Enrollment Form

Name of Student

School Year

Grade

Gender

Parent/Guardian 1

Relationship to child

Lives with child

Cell Phone

Home Phone

Home Address

Email

Employer

Work Phone

Work Address

Parent/Guardian 2 

Relationship to child

Lives with child

Cell Phone

Home Phone

Home Address

Email

Employer

Work Phone

Work Address

Brothers or Sisters

Brothers or Sisters

Brothers or Sisters

Brothers or Sisters

Restrictions of Contact
 

Are there any LEGAL restrictions on contact with your child by another family member, such as a restraining order or a custody agreement? If so, please provide copies of legal documentation upon enrollment.


Are there any family members whom you would PREFER to have no contact with your child? If so, please provide a separate and detailed written notice upon enrollment


Shiloh United School Emergency Contact Information


Introduction

To properly care for your child in an emergency, it is essential for us to have complete and up-to-date information. When any information provided changes, please notify us immediately. In case of emergency, we will make contact in the order listed below, so please list parents first. Three other contacts are required. Contacts may also be used during daycare, field trips, and school functions.  Only adults listed in this section will be able to pick up your child from school and if there are new pickup or drop off arrangements always inform the school office.

Student Name

Home Phone

Home Address

Contact First

Full Name

Relation to Child

Day Phone

Evening Phone

Cell Phone

Contact Second

Full Name

Relation to Child

Day Phone

Evening Phone

Cell Phone

Contact Third

Full Name

Relation to Child

Day Phone

Evening Phone

Cell Phone

Contact Fourth

Full Name

Relation to Child

Day Phone

Evening Phone

Cell Phone


Medical Questions

Does your child have any special medical condition, physical problem, disability, or allergy of which a doctor should be aware before medical treatment?

Does your child regularly take any prescription or other medication at home or at school?

If you answered “Yes” to either question, please include a detailed written explanation with your application.

Child’s Doctor

Hospital or Clinic

Phone

Phone

RELEASE AND CONSENT

We understand that in case of medical emergency, illness or injury, a reasonable effort will be made to contact us, or the authorized persons listed above to arrange medical treatment for our child. Should this effort fail, Shiloh United School is hereby authorized to arrange for such treatment. Shiloh United School may arrange for any qualified medical or emergency personnel to treat or do whatever may be deemed necessary for the health and well-being of our child. We consent to the school’s decisions regarding care for our child should it be unable to contact us or those listed above. We agree to accept full responsibility for the cost of any treatment or care which the school may arrange in such circumstances.

Shiloh United School Health Information

Immunizations

Proof of immunization is required for your child to attend school. For kindergarten, report of a full physical examination with the part six months is required. An exam is also required for first grade unless one is already on file from kindergarten. Added immunizations are required for other grades.

General Health

Please give approximate dates for illnesses if your child has experienced any of the below:

Chicken pox

Measles

Smallpox

Whooping Cough

Polio

Rheumatism

Rubella

Mumps

Pneumonia

Diphtheria

Influenza

Frequent Colds

Scarlet Fever

Tuberculosis

Head/Earaches

Other Severe Chronic Illness

Accidents or Serious Injuries

Surgeries or Operations

Physical or Academic Disabilities

Nervous Habits or Fears

General Health

Shiloh United School cannot administer medication without a parent’s written authorization and instructions. All medications, including over-the-counter items such as cough drops, aspirin, etc. are kept in and administered from the school office and students may not possess medications.

Behavioral

(Please write “none”, “some” or “much” for the child’s amount of difficulty in each area listed.)

Temper

Crying

Sleeping

Sulking

Disobedience

Non-Sociable

Fighting

Teasing

Nail Biting

Jealousy

Daydreaming

Sexual Curiosity

Thumb Sucking

Learning or Discipline Difficulties

Eating

Dishonesty

Bed Wetting

Withdrawal

Shiloh United School is committed to promoting the success of each student. Any student exhibiting severe or on-going health or behavior problems may be required to obtain professional aid as a condition of continued enrollment. Continuing difficulties which detract from the learning process for the child or class will result in review of whether to continue the student’s enrollment.

