PO Box 27 - 117 8th Street - McCleary, Washington 98557
Telephone: 360.495.3832 - E-Mail: oca@go2occ.com
This registration/enrollment form is for the 2013/2014 academic year. The registration fee of $50.00 (first child), $40.00 (2nd child) or $30.00 (3rd child or more enrolled) must accompany this registration/enrollment form and is not refundable. This is done by paypal to _ with the same name or this application will not be processed. This educational ministry is not a corrective institution; do not register your child with the idea that we will reform him or her. We are here to work with the home, but not to take the place of parents.
Student Information - Please type or print clearly
Name: (*)
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Address: (*)
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City: (*)
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State: (*)
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Zip: (*)
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Telephone: (*)
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Parent/Guardian Email Address: (*)
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Family Information
Father's Name: (*)
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Father's Employer/Position: (*)
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Home Phone: (*)
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Cell Phone: (*)
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Work Phone: (*)
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Mother's Name: (*)
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Mother's Employer/Position: (*)
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Home Phone: (*)
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Cell Phone: (*)
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Work Phone: (*)
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Emergency Contact (other than mother of father): (*)
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Home Phone: (*)
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Cell Phone: (*)
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Work Phone: (*)
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Religious Information
Religious Institution Attended by Student and/or Family: (*)
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Attend regularly? (*)
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Minister: (*)
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Phone: (*)
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- I understand that the educational program is an integral part of the church ministry and I hereby commit my full support, including prayer and finances.
- I understand that applicant is expected to take part in all activities, including sponsored trips away from the educational facility, and I absolve the church from liability to me or applicant because of any injury at supervised activities.
- I agree to uphold and support the high academic standard of the educational ministry by providing a place at home for applicant to study and by encouraging the completion of any homework or assignments.
- I appreciate the standards of the educational ministry and do not tolerate profanity, obscenity in word or action, dishonor to the Godhead or the Word of God, or disrespect to the staff or the church. I have read the educational handbook and understand it.
- I also agree to support regulations published therein in the applicant’s behalf and authorize the church to employ discipline, as it deems wise and expedient for training. I understand that the church reserves the right, after parental conference, to dismiss any child who fails to comply with the established regulations and discipline or whose parents do not assume their responsibility to the educational ministry.
Signature of Father: (*)
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Date:
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Signature of Mother: (*)
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Date:
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Signature of Student: (*)
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Date: (*)
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