Southport Christian School
STUDENT INFORMATION FORM
STUDENT INFORMATION
Last Name *
First Name *
Middle Name
Date of Birth *
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Age *
Sex *
Grade Entering *
Address *
City *
State *
Zip Code *
Allergies
If your Student has any allergies please list them below.
Medications
If your Student requires daily medication please list it below.
Does your child have any physical needs that will require special attention? *
If yes, please explain:
Does your student have any learning disabilities or has a previous school indicated a concern regarding this possibility? *
If yes, please explain:
Has your student ever been expelled, suspended, or been involved in frequent disciplinary action? *
If yes, please explain:
Primary Contact Relationship
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Primary Contact Last Name
Primary Contact First Name
Primary Contact Address
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Primary Contact Phone Number
Primary Contact E-mail Address
Primary Contact of Employment
Secondary Contact Relationship
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Secondary Contact Last Name
Secondary Contact First Name
Secondary Contact Address
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Secondary Contact Phone Number
Secondary Contact E-mail Address
Secondary Contact Place of Employment
GRANDPARENT INFORMATION
This information is used to invite Grandparents to special events.
Paternal Grandparent Names
Paternal Grandparent Address
Paternal Grandparent Email
Would you like these Grandparents to receive Correspondence?
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Maternal Grandparent Names
Maternal Grandparent Address
Maternal Grandparent Email
Would you like these Grandparents to receive Correspondence?
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EMERGENCY CONTACT INFORMATION
Emergency Contact #1 *
Name and Phone Number Required
Emergency Contact #2 *
Name and Phone Number Required
Student's Doctor's Name *
Name and Phone Number Required
Insurance Information *
Medical Insurance Company & Policy Number Required
PERMISSIONS
Field Trip Permission *
I hereby grant my permission for the above named student to attend any class trip with Southport Christian School. I understand that I will receive advance notice of all trips this year. I also hereby authorize the teachers and appointed chaperones to act as agent(s) for said child. I agree and consent to any emergency medical care or treatment that may be needed for my child during the entire outing, including the trip to and from the destination. I further assume responsibility for the decision made, the care or treatment administered to my child by or rendered under the supervision of any physician or surgeon either at a hospital or doctor’s office.
Computer, Internet & Photo Use Permission *
I hereby grant my permission for the above named student to use the Computer Lab and Internet Access under teacher supervision. I understand students may be held in violation. I accept responsibility for guidance of the Internet with my child. I understand that students are photographed on field trips and during other school activities. These photos may be shared with the local newspaper, school website and school/teacher social network sited for our parents to access and share.
Medical Treatment Permission *
I give my permission to treat my child for minor cuts and scrapes as explained below. "From time to time, students will require general medical treatment for scrapes and minor cuts. Treatments include: Tums for Abdominal Discomfort, Benadryl for Allergic Reaction, Hydrocortisone cream/Benadryl for Bug Bites, Throat lozenges for sore throat, Ice Pack for Bruise, Band-aid and ointment for minor scrape or cut, Children’s Tylenol or Ibuprofen for headache, fever and pain."
Family Handbook Agreement *
I/We the parents/legal guardians of the above named student have received and read in total the Southport Christian School Family Handbook and agree to comply by the rules and regulations of the school as set forth in the Handbook. https://s3.amazonaws.com/media.cloversites.com/6d/6dde27ee-c640-4edd-a572-9b4329ef8510/documents/Family_Handbook_18-19.pdf
STATEMENT OF FAITH
Statement of Faith *
Deuteronomy 6:4-9“Hear, O Israel: The Lord our God, the Lord is one. Love the Lord your God with all your heart and with all your soul and with all your strength. These commandments that I give you today are to be on your hearts. Impress them on your children. Talk about them when you sit at home and when you walk along the road, when you lie down and when you get up. Tie them as symbols on your hands and bind them on your foreheads. Write them on the door frames of your houses and on your gates.” - Southport Christian School's statement of faith strives to highlight the core biblical values of our common faith as followers of Jesus Christ. We do not seek to advocate or endorse any particular church or denomination but to simply communicate who we are as a school. As such, we present the following statements as the spiritual foundation upon which our school is based.We Believe . . . that there is only one true and living God, who exists in the form of the Trinity; God the Father, God the Son, and God the Holy Spirit.that Jesus Christ was born of a virgin, lived a sinless life, was crucified for our sins. He rose from the dead on the third day, ascended into heaven and sits at the right hand of God the Father. Jesus is alive today, He is the only hope for our salvation and He will come again to judge the living and the dead.that the Bible, both the Old and New Testaments, is the inspired, infallible and authoritative Word of God. The Bible is the foundation of Christian education, values and ethics.that the model by which we are to live our lives is Jesus Christ as He is revealed to us in the Holy Scriptures.that prayer is a powerful tool available to all Christians to effect personal and corporate change and should be practiced regularly.that the value of each person is evident in that God created us in His own image, and in that Christ died for us. Therefore every person, regardless of race, gender, creed, economic condition, or nationality possesses dignity and is worthy of respect and Christian love.that the events taking place in the world around us should be viewed and understood in light of God’s Word, as it is our supreme standard.that JESUS IS LORD!
Church Attendance
Please list where you attend church.
TRANSPORTATION
Student Transportation Form *
Permission must be given for anyone other than the child’s parent or legal guardian to transport him/her from the school grounds at any time during the school day. Please be advised that your child will not be allowed to leave the school grounds with anyone besides you or the individuals listed below unless the school’s office has been notified in writing or by phone.I give permission for my child to be transported from Southport Christian School by the following people: Name & Phone Number Required
TUITION
$5500.00 - Preschool, Pre-Kindergarten & Kindergarten
$6410.00 - 1st Grade thru High School - (1st Child)
$4820.00 - 1st Grade thru High School - (2nd Child)
$4360.00 - 1st Grade thru High School - (3rd Child)
Tuition Payment Choice *
Use this link to pay tuition in full to receive 5% discount. ( https://bngn.smarttuition.com/?id=xxudmmgnixg )
Smart Tuition Payment Date
If enrolling in SMART TUITION please pick a payment date.
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Tuition Payer Name *
Tuition Payer Address *
Tuition Payer E-Mail *
Tuition Payer Phone Number *
AFTER SCHOOL CARE
After School is from 2:30 pm - 6:00 pm. A light snack is provided but parents can send an extra snack and a change of clothes if they wish. After School Teachers can be reached at 910-530-5225.

Registration Fee $25.00
Weekly Fee $40.00
Daily Fee $10.00
Do you wish to enroll your Student in After School Care? *
If you choose to send your Student to After School Care how do you wish to be billed?
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FEES
Use the link below to pay the Registration Fee of $175.00, the Security Fee of $350.00 and the After School Fee (if applicable).

(Credit Card has a 2.73% surcharge, Bank Draft is free)
PAY HERE ( https://bngn.smarttuition.com/?id=4vb01j1mf3c ) YOU MUST RETURN TO THIS FORM AFTER PAYMENT TO SUBMIT THE APPLICATION. *
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