Online Application Supplement

Mission Statement:

First Baptist Junior Academy & DLC

exists in order to partner with Christian fami-

lies by

providing a Christ-centered Early Childhood

Education

for preschoolers; intentionally building strong

Online Application Supplement

Please attach a recent photo (may be

printed on regular paper or photo pa-

per) of your family here.

APPLICATION PROCESS

Admissions Criteria

First Baptist Junior Academy & DLC is a covenant school. Therefore, we

require that at least one parent/guardian has a personal relationship with Jesus Christ, having accepted Him as his/her Savior, and be a member of a Bible-believing church. You will have an opportunity to share your testi-

mony at your family conference or write your testimony in the following pages. (See Statement of Beliefs)

Enrollment Agreement Submit the following to the Junior Academy office:

_____ Completed Enrollment Application _____ Application Fee—Non-refundable ($100 Infant—Pre-3; $50 Enhanced

Pre-K Program; $25 Lunch Bunch)

_____ VPK Certificate (if applicable) _____ Church Reference Form

_____ Teacher Reference Form (2 yr. old—Pre-K if applicable)

_____ Certificate of Immunization

_____ School Entry Health Exam

Family Conference/School Tour

____ Dress Code ____ FACTS

____ Health Policy ____ Parent Involvement ____ Discipline Plan ____ Rest Time Bags/Infant-2’s Labels

____ VPK Attendance Policy ____ Parent Testimony Admitted by: _______________________________ Date: _________________ Administration

Medical Information & Authorization

Existing Illnesses: _____________________________________________________________________________

Previous Serious Illnesses and Injuries: ________________________________________________________

Medication Prescribed for Long Term/Continuous Use: _________________________________________

Disabilities/ Special Needs: ____________________________________________________________________

Special Instructions: __________________________________________________________________________

Hospitalization Within Last 12 Months: ________________________________________________________

Food Allergies: ________________________________________________________________________________

Medicinal Allergies: ____________________________________________________________________________

Environmental Allergies: ______________________________________________________________________

Doctor to Call in Case of Emergency: __________________________________________________________

Doctor's Address: __________________________________________________

Phone: __________________________

Name of Hospital: ____________________________________________________________________________

Address: _____________________________________________________________________________________

Parental Authorization for Medical Care

In case medical attention is needed for my child and neither parent can be reached by phone, I au-thorize the First Baptist Junior Academy & Developmental Learning Center staff to take whatever

emergency medical measures deemed necessary for the protection of my child while he/she is in

their care. I understand that this authorization may include calling the physician named above, im-

plementing doctor’s instructions, and transporting my child to a hospital or clinic without first ob-

taining my consent. I will not hold the staff liable for any accident or injury to the child while he/she is at the center, provided such accident or injury is not caused by the staff's negligence or willful

acts.

_________________________________________________________________________________________________

(Signature of Parent(s) or Legal Guardian) (Date)

Medical Information and Authorization

First Baptist Junior Academy & Developmental Learning Cen-

Information for the Teacher

First Baptist Junior Academy & Developmental Learning Cen-This page will be copied and given to the teacher. All About ____________________________________________________ Date _________________________

First Middle Last

My nickname is _____________________________________________________ My birthday is ___________

My address is _____________________________________________________________________________________

Street Address Apt. City State Zip

My home phone number is _________________________________________

My father's name is ____________________________ My mother's name is _________________________

I live with ________________________________________________________________________________________

My brothers and sisters are: Name _____________________ Age ______ Name _____________________ Age ______

Name _____________________ Age ______

Name _____________________ Age ______

Others living in my home are: Name ______________________________ Relationship ______________________________ Name ______________________________ Relationship ______________________________

Name ______________________________ Relationship ______________________________



____ I don't share my room OR ____ I share my room with ________________________

____ I am adopted OR ____ I am not adopted

My favorite pastime is ___________________________________________________________________________

My babysitter is __________________________________________________________________________________ My pet is a _________________________________________ My pet’s name is __________________________

I am especially afraid of __________________________________________________________________________

A traumatic experience I had recently was _______________________________________________________

____________________________________________________________________________________________________ ____________________________________________________________________________________________________

I am allergic to ___________________________________________________________________________________

Here is what happens when I have an allergic reaction ___________________________________________

My allergy is caused by _________________________________________________________________________

General Hours of Attendance _____________________________________________________________________

THE FIRST BAPTIST ACADEMY OF JACKSONVILLE, INC.

