God and the truths of God's Word in
relationship to man and his world; recognizing that the way to God comes through personal
faith in Jesus Christ; and Christian maturity comes by application of the truths of the Bible
in all areas of life. In its approach to spiritual matters, the school shall be consistent with
Cornerstone Christian Center and the General Council of the Assemblies of God, but shall
also be respectful of and sensitive to the teachings of other evangelical denominations.
_____ I pledge my fullest cooperation to the school and administration. If a misunderstanding should arise, I
will register the necessary comments and complaints only with a teacher, secretary, or principal.
_____ As a school dedicated to Jesus Christ, there may be certain standards that may go beyond some of my
personal attitudes and opinions as an individual; therefore, I willingly accept this position in my responsibility
to uphold school standards, rules and regulations.
_____ I recognize that attendance at Cornerstone Christian School is a privilege. By enrolling my child I
indicate my willingness to abide by the standards, rules and regulations set forth in the student handbook. If I
am out of harmony with these stated aims and objectives, I will withdraw from the school or accept the right of
the school to institute a dismissal.
_____ I further agree to authorize CCS to employ such discipline as seems wise and expedient for my child. I
also agree that I will cooperate and discipline my child in the home as needed.
_____ I agree to follow the terms and conditions regarding our financial obligation to the school. I also know I
am liable for any damages to school property that my/our child is responsible for committing. Damage to
school property, which includes textbooks, may cause your child's report card or cum records to be withheld
until damages are paid.
_____ I understand that educational excursions away from the campus are a regular part of the total
educational experience at Cornerstone Christian School. I give permission for my child to take part in these
activities, or any school sponsored activity, educational or otherwise, away from the school premises. I
understand I will be notified previous to the time when there is such an activity away from the school.
_____ I absolve the school from liability to me or my child because of any injury incurred at school during any
school sponsored activity, or school sponsored activity away from school, with the understanding that
insurance will be maintained on my child during the school year.
_____ I agree that Cornerstone Christian School’s biblical role is to work in conjunction with the home to
mold students to be Christians. On occasion, the atmosphere or conduct within a particular home may be
counter or in opposition to the biblical lifestyle the school teaches. This includes, but is not necessarily limited
to, sexual immorality, homosexual sexual orientation, or inability to support the moral principles of the school.
In such cases the school reserves the right, within its sole discretion, to refuse admission of an applicant or to
discontinue enrollment of a student.
Signature of Father or Guardian
Date
Signature of Mother or Guardian
Date
Person Responsible for Bill:
Address:
Phone #____________
City
State
Zip
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
NEW STUDENT QUESTIONNAIRE
Students Full Name_______________________________________________________
Last
First
Middle
Has the student had any discipline problems in school? No___ Yes___ if ‘yes’ explain:
What are the student’s most difficult subjects? _______________________________________
What are the student’s best subjects? ______________________________________________
If the student has ever been tutored, by whom, and for which subject (s):
_____________________________________________________________________
If the student has received specialized testing, please describe: _______________________
_____________________________________________________________________
Please list the student’s special interests, skills or hobbies:
_____________________________________________________________________
_____________________________________________________________________
Why was Cornerstone Christian School your choice? ______________________________
_____________________________________________________________________
Do you practice Bible reading and prayer in your home? Yes ___No___
What are the student’s personal goals for the coming year? __________________________
_____________________________________________________________________
Has the student made any long-range goals? No___ Yes___ if yes, what are those goals?
_____________________________________________________________________
Parent Signature ________________________________ Date__________
CORNERSTONE CHRISTIAN SCHOOL
1745 E. 18th St ● Antioch, CA 94509 ● 925-779-2010
Extended Day Ministries (E.D.M.)
Offered to students grades K-8
Welcome to our Cornerstone Christian School Extended Day Ministries Program! This program
strives to provide a flexible curriculum with appropriate activities to meet the social, spiritual, and
physical needs of each student.
ARRIVAL AND DEPARTURE
Any student arriving15 minutes prior to school starting must be brought inside the daycare by an
adult and released to the custody of the E.D.M. staff member. The adult must sign the student in on
the form provided. The adult signs his/her name and the time beside the students’ name at the time of
arrival. There will be a $2 fee for not signing in or out, either one.
The child will be released only to the parent or the adult authorized by the parent/guardian
(authorization form must be filled out and on file in the E.D.M. office) unless proper notification has
been given for other arrangements.
The adult picking up the student must again sign his/her name at the time of departure next to the
student’s name.
