Corban Academy Admissions Application Form
Note to parents/guardians: Students who are middle school or high school age need to include a paragraph about their personal relationship with Jesus in this form.
Student Info:
Contact
✕
First Name
Last Name
Email
Phone Number
Date of birth
Month
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Address
Apartment, suite, etc.
City
State
Postal / Zip Code
Gender
Male
Female
I'd prefer not to say
Add another person
Is physical address different than address listed above?
Yes
No
Physical Address
City
Father (or legal guardian) info:
Contact
✕
First Name
Last Name
Email
Phone Number
Address
Apartment, suite, etc.
City
State
Postal / Zip Code
Marital Status
Single
Married
Widowed
Separated
Divorced
I'd prefer not to say
Add another person
Mother (or legal guardian) info:
Contact
✕
First Name
Last Name
Email
Phone Number
Address
Apartment, suite, etc.
City
State
Postal / Zip Code
Marital Status
Single
Married
Widowed
Separated
Divorced
I'd prefer not to say
Add another person
In case of emergency, contact the following people in the following order:
Primary Emergency Contact Name
Primary Emergency Contact Phone
Primary Contact's Relationship to student
Secondary Emergency Contact Name
Secondary Emergency Contact Phone
Secondary Contact's Relationship to student
Tertiary (third) Emergency Contact Name
Tertiary Emergency Contact Phone
Tertiary Contact's Relationship to student
If parent/legal guardian is unavailable, contact (for medical decisions)
Contact's Phone
Student's allergies, medical history, drug reactions, etc. that may be needed for medical treatment**
**Note: If a student needs specific medicine administered during the day, a
Medication
Form
needs to be submitted.
Student's conditions/special needs (explain below)
Family Physician Name
Family Physician Phone Number
Insurance Carrier
Group/Policy Number
*Please note: all students need to submit applicable medical forms upon admission to Corban Academy.
Additional background information:
Does the student have any siblings attending or applying to Corban Academy?
Yes
No
What are the siblings' names?
Is the student transferring from another school?
Yes
No
What school?
Why is the student (applicant) transferring from another school?
Spiritual Information:
Name of church the family belongs to
How often does your family attend church per month?
1-3 times
4-6 times
7-8 times
9+ times
Describe your family's participation in your church
Middle or High School Students: in one page, describe your personal relationship with Jesus.
Copy/paste your answer here:
As a member of Corban Academy I hold to and agree with the foundational truths laid out in Covenant of Faith.
The Scriptures are inspired by God (2 Timothy 3:15-17; 1 Thessalonians 2:13; 2 Peter 1:21)
There is one true God (Exodus 3:14; John 5:58; 1 John 5:7; Matthew 28:19)
The Deity of the Lord Jesus Christ
His virgin birth (Matthew 1:23; Luke 1:31, 35)
His sinless life (Hebrews 7:26-27; 1 Peter 2:22)
His miracles (Acts 2:22, 10:38)
His substitutionary work on the cross (1 Corinthians 15:3; 2 Corinthians 5:21; Romans 3:25; Hebrews 2:17; 1 John 2:2, 4:10)
His bodily resurrection from the dead (Matthew 28:5-6; Luke 24:39; 1 Corinthians 15:4-6)
His exaltation to the right hand of God (Matthew 26:64; Mark 16:19; Acts 2:33-34, 7:55-56)
The Fall of Man (Genesis 1:27, 2:17, 3:6; Romans 5:12-14)
The Salvation of Man
Conditions to Salvation (John 3:3; Romans 5:15-21, 10:8-15; Ephesians 2:8; Titus 3:5-7; Acts 3:19)
Evidences of Salvation (Romans 8:16; Titus 2:12; 2 Corinthians 5:5, 1:20-22; Ephesians 1:13-14, 4:24)
The Baptism of the Holy Spirit (Luke 24:49; Acts 1:4, 1:8; Mark 16:17-20; 1 Corinthians 12:1-14)
Evidence of the Baptism in the Holy Spirit (Mark 16:17; Acts 2:4, 10:44-46, 19:6)
Sanctification (Romans 12:1-2; 1 Thessalonians 5:23; Galatians 2:20; Hebrews 12:14, 13:12; 1 Peter 1:15-16)
The Church, God’s Plan for Everyone (Ephesians 1:22-23, 2:22; Hebrews 12:23)
The Ministry - The Work of the Church (Matthew 28:18-20; Mark 16:15-18; Ephesians 4:11-13)
Divine Healing is our Covenant Promise (Isaiah 53:4-5; Matthew 8:16-17; James 5:14-15)
The Laying on of Hands (Acts 5:12, 19:6; Hebrews 6:1-2)
Resurrection of all People (Romans 8:23; 1 Corinthians 15:51-52; 1 Thessalonians 4:16-17; Titus 2:13)
The Millennial Reign of Christ (Ezekiel 37:21-22; Matthew 24:27-30; Romans 11:26-27; Revelation 1:7, 20:1-6)
Eternal Judgment (Matthew 25:46; Mark 9:43-48; Revelation 19:20, 20:11-15, 21:8)
The New Heavens and the New Earth (2 Peter 3:13; Revelation 21:22-23)
The Reality of Satan (John 5:29, 12:31; Ephesians 2:2-3, 6:12; James 4:7)
The Sanctity of Marriage and the Sanctity of Life (Genesis 1:27, 2:18, 21-24; Matthew 19:4-6; Jeremiah 1:5; Psalm 139:13-16; Galatians 5:19; Ephesians 5:1-4, 21-33; Romans 1:24-28; 1 Corinthians 6:9; Jude 1:7)
Gender Identity (Genesis 1:26-27)
I agree to all 18 Tenets of Faith.
