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Emergency Information Update
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Current Student Registration

Student Information
Name  *
    Middle      Last  *
City       State       Zip 
Phone       Birthdate     Age     Grade Entering

Family Information
Father Name  
                   Home Phone    
Address              Cell Phone      
City      State       Zip                   Work Phone    
E mail Address 

Mother Name                    Home Phone  
Address              Cell Phone      
City       State       Zip                  Work Phone   
E mail Address 

If living with guardian:
Guardian Name                Home Phone  
Address              Cell Phone      
City       State       Zip                  Work Phone   
E mail Address 

In Case of Emergency Contact: (parent will be contacted first)
Home Phone  
      Cell Phone         Work Phone  

Medical Information
Significant medical information concernting student:

Religious Information:
Church Membership:

            Seventh-day Adventist
                        35th Avenue SDA     Fairview SDA   Selah SDA _____
                        Other (specify) 
            Other Denomination

    This year  
                         Father       Mother     
Financial Responsibility:
I am responsible for the tuition and other fees for this student/s. I agree to follow the guidelines outlined in the handbook for payment.
Name  *                Phone    
City      State       Zip          

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Student Commitment  (Students is grades K-4)
          I have heard the school mission statement and want to be more like Jesus.  I will do my best to follow school rules, cooperate with teachers, and finish all assigned work.

Student Commitment
            I have read the mission statement of the school and also wish to dedicate my life to Jesus Christ and the service of my fellow man.  I understand that my body is the temple of God and I will refrain form smoking, drinking alcoholic beverages, the use of drugs, or involvement in sexual activity.  I agree to follow the school rules and citizenship guidelines listed in the handbook. 
acknowledge that attendance at YACS is a privilege, not a right, and can therefore be withdrawn if my behavior or attitude is not in harmony with the mission statement.  I will be cooperative in my relationship with teachers and will complete all assigned work. 
 I understand that an integral part of my training and education is the responsibility of my parents and that this institution merely assists parents in achieving educational goals.

Parent Commitment
            I agree that the parent is most responsible for the training and education of their child and wish to fully cooperate with the teaching staff.  I have read YACS’ mission statement and agree to center Christ in my life and to demonstrate my commitment in my actions and attitudes.
            I agree that my child also wishes to have Christ centered in his life and will adhere to the citizenship guidelines or face possible dismissal from YACS,  I understand that attendance at Yakima Adventist Christian School is a privilege and not a right. The school reserves the right to refuse admittance and to dismiss any student in order to safeguard the scholastic, spiritual, and moral atmosphere of the school.
Parent   *   Date
By e-mailing this document you agree: 

* 1.  The person listed as financially responsible will be responsible for the tuition  
                and fees for this student.
* 2.  The student has read and agrees to the student commitment.

* 3.  The parent/guardian has read and agrees to the parent commitment.  


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