Section 1 - Student Information (to be completed by the student)

Legal Name:

Student Email Address:

Student Photo: Please send a picture along with your application to info@fountainview.ca. Your application will not be reviewed until we receive your photo.

Address:

City:

Prov/State:

Country:

Postal Code:

Birth Date: Jan Feb Mar Feb Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Birthplace:

Grade Entering: 9 10 11 12    

Gender: Male Female

Citizenship:

Social Insurance #: - -

BC Medical Services Plan #:  OR I need BC Medical insurance No Yes

Note: Fountainview Academy requires that all students carry medical insurance. Medical insurance is available under the Medical Services Plan of British Columbia.  Full coverage can be purchased for as low as $60.50 per month. Please contact our office for further information.

Religious Affiliation:

Church:

Baptized No Yes

Student Acknowledgement

By checking this box , I acknowledge that I have answered the above questions as accurately as possible, I have read and understand the student handbook, and if I am accepted as a student, I pledge to uphold the educational principles and practices of Fountainview Academy as outlined in the student handbook.

Now that you have completed the student information section of this application, please complete Section 3 located at the end of the page. Your parents or guardians should complete Section 2

Section 2 - Parents/Guardians (to be completed by the parents)

Primary Parent/Guardian

Name:

Relationship:

Street Address:

City:

Prov/State:

Country:

Postal Code:

Tel:

Cell:

Email Address:

Mail grades to this address.                 Mail financial statements to this address.

Secondary Parent/Guardian

Name:  

Relationship:

Street Address:

City:

Prov/State:

Country:

Postal Code:

Tel:

Cell:

Email Address:

Mail grades to this address.                 Mail financial statements to this address.

Medical Information

When was your child last immunized for:

Tetanus/Diphtheria: Polio:

In British Columbia, students in 9^th grade are offered Tetanus/Diphtheria booster immunizations.  Immunization is voluntary, therefore, it is important to discuss the issue of immunization with your healthcare practitioner before signing this consent and especially if your child:

• has any serious illness;
• is receiving corticosteriods or other immunosuppressive drugs;
• has a history of a shock-like allergic reaction (anaphylaxis) to a previous dose of diphtheria-tetanus; or
• has an allergy to thimerosal.

Do you want your child’s immunizations updated? No Yes

If yes, please read the following consent.

I have read or had explained to me the information on the vaccines listed below and I believe I understand their benefits, risks, contraindications, and side effects. I have had the opportunity to ask questions which were answered to my satisfaction. I request that the student named herein be immunized when requested against:

(Checking these boxes signifies your consent)

DIPHTHERIA      TETANUS

Has your child had any major illnesses, surgeries or chronic diseases that we should be aware of in the event of an emergency? No Yes

If yes, please describe below:

Does your child suffer from allergies? No Yes

If yes, please list them including any reactions they may have had.

Family Doctor:

Phone No:

Date of last visit:

Note: Fountainview Academy is located 25 kilometers from the nearest medical facility. Students with minor illnesses are examined by the campus nurse or dean but will not normally be taken for treatment unless the illness persists, becomes serious, or we are directed to do so by the parent. If you have any special concerns in this regard please advise the Director of Student Life.

Activities Approval

As part of Fountainview Academy’s balanced program of education, recreation, and spirituality, we offer unique programs in physical education, leadership, and outreach as part of our standard curriculum. These programs form an integral part of our educational philosophy and require frequent travel, outdoor pursuits, and fitness training. At times these trips may necessitate travel to provinces outside of British Columbia and into the United States. Please indicate below your consent/non-consent for your child to participate in our programs.

Yes I grant my son/daughter/ward permission to participate in ALL of the activities.

Yes I grant my son/daughter/ward permission to participate ONLY in activities as checked below:

Educational Information

Please list schools or home school programs attended from the 8th grade to the current year:

Note: Please send copies of your child’s grades or grade reports from 8th grade to the present

Is your child enrolled in any correspondence courses? No Yes

If yes, please list schools and subjects:

Does your child have any difficulty learning? No Yes

If yes,  please explain

Does your child desire special help in any subject? No Yes

If yes, which subject(s)?

If your child plays a musical instrument, which kind and for how long?

Financial Information

Note: All fees are in Canadian funds unless otherwise stated and subject to change without notice.
For more information, please visit our financial information page

* Please see our Financial Page for more information.

Do you have an unpaid bill at any other school? No Yes If yes, what amount?

School
Address
Phone:

Parental Acknowledgement

By checking this box , I willingly pledge to support the high ideals and standards of Fountainview Academy.  The information I have provided above with regard to activities correctly represents my wishes for my child/ward. I agree to assume all financial responsibility for the applicant.  

Application Procedure

To complete the application process, please ensure that the following items are sent to Fountainview Academy. To send this application click the submit button below. Your application will not be processed until all items are received.

1. Non-refundable application fee (see financial section of this application);
2. A copy of grades or reports from grade 8 to the present;
3. A copy of the applicant’s birth certificate; and
4. Character references from the following three persons
• your pastor or head elder,
• a principal/teacher who has taught you recently,
• some other person who knows you well (a non-relative),

Please remember that we must have a signed copy of the application form before a student's arrival at the academy.

Note: We have found that references generally delay the application process. Please encourage your references to respond as soon as possible directly to Fountainview Academy, Attention: Admissions. References may submit their forms online at this web site for quicker processing or you can download and print paper forms from our home page. You may consider providing your references with a stamped envelope.

When all items above are received in our office, we will contact you by phone to arrange a telephone interview or a visit. We encourage you to visit our campus if at all possible. Feel free to bring your family — accommodations will be provided free of charge.

Thank you for taking the time to apply. We pray for a special blessing on each applicant as you seek an education that will build character for eternity.

Section 3 - Personal Essay (to be completed by the student)

Please use the text box below to address the following issues in a short essay:

• why you wish to attend Fountainview Academy,
• a description of your Christian experience,
• how your parents feel about your desire to attend Fountainview Academy, and
• any other information that you feel will aid the application process.