Shiloh United School Enrollment Agreement

For your child’s enrollment at Shiloh United School to be considered, this application must be completed truthfully with each page signed by both parents showing it has been read, understood, and agreed to. Payment of the registration and book fees ensure placement on the class rolls, and students will only be admitted upon payment of the first month’s tuition. All applications are subject to approval by the Principal and/or the School Board. Appeals may be made in writing to the School Board by way of the Principal’s office.

 

It is our desire that our child be considered for enrollment in Shiloh United School for the current or upcoming school year. We agree to be bound by all the terms and conditions expressed throughout this application. In applying for enrollment, we specifically acknowledge and agree to the following:

 

That since this is a Bible-centered school all knowledge will be taught in accordance with the school’s Statement of Faith, and that our child will be taught that Jesus Christ is the only Savior and Lord.

 

That the school is duly licensed and certified to operate by all appropriate regulatory agencies; that staff members are qualified professionals; and that volunteers and associates are competent to perform their duties.

 

That our child will be given opportunity to participate in activities aside from regular classroom instruction (including special classes and off-campus trips), for each of which our specific permission will be required (blanket permission may be given for recurring field trips) and provided reasonable care has been taken, we absolve both Shiloh United School and San Mateo/Foster City Elementary School District – corporately and their staff, volunteers and associates together and individually – from any  and all liability in the event of our child’s injury, illness, or exposure to infection at school or in the course of any regular or special school activity.

 

That in case of emergency the school will make a reasonable effort to contact us or our authorized representatives before proceeding to arrange for medical care; and that the school maintains a supplemental accident insurance policy for students.

 

That only ourselves, our authorized representatives, or certain officials designated by law may at any time remove our child from the school premises; and we will provide written authorization in advance for anyone else to do so.

 

That the school is authorized to employ such discipline as it deems wise and expedient for our child, short of using either physical contact or restraint as punishment; and that we will be contacted if inappropriate behavior persists.

 

That parental support being critical to the school, we are responsible to the best of our ability to participate in volunteer service to the school; to participate in fundraisers, special events and field trips; and to lend our involvement to the school’s parent group.

 

That we and our child will conform to and abide by all school policies including applicable governmental laws and regulations, curriculum guidelines, this application, parent handbook, and any actions taken, published and endorsed by the Principal, or School Board. Copies of all documents are available.

 

That the fees paid do not cover the cost of our child’s education, the remainder being provided by donations and fundraisers which we pledge to support; and that we agree to abide by the financial policies stated in the Financial Agreement included in this application.

 

We declare: That we have read, understood, and in good faith agreed to all the provisions, requirements and obligations of enrollment as set forth in this application; and we have provided all requested information freely, fully and truthfully.

We Agree: That if we have given any false, misleading, or misrepresented information, it will be grounds for rejection of this application without appeal; and if discovered after enrollment, is grounds for our child’s immediate removal from the school and the forfeiture of all monies and fees paid, even if non-refundable.

Shiloh United School Statement of Faith

Parents, students, community leaders and volunteers have come together to form a school that lays a solid foundation for our children so that they excel spiritually, socially, emotionally, and intellectually.

As a united family with Biblical values, we build character, mentor talents, and educate for tomorrow in a culture of honor that allows students to grow in leadership, find their purpose and make a positive impact on their generation.

Shiloh United School sees the value in unity and is a community in which each part builds each other up so each member will thrive. Together we are making positive impact on the future of our children!

What We Believe

  1. God

  • Jesus Christ of Nazareth came in human flesh, was born of a virgin, lived a sinless life

  • He died a brutal death on the cross taking all our sin upon himself and with his death he paid the penalty for our sin, thus providing us a way to be reconciled with God.