AFTER SCHOOL
Any student remaining in the after- school program will be signed into the program by the classroom
teacher. It is very important that your child be informed whether or not he/she will be coming to
Extended Day Ministries.
ITEMS
We cannot be responsible for loss or damage to personal articles. IT IS VERY HELPFUL IF YOU PUT
YOUR CHILD’S NAME ON ALL CLOTHING ITEMS, AS WELL AS ON PERSONAL ITEMS. The LOST
AND FOUND BASKET is located in the daycare room. All unclaimed articles will be discarded weekly..
PLEASE CHECK THIS BASKET REGULARLY.
DAILY SCHEDULE
HOURS: Monday - Friday 6:30 – Class Start / Class End – 6:30 P.M.
School holidays and vacation time subject to additional charges if
E.D.M. is made available at such times.
Please keep for your records.
CORNERSTONE CHRISTIAN SCHOOL
CORNERSTONE CHRISTIAN SCHOOL
1745 E. 18th St ● Antioch, CA 94509 ● 925-779-2010
EXTENDED DAY MINISTRIES
HOURS: 6:30 – School Day Start / School Day End – 6:30 P.M.
Parent Commitment Form
FULL-TIME ($160/month) MONTHLY FEES are to be processed by EFT. (See EFT contract form.)
PART-TIME ($5/hour) FEES are billed by the end of the month and are due by the 10th the following month.
ANY STUDENT dropped off 15 minutes prior to school starting without being signed in will be signed in and
billed an additional $2 fee per occurrence.
ANY STUDENT not picked up from school within 15 minutes after school ends will automatically be placed
in the Extended Day Ministries (E.D.M.) program. Students will be charged the hourly rate until he/she is
picked up.
IF A STUDENT is not picked up by 6:30, there will be a $1.00 charge PER MINUTE or portion of a minute
thereafter. The E.D.M. clock will be used to determine the exact time.
STUDENTS WILL ONLY BE RELEASED to persons listed on the Emergency Card (be prepared to show valid I.D.
if requested).
THE UNDERSIGNED AGREE TO:
 Abide by all E.D.M. guidelines.
 Cooperate with the E.D.M. Director and staff, and be supportive of the program.
 Sign student(s) in and out daily.
 Meet with E.D.M. staff if student’s behavior is unacceptable.
 Understand that removal from the E.D.M. program is an option for unacceptable behavior.
 Withdrawals occurring on or before the 15th of the month will be charged 1/2-month’s fee.
 Withdrawals occurring on or after the 15th of the month will be charged for the entire month.
 A TWO-WEEK NOTIFICATION IS REQUIRED FOR WITHDRAWAL OF FULL -TIME E.D.M. ATTENDEES.
To withdraw a child, the parent responsible for the account must complete a withdrawal form.
THIS FORM MUST BE SIGNED/RETURNED TO SCHOOL OFFICE -ONE FORM PER STUDENT
_______________________________
FATHER (GUARDIAN) SIGNATURE
________________________________________________
ADDRESS
_______________________________
MOTHER (GUARDIAN) SIGNATURE
___________________________
PHONE
_______________________________
CHILD’S NAME
___________
GRADE
______________________________
DATE
FULL TIME
AS NEEDED
CIRCLE ONE:
Please sign and return.
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Parking Agreement
In agreement with the philosophy of Cornerstone Christian School, I
understand that the safety of our children is of the highest priority.
Therefore, I agree to drop off and pick up my child/children only in the
designated areas within the parking lot of the school/church facility. I agree
not to drop off or pick up my child in any other area including sidewalks or
any streets that surround the school/church property. I understand that I
am responsible for the transportation arrangements for my child/children
and that this agreement must be upheld by any person(s) designated to
transport my child/children to and from the facility.
I understand that failure to comply with this agreement could result in the
dismissal of my child/children from Cornerstone Christian School.
_________________________________
Father (Guardian) Signature
_____________
Date
_________________________________
Mother (Guardian) Signature
_____________
Date
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Parent Participation Agreement
In agreement with the 2015-2016 Cornerstone Christian School Policy
parents will be required to volunteer 20 hours per school year on
campus helping classroom functions as communicated by the
teaching staff. A fee of $100.00 will be accessed prior to school
beginning and upon completion of school year, if volunteer hours
have been completed, a refund will be issued or rolled over into the
next school year if student is returning. Volunteer hours are to be
logged in the school office for credit.
I understand that failure to comply with this agreement would result
in forfeiture of a refund.
