Re-Enrollent Application - Oakdale Christian Academy

Student Details

Student Name *

Student Date of Birth *

Student SSN *

Re-Enrollment is for: *

Enrolling Parent / Guardian Contact Details

Parent/Guardian 1

Parent/Guardian Name *

SSN *

Relationship to the student: * (1 required)

Father Step-Father Mother Step-Mother Other

Phone Number *

Email *

Home Address *

Address 1
Address 2

City

State

Zip

Occupation

Parent/Guardian 2 (IF APPLICABLE)

Parent/Guardian Name

SSN

Relationship to the student

Father Step-Father Mother Step-Mother Other

Phone Number

Email

Address

Address 1
Address 2

City

State

Zip

Occupation

Emergency Contact

Name *

Phone Number *

Relationship to Student *

Is there any change in family structure, guardianship, etc that we should be aware of? (If yes, please explain.) *

Statement of Financial Responsibility

Name of person financially responsible for student *

SSN of person above *

Oakdale's tuition for 2025-26 is $29,652. This includes tuition, room, board and most fees. Will you be applying for financial aid? * (1 required)

Yes No

If you answered yes to the previous question, what is the maximum amount you can afford each month? *

Virtual Signature *

Health History

to be completed by parent/guardian on an annual basis

Are there any notable changes in your child's health? * (1 required)

Yes No

If yes please explain, If no answer N/A *

Please list any significant family medical history: *

Does the student have any known allergies, including allergies to foods or medicines? * (1 required)

Yes No

If yes, please list. If no, answer N/A *

Please check any of the following that the student has currently, or has had in the past. If none apply, please check 'none of these'.

Please explain any conditions checked above. If the student has any condition not listed above please describe here: *

List (including dates) any hospitalizations, serious injuries, surgeries, etc. pertaining to a physical condition or injury. *

Has your child ever been hospitalized or received treatment for a mental health or substance abuse issue? * (1 required)

Yes No

If yes, please explain the situation, including dates of treatment, clinical diagnoses, and any past and ongoing treatment.

If you answered yes above, please list the name of a therapist/ doctor that works with your child.

Phone number for therapist/ doctor named above.

Does your child have any physical restrictions in regard to physical activity/ physical education classes? * (1 required)

Yes No

If yes, please explain.

Please list the name of your child's primary care physician. *

Physician's office phone number: *

Date of last physical checkup:

Please list the name of your child's dentist.

Dentist's office phone number:

Date of last dental visit:

Does your child have any ongoing dental/orthodontic needs (ie braces, etc)? If so, please list.

Permission to Administer Medication

This form must be completed on an annual basis.

I hereby request that personnel from Oakdale Christian Academy to give the above medication to (student name) *

Student Date of Birth *

For school personnel to administer any prescription or over-the-counter medication on a routine basis, WE MUST HAVE THIS FORM COMPLETED AND SIGNED BY THE STUDENT 'S PARENT/ GUARDIAN OR PHYSICIAN. ONLY MEDICATIONS IN THE ORIGINAL CONTAINER WITH CLEAR INSTRUCTIONS WILL BE ADMINISTERED TO STUDENTS. All medication will be kept locked with school personnel unless a doctor authorizes them to carry a medication at all times.

Does your child routinely take any prescription or over the counter medication? (If yes, you will be asked to list them in the next section.) * (1 required)

Yes No

Please list all current medications, dosage required, time of day, purpose, and duration. *

Please list any potential side effects or reactions that your child may have to these medications. *

Does the student need to carry any of these medications on their person at all times?

Yes No

If YES, please list doctor's name *

If YES, please list doctor's phone number. *

I understand that: * (3 required)

Ongoing medications must be monitored by the student's own primary care physician. A new PERMISSION TO ADMINISTER MEDICATION form must be submitted with any change in medication. It is the parents responsibility to keep track of when the prescriptions are in need to be refilled

Type your name *

Current Date *

Current Time *

I give permission for Oakdale staff to administer over the counter medication at their discretion - to address occasional symptoms such as headaches, cough, congestion, sore throat, upset stomach, etc * (1 required)