WAIVER OF LIABILITY AND RELEASE

This WAIVER OF LIABILITY AND RELEASE (hereinafter “WAIVER/RELEASE”) is be-

ing signed knowingly, freely, and voluntarily in my individual capacity and in my capacity as

the parent and natural guardian of, or the legal guardian of, ___________________________

(hereinafter “CHILD”), and on behalf of CHILD, and it is being signed in favor of THE

FIRST BAPTIST ACADEMY OF JACKSONVILLE, INC. (the “ACADEMY”) (the pre-

school section of the ACADEMY is known by the name “First Baptist Junior Academy” or

“Junior Academy”, which is a part of, and included in the term, the “ACADEMY”), FIRST

BAPTIST CHURCH OF JACKSONVILLE, FLORIDA, INC., (the “CHURCH”), AND

THEIR FACULTY, STAFF, EMPLOYEES, AGENTS, AND VOLUNTEERS, (hereinafter

collectively referred to as the “RELEASEES”). I acknowledge that I am seeking to voluntarily

enroll CHILD in the ACADEMY located on the property owned by the CHURCH and that the

ACADEMY’S decision to accept CHILD for enrollment at the ACADEMY is based in part

on, and in consideration of, this WAIVER/RELEASE.

In consideration of the opportunities afforded me and my CHILD for my CHILD to be en-

rolled as a student and participate as a student in the ACADEMY (including, but not limited

to, all of the ACADEMY’S programs and activities and related services, whether academic,

athletic, extra-curricular, or otherwise, and whether conducted during the normal operating

hours of the ACADEMY or after the normal operating hours of the ACADEMY), and in fur-

ther consideration of the privileges and benefits relating to such enrollment and participation in

the ACADEMY located on the property owned by the CHURCH, I, on behalf of CHILD, and

individually, hereby release RELEASEES from, and waive against RELEASEES, any and all

claims, expenses, compensation, demands, and causes of action, of any nature whatsoever, for

any injuries, death, and damages of any nature whatsoever that might occur to CHILD or me

from the date hereof and forward relating to or resulting from CHILD’s enrollment and partici-

pation in the ACADEMY and any of its programs and activities as referred to above. By way

of explanation and not limitation, this WAIVER/RELEASE includes the waiver and release of

any alleged negligent conduct (excluding any willful, malicious, or grossly negligent conduct)

on the part of the RELEASEES.

I acknowledge that prior to signing this WAIVER/RELEASE, I have been advised by the

ACADEMY to, and have had the opportunity to, consult with an attorney of my choice regard-

ing this WAIVER/RELEASE and its full meaning and legal effect and am knowingly and vol-

untarily signing this WAIVER/RELEASE and agreeing to be bound by it. I further agree to

indemnify and hold harmless RELEASEES from any and all damages of any nature, including,

but not limited to, attorneys fees and costs of defense, in the event that any person or entity on

behalf of me or CHILD seeks to void this WAIVER/RELEASE or otherwise seeks to make

any claim or obtain any type of damages against RELEASEES which are otherwise waived

and released as set forth above.

_______________________________ _______________________________

Signature: Father/Guardian Date Signature: Mother/Guardian Date

(Circle the relationship to CHILD) (Circle the relationship to CHILD)

Waiver of Liability and Release

First Baptist Junior Academy & Developmental Learning Center

First Baptist Academy of Jacksonville, Inc.

