Welcome to our online registration for current students!

Directions for registering your child for Headwaters Christian Academy.

1. Read all the documentenation in the links below. You will be required to confirm that you have read and will comply with the information in the Parent-Child Handbook using the link below.

Headwaters Parent-Child Handbook
Headwaters 2023-2024 Calendar (DRAFT) – to be finalized by 3/1/2023 (we mostly follow ISS calendar)

2. Fill out all required information in the registration form below. Your registration will not submit if all required fields are not completed. You will see a confirmation screen if your registration submitted successfully. Please include any and all information in detail. These forms are the first step towards ensuring that your child’s records are accurate,

3. Pay Yearly Registration Fee. Registration fees can be dropped by or mailed to our office at 2659 S Chipley Ford Rd, Statesville, NC 28625. Please make checks are payable to South River Baptist Church with Headwaters Registration Fee in the memo field. If you would prefer to pay via checking account, debit or credit card you can use this link > https://onrealm.org/headwaters/give/regfee

4. Pay Yearly Resource Fee. Resource fees can be dropped by or mailed to our office (address above). Please make checks are payable to South River Baptist Church with Headwaters Resource Fee in the memo field. If you would prefer to pay via checking account, debit or credit card you can use this link > https://onrealm.org/headwaters/give/resourcefee

If you have any questions, please contact Kim williams at 704-876-1520 ext 112 or kim@southriverbaptist.com. We look forward to enriching your child’s education this coming year!

STUDENT INFORMATION:
Child's Name*
First Middle Last Goes By
Birth Date*
Month
Day
Year
Gender:*
Gender at Birth
- Male
- Female
Applying for Grade:*
Note: Pre-K must be at least 4 by 8/31/23 and K must be at least 5 by 8/31/23.
Applying for After School Care Program?*
After School Care hours are from the end of Headwaters school day, 2:30pm, until 6p Mon-Fri. It will be an additional $200 per month for each child enrolled regardless of how many days they attend.
- Yes
- No
Home Address:*
Street Address City State ZIP Code
EMERGENCY CONTACT INFORMATION:
1st Emergency Contact Name*
First Last
1st Emergency Contact Relationship*
1st Emergency Contact Phone*
2nd Emergeny Contact Name*
First Last
2nd Emergency Contact Relationship*
2nd Emergency Contact Phone*
FAMILY INFORMATION:
Father or Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Mobile Phone*
Email*
Enter Email Confirm Email
Occupation:*
Employer:*
Name of church where you are a member:*
Attending Regularly?*
- Yes
- No
Church City/State*
City State
Mother or Guardian Name*
First Last
Address:*
Street Address City State ZIP Code
Mobile Phone*
Email*
Enter Email Confirm Email
Occupation:*
Employer:*
Name of church where you are a member:*
Attending Regularly?*
- Yes
- No
Church Address*
City State
Parent's Marital Status:*
Child resides with:*
Number of children living in the home:*
Are there any custodial issues?*
Agreement with Fees and Policies
Links to documents and handbooks where applicable, are included at the top of this form.
We agree to pay the Registration Fee of $125 per child.*
Fee due with submission of this form (see details at the top of this form for payment options.) Registration is not complete until fee is submitted. ----------------- This registration fee includes one Headwaters T-shirt and one end of year test. Testing is only for children grade 1st and up.
- Yes
We agree to pay a one time, per child Resource Fee upon registration approval.*
Pre-K $250 per child, K-5th $400 per child, 6th-9th $500 per child. Resource Fee is due upon registration approval to confirm enrollment in Headwaters Christian Academy.
- Yes
We agree to commit to paying Headwaters fees in the following manner:*
See tuition and fee schedule for cost details
- I prefer to pay a lump sum payment by April 1st at 2022-2023 rates
- I prefer to pay monthly installments starting August 1st
We understand that images of our child may be captured and used through video, photo and digital camera, to be used solely for the purposes of promotional material and publications, and we waive any rights of compensation or ownership thereto.*
- Yes
Upon enrollment approval and we will submit the required additional Medical and Liability form as well as additonal forms as required.*
Form must be submitted prior to attending 1st day of school
- Yes
Upon enrollment approval we will submit the required immunization documentation required by the State of North Carolina.*
Updated immunization records are required before attending the first day of of school.
- Yes
We have received and read Parent-Child Handbook V4.0. We understand and will abide by the terms and policies as presented in the document.*
- Yes
We confirm that all the information submitted in this form is accurate and truthful*
- Yes
Date*
MM slash DD slash YYYY
Signature of Father or Guardian*
Signature of Mother or Guardian*

Register Current Students

Welcome to our online registration for current students!

Directions for registering your child for Headwaters Christian Academy.

1. Read all the documentenation in the links below. You will be required to confirm that you have read and will comply with the information in the Parent-Child Handbook using the link below.

Headwaters Parent-Child Handbook

Headwaters 2023-2024 Calendar (DRAFT) – to be finalized by 3/1/2023 (we mostly follow ISS calendar)

If you have any questions, please contact Kim williams at 704-876-1520 ext 112 or kim@southriverbaptist.com. We look forward to enriching your child’s education this coming year!

STUDENT INFORMATION:

EMERGENCY CONTACT INFORMATION:

FAMILY INFORMATION:

Agreement with Fees and Policies