____________________________
Father (Guardian) Signature
_______________
Date
______________________
Mother (Guardian) Signature
____________
Date
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Request for Cumulative Records
Name of School:
School Address:
School Phone: ____________________
School Fax:
Student(s) Name(s):
Grade(s):
_____________________________
_________________
_____________________________
_________________
_____________________________
_________________
The above-named student(s) has/have enrolled in our school. Please forward all
cumulative records, psychological tests, special ed files, and health records for
this student to our school. For 8th grade and up, please include an official
transcript. Send to:
Cornerstone Christian School
1745 East 18th Street
Antioch, CA 94509
Fax (925) 754-1294
Rebecca Leiss, Registrar
Name/Title
Date
I hereby certify that I have requested the transfer of all school records for my
child. Cornerstone Christian School will maintain the confidentiality of these
records and will not disclose the information therein to unauthorized persons or
agencies. I understand that I may examine the records upon their arrival.
______________________________________
Parent or Guardian Signature
_____________________
Date
Accredited Schools
World-Class Advantages
Spiritual
Cultural
• ACSI accredited schools have remained the most
theologically stable and consistent over the past five
years of any surveyed.**
•A greater percentage of ACSI accredited schools offer
mission and social service opportunities both in the
United States and Canada.**
• Christian school graduates are significantly more likely
to pray and read Scripture both alone and with a
spouse and children.*
•Christian school graduates donate significantly more
money to their churches, religious causes,
and other charitable causes overall.*
• ACSI accredited schools have these
top priorities: for students to have
a close, personal relationship with
God and for students to develop a
Christian worldview.**
• A higher percentage of ACSI accredited
programs have official ties to student
social service organizations.**
•C
hristian school
graduates give more of
their time to volunteer
in their congregations, on mission
trips, and on relief/aid trips.*
• Christian school graduates are
more likely to attend religious
services and respect
the authority of church
leadership.*
• All ACSI accredited schools
that were asked responded
affirmatively that the Bible is
the inspired Word
of God and that
it does not err in
moral, spiritual,
and religious
• On average, ACSI accredited schools require
matters.**
more rigorous course loads in math, science, English,
• A
higher percentage of ACSI
accredited schools report
student involvement in political
campaigns, meetings, or rallies.**
Academic
languages, civics, social studies, art or music, and Bible
than all other programs surveyed.**
• ACSI accredited schools, on average, offer
more Advanced Placement courses than other
Protestant schools.**
• ACSI school graduates attend college at a significantly higher rate than
the national average (86 percent compared with 68 percent).
• Since 1974 ACSI schools have scored significantly higher than the national
norm in every grade level on a national achievement test.
• A recent study shows that religious school graduates, on average, exceeded
the SAT College & Career Readiness Benchmark while public school
students, on average, failed to meet the same standard. On average,
religious school graduates scored 44 points higher.
Top Emphasis
ACSI Accredited vs. Public Schools
More than two-thirds
of administrators
in ACSI accredited
schools said their top
priorities for students
were development
of a Christian worldview, involvement
in evangelism, or a close, personal
relationship with God.
69%
Eighty percent
of public school
principals said their
top priority was for
student basic literacy.
Find out more about these facts and the related studies by visiting www.acsi.org/about-acsi/why-acsi-schools. These comments do not promise the quality of an individual school;
they are representative comments of ACSI schools as a whole.
* Protestant Christian schools compared with Catholic, public, and private nonreligious schools as well as homeschools
** ACSI accredited schools compared with other ACSI members, Protestant Christian schools, and Catholic schools
CORNERSTONE CHRISTIAN SCHOOL
1745 E. 18th St ● Antioch, CA 94509 ● 925-779-2010
2015-2016 TUITION/EDM CONTRACT
Cornerstone Christian School uses the ACH program for tuition payments.
Please fill in the portion below to set up your ACH or credit card payment process.
_________________________________________________________________________________________________________
Student Name
Student Grade
Phone#
__________________________________________________________________________________________________________
Address
City/State
Zip Code
OPTION #1—EFT Withdrawal
I authorize my bank to make payments to CORNERSTONE CHRISTIAN CENTER through my checking account.
*See agreement terms below.
(PLEASE ATTACH A COPY OF A VOIDED CHECK)
______________________________________________
Bank Name
_______________________________________________________
Account Number
My Tuition Payment is $_________ each month beginning August 1, 2015 and ending June 1, 2016.