Dispute Resolution Policy Agreement (Mediation and Arbitration)

We, _____________________and_____________________, in our individual capacity and in our capacity as the

parent(s) and natural guardian(s) of, or the legal guardian(s) of, and on behalf of, ____________________ (the

“CHILD”), THE FIRST BAPTIST ACADEMY OF JACKSONVILLE, INC. (the “ACADEMY”) (the Preschool

section of the ACADEMY is known by the name “FIRST BAPTIST JUNIOR ACADEMY” or “JUIOR ACAD-

EMY”, which is a part of, and included in the term, the “ACADEMY”), and FIRST BAPTIST CHURCH OF

JACKSONVILLE, FLORIDA, INC. (the “CHURCH”), (hereinafter collectively referred to as the “PARTIES”), in

consideration of the opportunities afforded me and my CHILD for my CHILD to be enrolled as a student and par-

ticipate as a student in the ACADEMY (including, but not limited to, all of the ACADEMY’S programs and ac-

tivities and related services, whether academic, athletic, extra-curricular, or otherwise, and whether conducted dur-

ing the normal operating hours of the ACADEMY or after the normal operating hours of the ACADEMY), and in

further consideration of the privileges and benefits relating to such enrollment and participation in the ACADEMY

located on the property owned by the CHURCH, AFFIRM AND AGREE as follows:

We believe that the Bible commands us to make every effort to live at peace and to resolve disputes with each

other in private or within the Christian church (see Matthew 18:15-20; I Corinthians 6:1-8). Therefore, the PAR-

TIES agree that any claim or dispute of any nature whatsoever that might hereinafter arise between or among the

PARTIES, whether based on a tort, contract, or other theory of recovery, arising from or related to the CHILD’s

enrollment and involvement as a student in the ACADEMY and attending the ACADEMY on the CHURCH’s

property, shall be settled by biblically-based mediation and, if necessary, legally binding arbitration, in accordance

with the Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation, a division of

PeaceMaker Ministries. (A complete text of the Rules is available at www.Peacemaker.net, as well as from the

ACADEMY upon request.) Judgment upon an arbitration decision may be entered in any court otherwise having

jurisdiction in Duval County, Florida. The PARTIES understand that these methods shall be the sole remedy for

any controversy or claim arising out of the CHILD’s enrollment and involvement as a student in the ACADEMY

and expressly and voluntarily waive their right to file a lawsuit and to have a jury trial in any civil court against one

another for such claims and disputes, except to enforce an arbitration decision. The PARTIES acknowledge that

they have been advised to, and have had the opportunity to, consult with an attorney of their choice regarding this

Dispute Resolution Policy Agreement and its full meaning and legal effect and are knowingly and voluntarily en-

tering into this Agreement and agreeing to be bound by it.

_____________________________________ _______________________________________

Signature of Father/Guardian Date Signature of Mother/Guardian Date

(Circle the relationship to CHILD) (Circle the relationship to CHILD)

FIRST BAPTIST ACADEMY, INC. FIRST BAPTIST CHURCH OF JACKSONVILLE, INC

______________________________________ ________________________________________

Amie Shields Date Shelly Taylor Date

Director of Junior Academy & DLC Executive Staff Director, FBA/FBJA

Dispute Resolution


Financial Agreement


FINANCIAL AGREEMENT

Person(s) responsible for payment (“Responsible Parties”)

_______________________________________________________ _________________________

Date Parents/Guardians of _________________________________________

(Child’s Name)

In consideration of the enrollment of the above-named child at First Baptist Junior

Academy and Developmental Learning Center, I acknowledge and agree to the following:

I. TUITION PAYMENT SCHEDULE

I agree to pay ______________weekly. Payments are made to a tuition management system

(FACTS). The annual fee is approximately $46/family.

II. Withdrawal Policy Two weeks prior to the withdrawal date, parents should make direct contact with the Junior

Academy & DLC Director. The parent should pick up a withdrawal form from the office. The

withdrawal form must be returned to the office when completed.

III. Delinquent Tuition and Fees

The Junior Academy & DLC tuition fee is due on Monday or Tuesday of the current week. Payment is considered late if not received by the close of the business day on Tuesday. Late

payments are subject to a late charge of 10% of the total account balance. There will be no

reduction or rebate for absences or vacations. At the discretion of the Director, a child may

be dismissed for delinquent fees or non-payment after the third consecutive week of non-

payment.

IV. Registration Fees

An annual, non-refundable registration fee is due at the time of registration.

