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*** Enrollment for 2024-2025 IS OPEN ***

Call Support (704) 876-1520 ext 112

Email Support kim@southriverbaptist.com

Location 2659 S Chipley Ford Rd, Statesville NC

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Welcome to our online registration for current students!

Directions for re-enrollment for your child for Headwaters Christian Academy the 2025-2026.

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 v6.0
Headwaters Statement of Beliefs
Headwaters Calendar (DRAFT)

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 below this informaiont if your registration submitted successfully. Please include any and all information in detail. This information will help us update your child’s records.

3. Pay a Non-Refundable Enrollment Fee per child. Fees can be dropped by or mailed to our office (address above). Please make checks are payable to South River Baptist Church with Headwaters 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/enrollmentfee

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 again this coming year!

STUDENT INFORMATION:
Child's Name*
First Middle Last Goes By
Birth Date*
Month
Day
Year
Gender:*
Gender at Birth
- Male
- Female
T-Shirt Size
Applying for Grade:*
Note: Pre-K must be at least 4 by 8/31/25 and K must be at least 5 by 8/31/25.
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 $220 per month (will be prorated for months we are here less than 18 days) or each child or $14 per day as needed.
- Yes, we will need monthly
- Yes, we will need occasional after school care at $14 per day
- No, we will not need after school care
Home Address:*
Street Address City State ZIP Code
EMERGENCY CONTACT INFORMATION:
Parents will be contacted 1st and then Emg Contacts will be next ones we contact for any illness or emergency we have with your child.
1st Emergency Contact Name*
First Last
1st Emergency Contact Relationship*
1st Emergency Contact Phone*
2nd Emergency 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:*
Please select choice child is with more than 50% of the time.
Number of children living in the home:*
Are there any custodial issues?*
Agreement with Belief Statement, Fees and Policies
Links to documents referenced below and payment links are included at the top of this form.
We have read and agree to the Headwaters STATEMENT OF BELIEFS & STATEMENT ON MARRIAGE, GENDER, AND SEXUALITY .*
These statements are available at the top of this form and at this link > https://headwaters-academy.com/beliefs/
- Yes
We agree to pay the non-refundable, yearly, per child Enrollment Fee of $250.*
The $250 Enrollment Fee is due upon registration to confirm enrollment in Headwaters Christian Academy.
- Yes
We agree to commit to paying Headwaters tuition in the following manner:*
Tuition costs are available in the Parent-Child Handbook and on our website.
- We/I prefer to pay a lump sum payment by August 1st.
- We/I prefer to pay 10 monthly installments starting August 1st.
- We/I will be (re)applying for the NC Opportunity Scholarship and will depend on the scholarship funds to cover for tuition costs in full.
- We/I will be (re)applying for the NC Opportunity Scholarship to see if we can offset some of the cost of tuition.
We understand that images of our child may be captured and used through videos and photos, to be used on our website and social media platforms solely for the purposes of promotional material and publications, and we waive any rights of compensation or ownership thereto.*
- Yes
We will submit the required additional Medical and Liability form as well as additonal forms as required.*
All required forms must be submitted prior to attending 1st day of school
- Yes
We will submit the required immunization or exemption documentation required by the State of North Carolina.*
Updated immunization records or exemptions are required before attending the 1st day of of school.
- Yes
We have read and agree to the terms and policies as presented in the Parent-Child Handbook V6.0.*
- 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*

Wisdom is the principal thing; Therefore get wisdom. And in all your getting, get understanding. Proverbs 4:7