Intramural Sports Application Thanks for taking the time to fill out an Intramural Sports Application. Step 1 of 5 20% Student InformationStudent Name* First Last Expected Incoming Grade Level*Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeGender*MaleFemaleDOB* MM slash DD slash YYYY Student's Mobile Phone Number*Student's Mobile Carrier (for intramural-wide texts)* Example: AT&T, T-Mobile, etc.. Student's Email Address* Address InformationCurrent Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student Lives With (check all that apply)* Select All Father Mother Stepmother Stepfather Other Other Family Members (check all that apply)* Select All Father is deceased Mother is deceased Parents are divorced Parents are separated None of the above Parent/Guardian InformationMain Contact Email* Enter Email Confirm Email Father's Name* First Last Father's Mobile Phone Number*Father's Mobile Carrier (for intramural-wide texts)* Example: AT&T, T-Mobile, etc.. Father's Email* Photo of Father*Accepted file types: jpg, jpeg, png, Max. file size: 256 MB.Mother's Name* First Last Mother's Mobile Phone Number*Mother's Mobile Carrier (for intramural-wide texts)* Example: AT&T, T-Mobile, etc.. Mother's Email* Photo of Mother*Accepted file types: jpg, jpeg, png, Max. file size: 256 MB. How did you hear about Wellmont's intramural sports program?*FriendRelativeWebsite SearchPinellas Parent Educators AssociationFacebookInstagram Emergency ContactsEmergency Contact*Person other than parent/legal guardian who is to be contacted in case of emergency. This person must be local and from a separate household. First Last Relationship* Phone*Medical InformationPlease list any medical concerns or psychiatric care we should be aware of. If none, please type "N/A".* Wellmont Academy InformationDesired Intramural Entrance Date* MM slash DD slash YYYY Has student previously attended Wellmont Academy?*yesnoDo other siblings attend Wellmont Academy at this time? If so, please list their names and grades.*If none, type N/A.Notices of Values and RightsRegistration Fee and Payment Agreement*Upon completion of this application, a $25 registration fee will be collected for my annual participation in the intramural sports program at Wellmont Academy. I understand that this registration fee is non-refundable. I also understand that payment for my child's participation in the Wellmont Academy Intramural Sports program will be completed through the FACTS payment system only. I understand that I will be charged an annual fee of $50 to use the FACTS payment service, and this fee is also non-refundable. I understand that all tuition payments are to be made monthly through FACTS, on a 10 month cycle, August through May, according to the months of my child's attendance in the program, or paid in full at the start of my participation in the program, and that failure to make payments through FACTS will result in withdrawal from the program without refund if a 60 day period elapses without a payment. Do you understand and agree to these terms and conditions?I understand and agree to the above terms and conditions.I do not agreeFamily Values Statement*We understand and we agree.We do NOT agree.In a society of shifting values, Wellmont Academy chooses to use the biblical standard for evaluating and defining the family. We recognize marriage as a covenant between one man and one woman, and we believe that the responsibility for helping children to see their God-given identity, as defined by the Bible, rests primarily with the family. Our school is a support network for these values, not the primary influence of Christian character for your child. Your child WILL be taught to recognize and abide by Christian values at Wellmont Academy. At home, it is also essential that your child be taught and that you model Christian principals and God-given identity for them in order for them to be successful at Wellmont Academy. Do you agree to abide by this standard of Christian behavior and to hold up this standard at home?Identity Statement*We understand and we agree.We do not understand.We do NOT agree.Within the local Christian church, Wellmont recognizes that different interpretations of the Bible's stance on identity exist. Wellmont Academy abides by the Nashville Statement. When encountering questions regarding identity, identity choice, identity attitudes, and individual behavior, the Nashville Statement's interpretation of the Bible is what we use to determine what the Bible says and what we expect of our faculty and staff, our families, and our students. Do you agree to support the Nashville Statement interpretation of the Bible's stance on identity, marriage, family, and behavior? The Nashville Statement can be found in it's entirety at https://cbmw.org/wp-content/uploads/2017/08/Nashville-Statement-with-Scripture-Ref-1.pdfAgreement to abide by the rules of Wellmont Academy*As parents and prospective students, we agree to abide by the rules of Wellmont Academy. We understand that at any time, for any reason, Wellmont may choose to terminate our student's enrollment, making all payments and fees non-refundable if they see fit. We understand and agree.We do not understand.We do NOT agree.Notice of RightsWellmont Academy of Tampa Bay, Inc. admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of it's educational policies, admissions policies, scholarship and load programs and athletic and other school-administered programs. Application Fee* Price: Credit Card*Card Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.