V. Late Pick-up Fee

The center closes promptly at 6:00 p.m. Our employees are not paid after this time by the Junior Academy & DLC. After 6:00 p.m., there will be a late charge of $5.00 plus $1.00 per

minute per child. This money shall be paid to the teacher at the time you pick up your child.

The undersigned Responsible Parties hereby certify that we have read and understand all

terms and conditions set forth in this Financial Agreement of First Baptist Junior Academy &

Developmental Learning Center, and we agree to abide by and comply with all such terms and conditions. In the event of default of any provision of the Financial Agreement, we agree to pay

all amounts owed to the Junior Academy & Developmental Learning Center pursuant to this

Financial Agreement and all costs of collection incurred.

We understand that tuition and other fees are necessary in order for First Bap-tist Junior Academy & DLC to successfully fill its mission. I agree to submit tuition payments to FACTS Tuition Management System. I will enroll prior to my child’s first day of attendance by going to www.fbcjaxdlc.com/pay to access the FACTS website to complete the process.

We understand and agree that our obligation to pay tuition and fees described in this

Financial Agreement is unconditional and accept, as set forth in this Financial Agree-ment, that no portion of any such tuition and fees will be refunded or cancelled, regard-

less of the subsequent absence, withdrawal, or dismissal of the child from First Baptist

Junior Academy & Developmental Learning Center.

We understand and agree that any withdrawal of a child from the programs of the Jun-ior Academy & Developmental Learning Center must be in writing and must be acknowl-

edged by the Director of Junior Academy and DLC.

We understand that the Director of Junior Academy & Developmental Learning Center

reserves the right to terminate childcare services in the event of default of this Finan-

cial Agreement or violation of the policies and practices set out in the most current Parent Handbook.

__________________________________ _______________________________________

Signature (Father) Signature (Mother)

Accepted by:

__________________________________ _______________________________________ Amie Shields Shelly Taylor

Director of Junior Academy & DLC Executive Staff Director, FBA/FBJA

Financial Agreement (continued)


Parental Acknowledgements


Parental Acknowledgements DISCIPLINE

At First Baptist Junior Academy & Developmental Learning Center, we use positive discipline,

redirecting behavior, and providing alternatives to the children. We believe that good disci-pline consists of consistent, positive training in the right direction. Our staff must have the

right to correct a child's behavior, when and if necessary, in order to maintain a pleasant at-

mosphere. By providing an environment where participation in activities is consistent, fun,

and rewarding, good behavior becomes a natural part of the experience. We use positive rein-

forcement and praise to encourage appropriate behavior. It is our policy:

1. To use positive communication techniques. We want the child to become calm, express his or her feelings, and take responsibility for actions.

2. To redirect the child to another activity.

3. To allow the child to make limited choices.

4. To give the child a brief period of separation from the group, if necessary, to

consider his or her actions and then be able to return to the activities. If a child displays inappropriate behavior on a regular basis, the parents will be consulted for

help and support. Should the inappropriate behavior escalate to the point where other stu-

dents and/or faculty are at risk, First Baptist Junior Academy & DLC reserves the right to

remove the student from enrollment for a temporary or permanent period of time with or with-

out notice. Teachers are prohibited from acting upon children in the following manner:

physical punishment, humiliation, ridicule, or profane, threatening or abusive language, or punishment associated with food, naps, or toilet training. Our goal is to have every child

achieve positive growth in all areas. With that goal in mind, we must work together to guide

each child toward self-discipline.

Section 65C-22.006(2), F.A.C., requires a current physical examination (Form 3040) and

immunization record (Form 680 or 681) within 30 days of enrollment.

Section 402.3125(5), F.S., requires that parents receive a copy of the Child Care Facility

Brochure, “KNOW YOUR CHILDCARE FACILITY.”

Section 65C-22.002, F.A.C., requires that parents and legal guardians are notified in writing that smoking is prohibited on the premises of the childcare facility.

Section 65C-22.006(3)(c)2., F.A.C., requires that parents are

notified in writing of the disciplinary practices used by the

childcare facility.

During the 2009 legislative session, a new law was passed that

requires childcare facilities to provide parents with information

(The Flu, A Guide to Parents Brochure) detailing the causes,

symptoms, and transmission of the influenza virus every year

during August and September.