My ANNUAL ONE TIME PAYMENT is $ _________ due on or before July 1, 2015.
My full time Extended Day Care payment is $_________ each month beginning September 1, 2015 and ending May 1, 2016.
You will receive a bill for August 2015 and June 2016 EDM.
OPTION#2—Visa / MasterCard
I authorize Cornerstone Christian Center to charge payments to my VISA/MASTERCARD.
One time credit card administration fee of $100.00 __________(PLEASE INITIAL HERE)
My Tuition Payment is $_________ each month beginning August 1, 2015 and ending June 1, 2016.
My ANNUAL ONE TIME PAYMENT is $ _________ due on or before July 1, 2015.
My full time Extended Day Care payment is $_________ each month beginning September 1, 2015 and ending May 1, 2016.
You will receive a bill for August 2015 and June 2016 EDM.
Credit Card Number: ________________________________________  VISA  MASTERCARD Expiration Date: ____________
Last three digits on back of card ___________________ Customer’s billing zip code: ______________________________________
Name as printed on card: ______________________________________________________________________________________
_____________________________________________________________________________ ____________________________
Signature of cardholder
Date
*I fully understand that I am in complete control of my account, and if at any time I decide to change to a different bank account, I will notify Cornerstone
Christian School in writing. This agreement is to remain in full force until CCS has been given 15 days written notice of termination of agreement.
______________________________________________________________________________ ___________________________
Signature of person responsible for account
Date
Accounts which become thirty (30) days delinquent will result in the suspension of the student(s) until the account
is current. The account will also be turned over to a 3rd party collection agency.
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Office Use Only
2015-2016 ENROLLMENT
Student Emergency Information
Name Used
Last
First
Address
City
State
Home Phone
Male
_____
Grade
Teacher
____________
____________________________________
Female
_____
Birthdate
Zip Code
Race: White_____ Black_____ Hispanic_____
Asian_____ Other:____________________________
Cell Phone (Father)
Cell Phone (Mother)
Father
SS# (last 4 digits)
Work Hours
Employer
Work Phone
Mother
SS# (last 4 digits)
Work Hours
Employer
Work Phone
Email Addresses:
Father
Mother
Second Residence (if applicable) Mother’s______ Father’s______( please check one)
Address
City
State
Home Phone
Zip Code
Cell Phone (Father)
Cell Phone (Mother)
Father
SS# (last 4 digits)
Work Hours
Employer
Work Phone
Mother
SS# (last 4 digits)
Work Hours
Employer
Work Phone
Email Addresses:
Father
Mother
PLEASE CHECK APPROPRIATE BOXES:
Parent's marital status:
Married ____
Student living with: Mother & Father____
Divorced ____
Mother____
Mother & Step-Father____
Separated ____ Widow ____
Single ____
Father____ Guardian____
Father & Step-Mother____
Grandparents____
Pick-up Release (Please list parents plus three other people)
Adults (18+ years of age) with permission to pick up my child after school, or in the case of emergency:
Please list in order of preferred contact.
Parent
Name
Daytime Phone Number
Cell Number
Signature
Relationship
Parent
Siblings attending CCS:
Name__________________________________ Grade_______ Name__________________________ Grade_______
Name__________________________________ Grade_______ Name__________________________ Grade_______
Page 1 of 2
Health Information
Health Problems:
Diabetes___
Epilepsy___
Heart Condition___
ADD___
ADHD___
Asthma___ What triggers the asthma? ___________________________________________________________________________
Bee Sting Allergy____ Reaction symptoms? ______________________________________________________________________
Allergies: (specify triggers and symptoms)
Medications:
Eyes: Glasses___ Contacts___
Physical Limitations: (explain)
Ears: Hearing Loss___ Hearing Aid___
Medical Insurance Information
Insurer
Group #
I.D. #
Physician
Address
Phone
Dentist
Address
Phone
Hospital(s) Preferred
I give my permission for my child to take part in all school activities including sports and
school-sponsored trips away from the school premises. If it should be necessary for my
child to receive medical treatment for any reason during any of these activities, I authorize
school personnel to make arrangements for my child to receive medical care, including
transportation. I understand that my medical insurance acts in a primary position and I
agree to bear all cost incurred. I hereby release Cornerstone Christian School and its staff
from any liability related to personal damage or injury. Furthermore, I take full
responsibility for my child’s actions and will pay for any damages caused by my child.