  • He physically rose from the dead on the third day, was seen by over 500 people and ascended to the right hand of God the Father in heaven.

  • His physical return to earth is definite and He will judge the living and the dead.

  • Jesus, God the Father, and the Holy Spirit make up the Godhead. They are distinctly three in function and yet they are one in a perfect unity so that we can say “God is one.” Jesus said “I and my Father are one” (John 10:30), and “If you have seen me you have seen the Father” (John 14:9).

  • If you seek God with all your heart, you will definitely find Him.

  1. Bible

    • The Bible is the source of truth and is infallible and inerrant. It is scripture that has been given by inspiration of God, and is profitable for doctrine, for reproof, for correction, for instruction in righteousness that people who have been reconciled to God may be complete, thoroughly equipped for every good work (2 Timothy 3:16-17).

  2. The enemy

    • The enemy, Satan, desired to be worshiped, was cast out of heaven, and deceived Adam and Eve, encouraging them to disobey God.

    • Disobedience to God was the original sin and sin has been part of human nature ever since.

    • The enemy desires to keep people from God, deceiving them throughout their lives, keeping them from the original design God has for them, and captivates people to do his will and further his purposes.

    • The enemy’s purpose is to steal, kill, and destroy.

  3. Humans

    • Knowledge of God, and His Words in the Bible, reveals the holy standard for life we were designed to live.

    • Sin came into the world when Adam and Eve disobeyed God’s word, and we have had a sinful nature ever since. This sin has separated us from the relationship with God we were meant to have.  To be reunited with God we must be reconciled.

    • Reconciliation between God and us occurs when we individually confess that we have sinned, repent for our sin, believe in our heart that the death and resurrection of Jesus Christ is sufficient to pay for sin. At this point reconciliation is complete and sanctification begins. The proof of this reconciliation is our desire to obey God and follow Him.

    • As we embrace the journey of sanctification, we understand that we are perfect in our position as sons and daughters of God. We respond to the love of God by loving Him, obeying Him and seeking to honor and worship Him in every aspect of our life.

5. Unity

  • Unity of the believers begins with our love for God. When we keep Him in focus we have hope for unity.

  • We seek to love others as we love ourselves.

  • We honor what God is doing locally, regionally and globally in our time and seek to play our part in history to continue the growth of the Kingdom of God which is ever expanding.

  • Reconciliation is made complete when we are united to God, united with each other, and our community is reconciled to God and His purposes.

  • We believe the fundamental network for discipleship is complete when home, church, and school work together to provide a united community in which children can grow.

 

Shiloh United School provides a specifically Christian environment for education but is not a “parochial” school in the usual sense. We are an independent school and do not teach the doctrine of any one particular denomination.

 

All staff members are Christians active in their own churches, but there is no religious requirement for our students or their families. We seek to instill in our students an acceptance and respect for all persons regardless of faith. Our teaching conforms to the above enumerated Statement of Faith.

 

Shiloh United School holds that this statement expresses irreducible truths of our faith. Students are encouraged to begin and maintain a relationship with Jesus Christ as their personal Savior and Lord. If you do not wish your child to be so taught, we ask that you confer with the Principal about whether this school would be the best placement opportunity for your child.

Assent of Parents

We understand that all students enrolled in Shiloh United School will receive religious instruction and training in accordance with the above Statement of Faith. We hereby authorize the school to teach our child these truths, and we agree to encourage and support them in our child’s life to the best of our abilities.
 

Shiloh United School Information on Activities and Services

After School Program

After School Program is provided for a fee after class from 12:00pm to 6:00 PM for Kindergardeners and 2:45pm to 6:00pm for older children on school days. On school holidays and vacations, daycare is not available. Usually, after the ten-month school year, a summer program is operated separately.

 

After School Program time is determined by the school clock. On “minimum days” when class is dismissed at Noon, daycare begins at 12:15 PM for all students, and daycare is charged from that time. Students will not be received before 8:00 AM and those picked up after 6:00 PM will incur overtime charges. Please see the Fee Schedule for more details.