Parent Handbook: I agree to review and follow policies as de-

scribed in the Parent Handbook which is available on the

school website.

Your signature below indicates that you have received the above items and that the in-formation on this enrollment form is complete and accurate.

Parent’s Signature: ____________________________________________Date: ____________________

Media Release


FLORIDA DEPARTMENT OF EDUCATION (DOE)

CHILD RELEASE: MINOR

We, ________________________________, the undersigned custodial parent(s) or legal guardian(s) of our

child, hereby give to DOE, its legal representatives, and all persons and corporations acting with its permis-

sion, unrestricted permission to copyright, use, publish, and broadcast the image, voice, and/or likeness of our

child in still, single, multiple, moving, video or audio formats, or any other medium of communication. The

image, voice, and/or likeness of our child may be used in whole, in part, in composite, and in distorted form

for any lawful purpose.

We hereby waive in perpetuity all rights to inspect and approve the finished product that may be used in con-

nection to the image, voice, and/or likeness of our child, and the use to which the image, voice, and/or likeness

of our child may be applied.

We further release DOE from all claims for remuneration associated with any form of damage, foreseen or

unforeseen, associated with the commercial, public interest, and artistic use of the image, voice and/or likeness

of our child.

We acknowledge that the image, voice, and/or likeness of our child and any resulting use of that image by

DOE, shall be the sole property of DOE, which may copyright said property in its own name and with full

right of disposition in any manner whatsoever.

We acknowledge that our child is a minor. We certify that we have read and understand this document and

give our consent freely.

___________________________________

Child’s Name

_______________________________________ ___________________________________

Custodial Parent or Legal Guardian’s Signature Date

_______________________________________

Custodial Parent/Legal Guardian’s Name (print)


There is one God: the Father, the Son, and the Holy Spirit, who subsist as co-equals in

unity and as three separate, distinct Persons; Jesus Christ is God’s Son. He was born of a

virgin as both God and man, lived a sinless life, died to atone for the sins of human be-ings, was buried, arose from the grave, and ascended into Heaven where He will continu-

ally minister as our Great High Priest and Advocate.

We believe in the literal, bodily return of Jesus Christ to this earth.

The Holy Spirit is the Divine Helper, Assistant, Counselor, and lnstructor; and His work is

to reveal Christ, convict of sin, lead to repentance, guide believers, comfort, strengthen,

and sanctify the soul.

The Bible is God's Holy and Perfect Word, Truth without any mixture of error and is the

sole authority for life.

Human beings are the special creations of God, made in His image, and through the sin of

the first man, Adam, have inherited a sinful nature, and thus are in need of salvation.

Salvation is a gift through faith in Jesus Christ. Every person who truly is saved is eter-

nally secure in the Lord Jesus Christ and will spend eternity in Heaven, while those who die without salvation in Jesus Christ will spend eternity in Hell.

Each believer has, by prayer, direct access to God through the Lord Jesus Christ.

The church is a local body of baptized believers with the Lord Jesus Christ as the head.

Believers are to live in accordance to God's commandment and to proclaim the Gospel to

all the world.

In order to fulfill our Mission, it is essential that at least one parent know the Lord Jesus Christ as his/her personal Savior. Please describe the time you

accepted Christ as your Savior, or indicate that you plan to share it verbally in your Family Conference. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________ ____________________________________________________________________________________

______________________________________________________________________________________________________ Received by: ________________________________________ Amie Shields Director of Junior Academy & DLC

Statement of Beliefs


Please read the following statements.

If there is any statement you cannot personally support,

please initial it and discuss it with us in your family conference.

Covenant A covenant is a binding agreement between two parties. It signifies a solemn oath and sincere pledge of mutual respect and cooperation. First Baptist Junior Academy and DLC covenants to provide in every manner possible for your children in the way of facilities, curriculum, faculty, athletics, social functions and instruction. We further pledge to do all that is possible to support your home in growing every stu-dent in the nurture and admonition of the Lord. As the legal parents (guardians) of our children, we

covenant to support First Baptist Junior Academy and DLC in its efforts in Christian education. We agree that it is our responsibility to strive diligently toward the observance of the Parents’ Statement of Support as God enables us by the power of the Holy Spirit. If for some reason we become dissatisfied, we promise to handle the matter as privately and lovingly as possible. If support or resolution cannot be reached, we recognize it is our responsibility to leave the Junior Academy and Developmental Learning Center and seek a school in alignment with our personal convictions. Together, as a school and as par-ents (guardians), we pledge to submit our lives to one another and to the final authority of the Word of God.

