Full Name *

First /Middle /Last

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender *

Male

Female

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Full Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Full Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is Your Student a Christian? *

Yes

No

If Yes, Does Your Student Attend Church? *

Yes

No

Name *

First Name

Last Name

Phone *

(###)

###

####

Name *

First Name

Last Name

Phone

(###)

###

####

Parent/Guardian Signature *

By typing your name, you are agreeing to the above statement.

First Name

Last Name

Date *

MM

DD

YYYY

*

I agree to have my student abide by the EPEC dress code. I understand that if my child violates the EPEC dress code I may be called to bring suitable clothing or my child may need to wear clothing provided by EPEC. I also understand that if my child repeatedly violates the dress code he/she may be sent home and/or given consequences at school (detention, trash duty, campus clean up, etc.).

Parent/Guardian Signature *

First Name

Last Name

Date *

MM

DD

YYYY

Tuition for EPEC may be paid in full or divided into 10 equal payments. Tuition for EPEC is due no later than the 10th of each month. Payments received after the 10th will incur a $10 late fee. Students may be asked to leave EPEC if tuition payments are more than 30 days late. I also understand that I am required to give a 30 day written notice if I decide to withdraw my child from EPEC or I will be charged the normal tuition rate. *

I agree to pay tuition on time and understand that if I do not, I will incur a $10 fee. I also understand that my child may be asked to leave EPEC if tuition is more than 30 days late. I also agree to give a written 30 day notice if I decide to withdraw my child from EPEC or I will be charged the normal tuition rate.

Parent/Guardian Signature *

First Name

Last Name

Date *

MM

DD

YYYY

*

I understand that I am ultimately responsible for my child’s behavior and education. EPEC is a center designed to come alongside families and work together to help children grow into the person God created them to be, as well as help them succeed academically. If this partnership is no longer working for EPEC or myself, I understand that it may be terminated.

Name *

First Name

Last Name

Date *

MM

DD

YYYY

*

I understand that EPEC is a Christian Educational Center. Students are required to attend morning prayer, chapel, read their Bible, follow Christian values/teachings, and discuss theological and spiritual topics.

Name *

First Name

Last Name

Date *

MM

DD

YYYY