_____________________________________ _____________
Parent/Guardian
Date
Page 2 of 2
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Family Handbook Agreement
2015-2016
Please carefully review the Family Handbook with your student(s), sign this
Agreement form, and return it to the office. If your child(ren) is/are in preschool
or grades K -5th, please list their name(s) and grade(s) below. If your child(ren)
is/are in 6th-12th grades, they must also read the Handbook and sign below.
Parent/Student Agreement
I have read the Cornerstone Christian School Family Handbook and agree to
follow, uphold, and support the policies laid forth by the Board, Administration,
and Staff of Cornerstone Christian School. I acknowledge that the terms of the
Handbook may be modified from time-to-time throughout the school year, and
although the School will do its best to keep me notified of significant changes
therein, it is ultimately my responsibility to stay informed of and follow the
contents thereof.
Student __________________________
Grade: ______________
Student __________________________
Grade: ______________
Student __________________________
Grade: ______________
Student __________________________
Grade: ______________
Mother’s Signature ________________________________________
Father’s Signature ________________________________________
Date: ___________________
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Authorization For Medication To Be Given During School Hours
(This form to be used for both prescription and over-the-counter medications)
The administration of medication to students by school staff may be done only in EXCEPTIONAL
CIRCUMSTANCES for ongoing health conditions. If the time schedule of the dosage is flexible, parents should
make arrangements to provide the medication to their child outside the school day. Parents are advised that
we do not have a school nurse.
Ed. Code 49423 “ Any pupil who is required to take during the regular school day, medication prescribed for him by a
physician, may be assisted by the school nurse or other designated school personnel if the school district receives (1) a
written statement from such physician detailing the method, (2) a written statement from the parent/guardian of the
pupil indicating the desire that the school district assist the pupil in the matters set forth in the physician statement.”
The following section is to be completed by the parent:
Child’s Name - ________________________________________ Birthdate - ___________
Physician’s Name
Address
Phone Number
I request that my child be assisted in taking the medications listed below at school by authorized staff persons or
permitted to self medicate her/himself as also authorized by me and my physician (see below).
Date
Parent Signature
The Following section is to be completed by Parent (for
Phone Number
over the counter medication) or PHYSICIAN
(for a prescription drug):
Diagnosis for which medication is given - _______________________________________________________________
Name of medication - _______________________________________________________________________________
Form - __________ Dose - _________ Does medication need to be refrigerated? Yes___ No ___
Is child allowed to self- medicate? Yes ___ No ___
Times when medication is to be given - __________________________________________________________________
If medication is to be given “as needed”, describe conditions - _______________________________________________
List significant side effects or medications that cannot be combined with the above medication:
__________________________________________________________________________________________________
Physician’s Signature
Date
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Parental Consent To Use Photography/Videotape Of
Students Or Student Work For Promotion/Advertising
I understand that my child’s/children’s likeness(es) may be photographed or videotaped
by the school in the course of school activities. I hereby give consent for the school to use
my child’s/children’s likeness(es) in promotional and/or advertising materials. Examples
may include, but are not limited to, school newsletters, advertisements, promotional
videos, brochures, CCS official website, yearbooks, and other promotional materials. In
addition, student work may be submitted to such organizations including, but not limited
to, the county fair and writing contest.
I agree to hold CCS, its employees, agents, licenses, and assignees harmless against
liability, loss, or damage resulting from the use of my child’s/children’s likeness(es) or
work, and I hereby release and discharge any claims whatsoever in connection with such
use.
Please print each student’s name:__________________________
__________________________
__________________________
__________________________
________________________
Father’s Signature
________________________
Mother’s Signature
___________________
Date
___________________
Date
If you wish to withhold permission for school use of your child’s likeness and/or
work, you must communicate your specific request in writing on the lines provided
below:
________________________
Father’s Signature
___________________
Date
________________________
Mother’s Signature
___________________
Date
CORNERSTONE CHRISTIAN SCHOOL
th
1745 E. 18 St  Antioch, CA 94509  925-779-2010
Record of Prior School Special Programs
To provide continuity in your child’s education program, it is important that we be made aware
of any special help or services he/she may have received or special program in which he/she
may have participated at any previous schools. Please provide the following information so
that we may expedite your child’s appropriate placement and instructional program.
My child has not participated in any special program.