1. We have received and read the Statement of Beliefs of the school; we are willing to have our child educated in accordance with them and we will attend a Christ-centered church regularly; we will actively participate in the spiritual forma-

tion process of our child and realize that success in this area begins with the home, and continues with the church and school. 2. We agree to support to the best of our ability the school's entire program through prayer, time, and financial contributions to the expenses, understanding that we are partners in the educa-tional process. 3. We will fully cooperate in the educational ac-

tivities of the JADLC by doing our best to make Christian education effective in the life of our child. 4. We will require our child to support the spiri-tual activities of the school (Chapel, Bible classes, Scripture memory, etc.). 5. We will pay all of our financial obligations to the JADLC on or before the date due. If we are ever unable to do so, we will notify the JADLC Office, giving a reasonable explanation for the delay and stating when payment will be made. 6. I have read the Parent Handbook in its entirety and agree without reservation that the school has my support in both the interpretation and en-forcement of the policies as it relates to my child.

7. The school reserves the right to place our child at the appropriate grade level and designate the appropriate teacher(s). 8. The school reserves the right to dismiss any

student when either the parents/guardians or the student does not cooperate with the policies of the school. 9. We will be faithful to attend all parent func-tions at the JADLC, to the best of our ability. These include Open House, Parent Conference requests, Information Nights, etc. 10. If we become dissatisfied with the JADLC in any way we will resolve the matter with the per-son(s) involved as outlined in the Parent Hand-book rather than spreading criticism and negativ-ism (Matt. 18:15-17; 5:23-24). We agree to follow the process of resolving conflicts as set forth in

the First Baptist Academy Dispute Resolution Policy. 11. The JADLC Biblical role is to work in con-junction with the church and home to mold stu-dents to be Christ-like. Understanding our role in the parent-school partnership, we agree to ab-stain from sexual immorality, including homosex-ual orientation (I Thess. 4:3-8, Lev. 20:13, Rom. 1:27). We understand that the JADLC reserves the right to refuse the admission of an applicant or to discontinue enrollment of a student. 12. We will seek to support and advance the JADLC in every area possible-spiritually, aca-demically, physically, and financially.

Parent/Guardian Statement of Support


Affirmation of Agreement

By signing below, we, the parents or guardians of this student, affirm that we have given completely truthful information herein; and that we have received,

read, understand, and will abide by the policies and agreements in the State-ment of Beliefs, Parent/Guardian Statement of Support, and will sign all other documents required by the JADLC upon acceptance for enrollment.

Application does not ensure enrollment. The Admissions Committee evalu-

ates each applicant, and decisions are based on the ability of JADLC to meet the needs of each child. Students may be refused admission for various rea-sons including, but not limited to, unavailability of classroom space or ongo-

ing disciplinary problems. Admission cannot be granted until all necessary records have been turned in to the JADLC office and the personal interview is

completed. Continued enrollment is contingent upon proper attitudes and conduct.

________________________________________ _________________________________________

FATHER/GUARDIAN DATE MOTHER/GUARDIAN DATE

________________________________________ _________________________________________

FATHER/GUARDIAN DATE MOTHER/GUARDIAN DATE

This application must be completed in its entirety on behalf of all students seeking admission to First Baptist Junior Academy & Developmental Learning

Center. It should be filed, along with a non-refundable Application fee of $100 (VPK exempt), at the school office on the campus of First Baptist Church or mailed to:

Admissions Office First Baptist Junior Academy & Development Learning Center 124 West Ashley Street Jacksonville, FL 32202 NON-DISCRIMINATORY POLICY First Baptist JADLC admits students of any race, color, national and ethnic

origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. The school does not discriminate

on the basis of race, color, national, and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.

Affirmation of Agreement

Documents

Online Application Supplement