Yes No

Type your name *

Permission for Medical Treatment

Student's Name *

Student's Date of Birth *

Student's SSN

Parent/ Guardian responsible for medical treatment decisions: *

Parent's Date of Birth *

Parent's SSN *

Parent's Address

Address 1
Address 2

City

State

Zip

Parent's Phone Number *

Emergency Contact (not parent/guardian) *

Contact's Phone Number *

Does the student have health insurance? *

Name of Insurance Company *

Insurance Company Phone Number *

Policy Number *

Group Number *

Name of Insured *

Is prior approval required for treatment? *

Is there a certain doctor or clinic in Jackson, KY that accepts your insurance? If so, please list: *

Please attach a scan of applicant's insurance card (front and back): *

(allowed file types: asx, avi, doc, docx, dot, dotx, gif, heic, htm, html, ico, jpeg, jpg, json, m3u, m4a, m4v, mov, mp3, mp4, mpeg, mpg, ods, pdf, png, potx, pps, ppsx, ppt, pptx, rm, rtf, svg, txt, webmanifest, webp, wma, wmv, xls, xlsx, xltx, xml, zip)

Consent to Medical Treatment

I, the parent/guardian of the applicant give my consent for OCA staff to secure medical services, in case of illness or injury. I agree to assume all financial responsibility for such services: *

I consent for x-ray, anesthetic, medical or surgical diagnosis and/or treatment, and hospital care for my child under the supervision and on the advice of a licensed medical professional. *

I consent for anesthetic, dental or surgical diagnosis and/ or treatment, and hospital care to be rendered to my child by a licensed dentist. *

I give consent for the exchange of pertinent medical/dental/surgical information between OCA and medical personnel involved in the treatment of my child, and for Oakdale to obtain copies. *

It is understood that consent is given in advance of any specific diagnosis or treatment. It is given to encourage OCA and the attending physician or dentist to exercise their best judgment. *

I authorize Oakdale Christian Academy power of consent in all matters related to keeping immunizations up to date, including signing for any required immunizations. *

I understand that this consent shall remain in effect as long as my child is a student at Oakdale Christian Academy. *

Parent/ Guardian Consent and Agreement

Please carefully review each section.

Student's Name *

INTERNET USE: I understand that the use of the internet may be required for some class assignments and give my consent for the student I am enrolling to use the internet as an academic resource. Beyond its role as an academic resource, the internet is utilized as an earned privilege for communication with family and friends. Please indicate your consent for the enrolling student by checking the appropriate box below:*

INTERNET USE * (1 required)

I grant permission for the student I am enrolling to use the internet for non-academic purposes I DO NOT grant permission for the student to use the internet for non-academic purposes

PUBLICITY: I understand that the funding for Oakdale Christian Academy and financial aid is made available because of the generosity of supporters who consider the mission of Oakdale to be important, and I give my consent for Oakdale to use photography and video of school activities that include the student I am enrolling in promotional material. The student may also participate in speaking and providing public statements or letters of thanks as part of Oakdale Christian Academy's public relations.

PUBLICITY: (Please Write Full Name) *

RECREATION/ TRIPS/ TRANSPORTATION: I agree that extracurricular activities are a vital part of a well-rounded boarding school program. I give my consent for my child to participate in sports and recreational activities sponsored by Oakdale Christian Academy and absolve the school from any liability should injury occur. I understand that some of the outdoor recreational activities may include hiking, canoeing, camping, rock climbing, rappelling and caving. I understand that safety precautions will be taken and that such activities will be supervised by staff with experience in these activities. I give my permission for my student to participate in off campus overnight activities as arranged and supervised by Oakdale Christian Academy. *

RECREATION/TRIPS/TRANSPORTATION: (Please Write Full Name) *

BEHAVIOR POLICIES: I have read and understood the parent- -student handbook. I will support the policies of the school as expressed in the handbook and will encourage my child to live up to the behavioral expectations of the school. *

BEHAVIOR POLICIES: (Please Write Full Name) *

PERSONAL ELECTRONICS POLICY: I recognize that the use of electronic equipment (cell phones, laptop computers, digital cameras, translators, digital music devices, etc) in violation of the electronic equipment policy, as stated in the student handbook, will result in the permanent loss of the equipment. In sending any electronic equipment with the enrolling student, I acknowledge that I am trusting their judgment in the use of these items, and understand that misuse may result in confiscation and permanent loss.

PERSONAL ELECTRONICS POLICY: (Please Write Full Name) *

Parent/Guardian Name *

Other Parent/Guardian Name (If Applicable)

Enter Your Email Address: *