My child has participated in the programs listed below:
Resource Specialist Program (RSP)
Learning Handicapped Program (LH-SDC)
Other Special Education Programs/Services:
Adaptive Physical Education (APE)
Hearing Impaired
Visually Impaired
Speech and Language Therapy
Other:
My child has an Individualized Education Plan (IEP)
My child has a 504 Plan
Child’s Name:
Date of Birth:
Previous School:
City:
Parent Signature:
Date:
CORNERSTONE CHRISTIAN SCHOOL
1745 E. 18th St ● Antioch, CA 94509 ● 925-779-2010
TUITION FEE SCHEDULE:
2015/2016 School Year
Annual
Yearly
11 Monthly
Obligation
6% Discount
Payments
Paid July 1
Paid
K – 5th
Aug. 1 – June 1
1st Child
$5444.25
$5117.60
$494.93
2nd Child
$4924.50
$4629.03
$447.68
3rd Child
$4457.25
$4189.82
$405.20
4th Child
$2766.75
$2600.75
$251.52
Annual
Yearly
11 Monthly
Obligation
6% Discount
Payments
Paid July 1
Paid
6th-8th
Aug. 1 – June 1
TEST, REGISTRATION & CONSUMABLE
FEE SCHEDULE
Testing Fee
$75
K-High School Registration
$150
Returning
$225
New
Consumable & Material Fee
If paid by March 27th $250 K-5th
$300 6th-12th
After March 27th
$300 K-5th
$350 6th-12th
1st Child
$5990.25
$5630.84
$544.56
2nd Child
$5412.75
$5087.99
$492.06
Parent Participation
(refundable)
$100 K-12th
3rd Child
$4893.00
$4599.42
$444.81
Yearbook
$50
4th Child
$3029.25
$2847.50
$275.38
Annual
Obligation
9th-12th
Yearly
11 Monthly
6% Discount
Payments
Paid July 1
Paid
Aug. 1 – June 1
1st Child
$6945.75
$6529.01
$631.43
2nd Child
$6294.75
$5917.07
$572.25
3rd Child
$5670.00
$5329.80
$515.45
4th Child
$3494.40
$3284.74
$317.67
Sports Participation Fee Per Sport
$200 Junior High
$250 High School
$400 Tackle Football
High School Retreat
$225
Payable in 2 payments
$112.50 on 8/1
$112.50 on 9/1
See attached payment instructions
All fees are non-refundable unless noted.
CORNERSTONE CHRISTIAN SCHOOL
1745 E. 18th St ● Antioch, CA 94509 ● 925-779-2010
TUITION & FEE INSTRUCTIONS
2015/2016 School Year
Parent Participation
A fee of $100.00 will be accessed prior to school beginning and upon completion of school year a credit
towards your account or a refund will be issued if volunteer hours (20 per family) have been completed.
Hours MUST be logged in school office for credit.
EXTENDED DAY MINISTRY: Open 6:30 a.m. until start of school - end of school until 6:30 p.m.
1st child $160.00 per month, each additional child $140.00. Hourly E.D.M. is available for $5.00 per hour. Full
time E.D.M. fees are due on the first of each month. Part-time/hourly E.D.M fees are billed at the end of the
month via email and are due by the 10th of the following month. E.D.M. fees not paid by the 10th of each
month will incur an automatic $25.00 late fee.
TUITION PAYMENT POLICY
All payments are automatically due the FIRST of each month. You will not be sent a bill for tuition.
Yearly with 6% discount due July 1st.
11 monthly payments due August 1st – June 1st
Tuition payments are automatically deducted from your checking/savings account, or Visa/Mastercard
(See contract for details).
EDM payments are paid by cash or check made payable to “Cornerstone Christian School”.
VISA/MASTERCARD:
There is a one time credit card administration fee of $100.00 for monthly or annual tuition.
LATE CHARGE:
A $25 late charge will be added to your account weekly if your payment is not able to be processed by the
10th of each month.
RETURNED CHECKS:
Returned checks will result in a $25 per check fee and a late fee (See above for late fee rates).
EARLY WITHDRAWAL:
A two (2) week written notification is required for withdrawal of a student. Tuition will be calculated on a PER
DIEM basis for days enrolled, taking the two (2) weeks into consideration.
PAST DUE ACCOUNTS:
Accounts which become thirty (30) days delinquent will result in the suspension of the student(s) until the
account is current. The school reserves the right to refuse re-enrollment at the beginning of any semester if
a student’s account is not paid to date. The account will also be turned over to a 3rd party collection agency.
REGISTRATION FEES DUE WITH REGISTRATION FORMS:
YOUR REGISTRATION WILL NOT BE
PROCESSED WITHOUT ALL FORMS & FEES