NSCA Registration

Registration Packet & Fee Schedule 2019-2020
Registration Checklist:
- Registration Packet
- Health Statement signed by a MD or RN
- Financial Information
- Copy of Student Birth Certificate
- Copy of Student Immunization Records
Registration Fees: (non refundable)

On or before April 15, 2019 $ 60 After April 15, 2019 $120

Tuition Schedule

CLASS	MONTHLY TUITION
3 Year old	$350
4 Year Old	$490
Junior Kindergarten	$550
Kindergarten	$620

Please ask about discounts that may be available for additional siblings and pre-paid tuition. Fees are assessed and paid in 9 equal monthly installments from September through May.

New Song Christian Academy

1291 Cornet Street, Henderson NV 89052

Phone: (702)492-1771 Fax: (702)294-1571

Registration Information for 2019-2020 School Year
Student Information
Student's Name*

First NameLast Name
Nickname
Nickname
Date of Birth*

MonthDayYear
Gender*

FemaleMale
Class Enrolling for:*

3 year old classes (Tues/Thu, 8:30am-12:30pm)4 year old classes (Mon/Wed/Fri, 8:30am-1:30pm)Junior Kindergarten (Mon-Fri, 8:30am-2:30pm)Kindergarten (Mon-Fr, 8:30am-2:30pm)
Parent Information

Custodial Parent/Guardian
Parent/Guardian*

First NameLast Name
E-mail*
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone
Cell Phone*
Parent/Guardian #2
Parent/Guardian 2

First NameLast Name
Both Parents reside at the same address
E-mail #2
Home Address #2

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone #2
Cell Phone #2
Authorized Student Pick-up

In the event of an emergency, additional persons may be authorized to remove the child from the facility. We will not release a child into the care of anyone who is not listed on this form as either a parent/guardian or an emergency contact. Photo identification will be required from anyone listed.
Emergency Contact 1*

First NameLast NamePhone Number
Emergency Contact 2*

First NameLast NamePhone Number
Emergency Contact 3

First NameLast NamePhone Number
Emergency Contact 4

First NameLast NamePhone Number

Medical Information
Primary Care Physician*

PrefixFirst NameLast NamePhone Number
Dentist*
Dentist Phone
Please list any allergies or other health problems that we should be aware of*
Please enter a value. Enter "N/A" if not applicable.
Permission & Consent

Consent for Medical Treatment
In an emergency, New Song Christian Academy has my permission to call an ambulance or take my child to any available physician or hospital at my expense.*

YesNo
In an emergency my child may receive first aid*

YesNo
In an emergency New Song Christian Academy has my permission to call*

First NameLast NamePhone Number
and, if necessary, I give my consent to any doctor or hospital to administer medical or surgical treatment and care for my child at my expense: *

YesNo
Medication Release
Are you requesting any medication to be administered at/by school?*

YesNo
A completed medication authorization must be on file in the student's records. Please see the Academy Director for details.

Permission & Consent

NAC 372.2(a) Consulting with Physicians or registered nurses regarding the health of the child:

Parent or guardian agrees for provider to consult with a nurse or physician in regards to child(ren)'s health as needed for his/her clarification. In the event that we should have questions regarding the health of any child we may contact one, or more. of the following sources for information:
Child's doctor*

First NameLast NamePhone Number
Hospital Name
Hospital Phone
Southern Nevada Health District (702)759-1301
Signature of custodial parent

Clear
Date*

MonthDayYear
Date
NRS 178

I am aware that I have the right to request and review any complaints the facility has received within the last 12 months of my child's(ren's) enrollment.
Signature of parent or guardian

Clear
First NameLast Name
MonthDayYear
Date
Permission to release information
I understand that the time my child, named below, is in the facility that the director may be asked for information regarding my child.*

Child First NameChild Last Name
Permission to Release Information*

Yes, I hereby give permission to release information to official persons only, who identify themselves, such as schools, health care personnel, welfare or other government officials.No, I do not give permission to release information about my child as set forth in the aforementioned statement. I realize that the Bureau of Services for Child Care has access to my child's record as the licensing agent.
Parent/Guardian Signature

Clear
MonthDayYear
Date
Photographic Release

As a parent or guardian of this student, I hereby consent to the use of photographs/audio visual material taken during the course of the school year for publicity, promotional and/or educational purposes (including publications, presentations, or broadcast via newspaper, internet, such as Facebook or school website, or other media sources). Only first names and possible last initials (in the event of two or more children with the same first name) may be displayed with the photograph. I do this with full knowledge and consent and waive all claims for compensation for use or dmages.
Photo release*

Yes, I give consent to the use of photographs/audio visual materialsNo, I do not give consent to the use of photographs/audio visual materials
Field Trip Permit

I understand that during the year my child may take part in field trips and educational excursions, either by private car (parenst take the child) or on foot. I further understand that my child will be chaperoned by a responsible adult at all times while away from the facility. Should any accident occur while my child is away from the facility on the aforementioned trip, I shall not hold the child's caretaker, members of the New Song Christian Academy facility or New Song Church and its employees, nor any participating adult responsible.
Field Trip Permission*

Yes, I give permission for my child to take part on aforementioned field trips.No, I do not wish for my child to take part in aforementioned field trips.
Policies and Procedures Agreement

I have read the Academy policies and procedures packet and agree to abide by the policies and procedures set forth within.
Signature

Clear
First NameLast Name
MonthDayYear
Date
Please direct any qustions concerning this form to the Academy Director, Jacqueline Anne, at jackie@newsonganthem.org or (702)492-1771.

Please print a copy of this form to submit with your completed registration packet. Upon submission this form will generate an invoice for your registration fee which will be sent to the email address described and may be paid online.

Financial Information
Student Name*

First NameLast Name
Who will responsible for Payment? This is the person who will receive the tuition invoices each month.*

Parent(s) jointlyParents will split paymentsOther person
Payor*

First NameLast Name
Other Person Responsible for payment*

First NameLast Name
Payor Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Payor Phone Number

Area CodePhone Number
Payor email*
This is the address to which invoices will be sent
Payor %
Payor 2*

First NameLast Name
Payor 2 email*
This is the address to which invoices will be sent
Payor 2 %
Payment options

Automatic monthly invoicesPrepay in full (5% discount)
Payment Terms & Conditions

Enrollment is contingent upon receipt of the complete registration packet and payment of the applicable registration fee, both of which must be received before the first day of school.

Tuition will be paid in nine (9) equal monthly installments via direct debit from a nominated savings or checking account, the first installment to be received by 09/01/2019 and the final by 05/01/2020.

Any payment returned by a financial institution issued to New Song Christian Academy will result in the assessment of a per payment service charge against the issuer’s account (or against the account of the student on whose behalf a third party payment was made). The returned payment service charge, as authorized by Nevada state law (NRS 597.960) is $25.
Late Fees

Tuition and fees (fees include, but are not limited to, any registration, program or supply fees) are due in full by the dates specified in your tuition agreement and/or in the registration form of that activity. Tuition or fees that are past due 15 days will incur a late fee of $25.
I hereby confirm and agree to the terms of payment as described above. By acknowledging and signing my initials below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.

Clear
First NameLast Name
MonthDayYear
Date
Should be Empty:

Registration Packet & Fee Schedule 2019-2020

Registration Checklist:

Registration Information for 2019-2020 School Year

Student Information

Parent Information

Authorized Student Pick-up

Financial Information