Coastline Christian Academy
ENROLLMENT APPLICATION
5950 Cathedral Oaks Road, Goleta, CA 93117
(805) 967-5834
A $100.00 non-refundable application fee is required for all new students. PLEASE NOTE: Fee must accompany
enrollment application.
Date of application ________________ School year applying for _________________
Student’s name _____________________________________________ M ____ F ____
(last)
(first)
(middle)
Address ________________________________________________________________
(street)
(city)
(zip)
Birth date _________________
Birthplace ___________________________
Applying to enter grade _________
Ethnic origin ________________________
Public school child would attend _____________________________________________
Father/stepfather/guardian ____________________ Living with child: Yes____ No____
Title (Mr./Dr./Rev.) ______
Address ________________________________________
Home phone _____________Work phone _________________ Dr. License # _____________
Occupation _________________
Social Security # ___________________________
Employer _______________________________________________________________
Mother/stepmother/guardian __________________
Living with child: Yes____ No____
Title (Mrs./Ms./Miss/Dr.)______ Address ________________________________________
Home phone _______________ Work phone _______________ Dr. License # ______________
Occupation _________________
Social Security # _____________________________
Employer _______________________________________________________________
Which parent is responsible for payments?
Please list other persons living in the home.
Name
Father _____
Relationship
Mother _____ Both _______
Age
School Attendance Record
Grade
(Please list all schools attended including pre-school and current school.)
School
City/State
Has the student ever repeated a grade? ________
Which one? ___________________
Explain: ________________________________________________________________
_______________________________________________________________________
Has the student ever been suspended or expelled from a school? ____________________
Explain: ________________________________________________________________
_______________________________________________________________________
Has the student ever been double promoted? ____
Which grade was skipped? _______
Explain: ________________________________________________________________
_______________________________________________________________________
List three references whom we may contact to recommend your child, one of whom may be a
pastor, youth pastor, or Sunday school teacher.
Name
City
Phone
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Coastline Christian Academy admits students of any race, color, national or ethnic origin to all the rights,
privileges, programs, and activities generally accorded or made available to students at the school. It does
not discriminate on the basis of race, color, national or ethnic origin in administration of its educational
policies, admissions policies, scholarship programs, or other school-administered programs.
Coastline Christian Academy
STATEMENT OF FAITH
1. We believe the Bible to be the inspired, the only infallible, authoritative, inerrant Word of
God (2 Timothy 3:16; 2 Peter 1:21)
2. We believe there is only one God, eternally existent in three persons – Father, Son and
Holy Spirit (Genesis 1:1; Matthew 28:19; John 10:30)
3. We believe in the deity of Christ (John 10:30); His virgin birth (Isaiah 7:14; Matthew 1:23;
Luke 1:34-35); His sinless life (Hebrews 4:15; 7:26); His miracles (John 2:11); His vicarious
and atoning death (1 Corinthians 15:3; Ephesians 1:7; Hebrews 2:9); His resurrection (John
11:25; 1 Corinthians 15:4); His Ascension to the right hand of the Father (Mark 16:19); His
personal return in power and glory (Acts 1:11; Revelation 19:11).
4. We believe in the absolute necessity of regeneration by the Holy Spirit for salvation
because of the exceeding sinfulness of human nature; and that men are justified on the
single ground of faith in the shed blood of Christ and that only by God’s grace and through
faith alone we are saved (John 3:16-19; 5:24; Romans 3:23; 5:8-9; Ephesians 2:9-10; Titus
3:5).
5. We believe in the resurrection of both the saved and the lost: those who are saved unto
the resurrection of life, and those who are lost unto the resurrection of damnation (John
5:28-29).
6. We believe in the spiritual unity of believers in our Lord Jesus Christ (Romans 12:5; I
Corinthians 12:12-13; Galatians 3:26-28) and that the body of believers must not forsake its
fellowship together both in worship and praise of our Lord and Savior Jesus Christ
(Hebrews 10:24-25).
7. We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is
enabled to live a Godly life (Romans 8:13-14; 1 Corinthians 3:16; 6:19-20; Ephesians 4:30;
5:18).
8. We believe there is no preferential treatment with God and make no distinction
concerning an individual’s race or ethnic background (Romans 2:11).
I/We believe in the above Statement of Faith:
____________________________
Signature of Father/Guardian
_____________________________
Signature of Mother/Guardian
___________________ _________
Print Name
Date
_______________________
Print Name
______
Date
Coastline Christian Academy
PARENTAL AGREEMENT
I/We hereby agree that I/we will abide by the following commitment:
1. Coastline Christian Academy shall have the authority to discipline our child when necessary and will encourage our
child to comply with all school regulations. We further agree that we will cooperate and discipline our child in the home
as needed.
2. We will endeavor to communicate our grievances honestly and directly to those involved and to forget them quickly,
following the principles set forth in Matthew 18 of maintaining a spirit of reconciliation.
3. We will pay for damage cause by our child.
4. We understand that a child who persists in undesirable conduct will not be permitted to remain in school.
5. We agree to pay all fees in advance or by the due date. We understand a $20.00 late charge will be applied to any
balance still owed after the fifteenth of each month. An additional fee of $20.00 will be applied to each previous
month’s tuition left unpaid.
6. We give permission for our child to take part in all school activities.
7. We give permission for our child to ride in school or chartered transportation or with school parents in their private
vehicles or to walk with an authorized adult to any school-sponsored event which may be scheduled during the school
year. While traveling to and from such activities, our child will be under the supervision of school personnel and will be
expected to abide by all school rules and regulations. It is understood that it is the teacher’s responsibility to notify us
of the dates and destinations of such trips.
8. We understand that the standards of Coastline Christian Academy do not tolerate profanity, obscenity by word or
action, or disrespect to the personnel of the school.
9. We understand that Coastline Christian Academy will evaluate our child for developmental and moral readiness as
well as grade placement. Furthermore, we agree that Coastline Christian Academy has full discretion, after
consultation with the parents, as it relates to the placement of our child(ren) in the appropriate grade or classroom.
_________________________________
Signature of Father/Guardian
______________________________
Signature of Mother/Guardian
_______________________
Print Name
_____________________
Print Name
_________
Date
How did you hear about Coastline Christian Academy?
____Newspaper ____Yellow Pages ____Friend ____Pre-School (Name) ___________________________
____Current School Family ____ Other (Specify) ______________________________________________
Coastline Christian Academy
______
Date
PARENTAL QUESTIONNAIRE
Please answer all questions as completely as possible.
1. Why do you wish to have your child attend Coastline Christian Academy?
2. What do you expect from your child’s education?
3. What do you expect your child will gain by attending Coastline Christian Academy?
4. What are your moral expectations of your child? Of Coastline Christian Academy?
5. What do you perceive as your child’s strengths and weaknesses (both academically and
morally)?
6. How do you perceive Coastline Christian Academy helping you achieve your personal goals for
your child?
7. Do you regularly attend church? ___Yes ___No
If yes, where ____________________
8. Do you attend as a family? ____Yes ____No
If no, explain ____________________________________________________________
_______________________________________________________________________
Pastor’s Name: _________________________________________________________
9. Briefly state your religious beliefs:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
10. What is your definition of a Christian?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_______________________________
Signature of Father/Guardian
______________________________
Signature of Mother/Guardian
_________________________________
Print Name
Date
__________________________ ______
Print Name
Date
Please use the space below to complete any answers, to express questions or concerns, or to inform us of a
family situation of which you think the administration of Coastline Christian Academy should know.