                                            

Only persons designated by parents IN WRITING IN ADVANCE may pick up children from school or daycare. All such persons must be legally responsible adults. Parents are responsible for instructing all such persons about school policies for pick-up, such as signing in or out and observing parking lot rules.

Field Trips

Parents are given written notice of upcoming field trips so that students only leave school grounds with parents’ knowledge and permission. A recurring field trip, such as a weekly visit to the library, may be covered by a one-time “blanket” permission. On field trips, students are always under the direct supervision of school staff or parent chaperones. Most field trips require a modest payment (for tickets, food, etc.) for a student to participate. Parents are responsible for arranging alternate care during any field trip their child does not attend.

                                 

By signing below, parents extend for all field trips the school’s authorization for emergency care for their child, as well as parental financial responsibility for emergency medical care. Parent signature agrees to indemnify and hold harmless Shiloh United School (including its officers, board members, staff, associates, and volunteers) for any harm, injury or exposure which their child may receive at school or on field trips provided that reasonable safety precautions have been taken. These provisions include the San Mateo/Foster City Elementary School District which owns the school campus.

Parental Involvement

Parent involvement is critical to the success of our students and our school. Parents are expected to support and reinforce school standards, assignments, and discipline with their children. Parents are encouraged to attend special events and other opportunities for involvement which are publicized throughout the year. Parents are required to attend Back to School Night, Parent-Teacher Conferences twice in the year, All-School performances, and Graduation.

Shiloh United School Fee Schedule

Initial Fees for Full Day Student and Online Students
Registration Fee: $325.00
Book Fee: $250

Tuition Fees Grades 1-8
$12,720 Annual for Grades 1-8
$1,272 Monthly (10 month schedule)

Enrichment Program for Homeschool Families

Registration Fee: $245.00
Tuition Fees Grades 1-8

 

3 Classes per day:

$9,540 Annual
$954 Monthly (10 month schedule)

One Class five days a week:

$3,180 Annual

$318 Monthly

One Class per week:

$640 Annual

$64 Monthly

 

Multi-child discount
Second Child receives a 5% discount
Third Child receives a 10% discount
Fourth Child receives a 15% discount
Fifth Child receives a 20% discount

Tuition Kindergarten (5 yrs) and Pre-K (4 yrs 9 mo)
$9,550 Annual for Kindergarten
$955 Monthly (10 month schedule)


Daily Proration rate is $58/day for all students

 

After School Program

 

AFTER SCHOOL PROGRAM FEE is charged separately from tuition for students departing after 2:45PM. The After School Program fee is $9.50 per hour payable monthly. After School Program fee accrues in fifteen-minute increments at $3.00/ quarter-hour or portion thereof and is billed to parent accounts at the end of each calendar month. After School Program payments are due with tuition for the new month. Sign-in and sign-out times are determined by the school clock.

Other Fees - For other fees see the Financial Agreement sheet.

Shiloh United School works with families who have a hard time making the full tuition payment. This is discussed in the enrollment meeting.

Shiloh United School Financial Agreement

It is our desire to enroll our child in Shiloh United School. We agree to pay the following fees according to the current fee schedule and to abide by all school policies as a condition of our child’s enrollment and continuing attendance. We understand that we will receive at least thirty days’ notice of any change in financial policy affecting this contract.  We understand that tuition rates are according to the currently published Fee Schedule and subject to change with a thirty-day notice.

 

REGISTRATION FEE upon enrollment, and BOOKS and MATERIAL FEE before July 1st or upon enrollment, which fees are non-refundable, ensuring placement upon the class rolls, at the rate published on the current fee schedule.

 

TUITION FEE at the rate published on the current fee schedule. This total is an annual amount payable in ten equal monthly installments, on the first day of the month, beginning in August and ending in May. Students will not be admitted to class if tuition or other fees remain unpaid on the last day of a month. The daily rate for tuition is $50.00 per day for each day after admission or before notified withdrawal date. Withdrawal requires two weeks written notice. Unused prepaid tuition is refundable.

 

AFTER SCHOOL PROGRAM FEE is charged separately from tuition for students departing after 12:00PM for Kindgergardeners and 3:15 PM for 1-12th grades. The daycare fee is $9.50 per hour payable monthly. Daycare accrues in fifteen-minute increments at $3.00/ quarter hour or portion thereof and is billed to parent accounts at the end of each calendar month. Daycare payments are due with tuition for the new month. Sign-in and sign-out times are determined by the school clock.

 

OVERTIME FEE for students picked up from school after 6:00 pm, charged at the rate of $10.00 for each fifteen minutes  (or portion thereof) for the first hour, plus $20.00 for each fifteen minutes (or portion thereof) for the second hour. Sign-in and sign-out times are determined by the school clock. Overtime fees are due with the following month’s tuition.

 

LATE FEE in the amount of $25 for each instance a tuition or daycare payment is received after the 10th day of the month. Due dates are irrespective of weekends, holidays, vacations, or absences. Delinquency of thirty days will result in financial suspension from admission to class until the account is brought current. After three delinquencies, payment will be required by the 10th of ensuing months, with financial suspension beginning on the 11th until the account is cleared. Late fees are due with tuition.

BANK FEE in the amount of $25 for each instance a check is returned. Returned checks must be redeemed by cash, cashier’s check or money order within five days of notification to avoid financial suspension. After a second returned check, remaining payments for the school year will be required in the form of cash, cashier’s check, money order or enrollment in automatic withdrawal (ACH). Bank fees are due with redemption of the returned item.

 

ADJUSTMENTS to Registration, Books and Materials are not made, and these fees must be paid in full. The Finance Committee may consider an adjustment to Late, Bank, or Overtime Fees upon written request.

 

PAYMENTS: Make checks payable to Shiloh United School. Payments are to be made directly to the school office or online BY Credit Card or ACH Automatic withdrawal at give.shilohunited.org.

 

TUITION ASSISTANCE Scholarshare funds, or Commonwealth Scholarship may be granted for all or part of the school year. If granted, the parent’s portion must be paid in full, along with the Late Fee, before the student may attend class.

 

INVOLVEMENT: We recognize that since the fees paid do not fully cover the costs of education, we have an obligation to fully support and participate, as much as possible, in the fundraising efforts, workdays, conferences, and special events.

 

ABSENCES: We understand that there can be no adjustment in fees due to our child’s absence from school for any reason, and that school policy allows for corrective measures to be taken in the event of excessive absences or tardiness. Such measures may include Saturday School or Summer School at the family’s expense.

 

WITHDRAWAL NOTICE of two weeks in writing is required, and all fees continue to accrue at normal rates until the date of withdrawal specified, or until two weeks from the date on which the written notice is delivered to office staff, whichever comes later. All charges to student accounts are to be cleared by the last day of attendance.

Shiloh United School Photo Release

Shiloh United School has my permission to use my or my child’s photograph publicly to promote the school. I understand that the images may be used in print publications, online publications, presentations, websites, social media or in other media for similar purposes. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Shiloh United School – Form Checklist

In addition to this online form, all the following records listed below must be received by the school

Records Needed: 

Acceptance will be determined by:

  • Parents’/guardians’ and student’s understanding of and agreement with the Christian philosophy of the school. (see the accompanying statement)

  • Parents’/guardians’ and student’s agreement with school policies

  • Student’s grades and evaluation

  • Student’s attitude and behavior record

  • Student’s willingness to apply himself/herself to the academic program

Father’s Signature  

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Mother’s Signature 

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Contact Us

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Location

525 42nd Ave

San Mateo CA 94403

©2020 by Shiloh United School.