Yes
Photo Release (Adult)
I hereby authorize and consent to the use of images or videos, and their content, of me, with or without my name, by Corban Academy and Kona Faith Center, Inc. of Captain Cook, Hawaii for purposes including but not limited to: promotional materials, printed publications, internet posts, including social media, television, and other media sources. I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release Kona Faith Center, Inc., its officers, directors, employees, and agents from liability for any claims by me or any third party in connection with the use of my image.
Response to Adult Photo Release:
I agree
I decline
Name(s) of adult(s)
Photo Release (Child/Children under 18)
I, the legal parent/guardian of the child/children listed below, hereby authorize and consent to the use of images or videos, and their content, of my child/children listed above, with or without their names, by Corban Academy and Kona Faith Center, Inc. of Captain Cook, Hawaii for purposes including but not limited to: promotional materials, printed publications, internet posts, including social media, television, and other media sources. I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release Kona Faith Center, Inc., its officers, directors, employees, and agents from liability for any claims by me or any third party in connection with the use of the image of my children listed below.
Response to Child Photo Release:
I agree
I decline
Name(s) of child(ren)
Liability Waiver
If student is 18 years or older, he/she may initial for his/herself.
If a student is under 18 years old, each parent/legal guardian initials the form.
1. I (or my parent/legal guardian) sign this waiver voluntarily with the understanding that I (student) cannot participate in being part of the Corban Academy community (to be known as "event") without agreement to the terms and conditions that follow.
2. I shall conform to all applicable policies, rules, regulations, and standards of conduct established by the State/County of Hawaii, and Corban Academy, Kona Faith Center, Inc., Faith Center Property, Inc. (to be known as Non-profit Entity) and will not participate in any illegal activity.
3. I shall accept termination of my participation in this event if I fail to maintain acceptable standards of conduct as established by Nonprofit Entity and the State/County of Hawaii and United States of America.
4. I hereby release, waive, discharge and covenant not to sue (Nonprofit Entity, their directors, officers, employees, volunteers, and agents (hereinafter referred to as “Releasees”) from all liability to me, my personal representatives, assigns, heirs, next of kin or anyone else for any loss or damage in any claim or demands therefore, on account of property damage, personal injury or death, whether caused by the negligence of the Releasees or otherwise, arising out of any activity related to this event, including travel to and from this event.
5. I agree to indemnify, save and hold harmless the Releasees and each of them from any loss, liability, damage or cost that they may incur due to my participation in this event, including travel to and from this event.
6. I hereby assume full responsibility and risk of bodily injury, death or property damage arising out of participation in this event as named above. I understand that there are certain risks that may occur, including but not limited to: exposure to personal injury; accident or illness; forces of nature.
7. I further agree that the foregoing Release, Waiver, Indemnity Agreement, and Assumption of Risk is intended to be as broad and inclusive as possible, yet there may be unforeseen risks and will not hold the Releasees responsible in any manner.
8. I hereby grant permission for the performance of any first aid and/or emergency medical treatment that may be required in the case of an accident wherein I am rendered unconscious or unable to approve of the required medical treatment. In the event that I become the victim of an accident I will hold harmless from any liability or negligent actions which may arise in connection with the search and rescue, stabilization, evacuation, transportation, and emergency care I receive while secondary aid resources are being sought.
9. I hereby agree to permit Nonprofit Entity, agents, employees, volunteers, directors, officers, and other guests to take photographs (still or live) and make film records of this event without further recourse. I understand such photographs and/or film may be used for commercial and/or promotional purposes.
10. I have read and voluntarily signed the Release, Waiver, Indemnity Agreement, and Assumption of Risk.
11. It is understood that Nonprofit Entity is not responsible and will not provide any medical or liability coverage, Workman’s Compensation, Temporary Disability Insurance, Auto Insurance or ANY other liability or other insurance of any kind and Non-profit entity is not responsible to you or any other person or insurance company in the event of illness, accident, injury or death traveling to and from and while at our premises.
12. I hereby acknowledge and state that my participation in this activity is entered into as a free and voluntary act with full and complete knowledge of the risks involved.
13. In addition, in case of accident or need for medical attention, I give permission to the Nonprofit Entity representatives to take named participant to a doctor and/or emergency facility. It is understood that all expenses for treatment provided will be borne by the parent, guardian or the participant with no cost to Corban Academy, Kona Faith Center, Inc., or Faith Center Properties, Inc.
Check the boxes below to note you have read the above sections and agree to their contents. (Checking each box equates to initialing the section.)
Please check all boxes:
Sections 1-4
Section 5
Section 6
Sections 7-8
Sections 9-10
Section 11
Sections 12-13
This event as named above includes activities involving risks or injury. I understand that activities will involve participation in exercises that are, by their nature, physically demanding and will subject the participant to stress, anxiety and possible hazards, not all of which can be foreseen.
Please write down (print) any activities you DO NOT want to participate in relating to this event:
I authorize the following people (besides myself) to pick up my child from campus or events after academic hours:
Pickup person 1
✕
First Name
Last Name
Email
Phone Number
Add another person
Add another person?
Yes
No
Pickup person 2
✕
First Name
Last Name
Email
Phone Number
Add another person
If there are any other persons allowed to pick up your child from campus or events, please list them below with their phone numbers:
I verify the following:
My student (or myself if 18 or older) has the ability and motivation to be successful in a self-directed, self-paced, self-motivated learning environment.
My student (or myself if 18 or older) has the social skills necessary to be successful in a self-directed, self-paced, self-motivated learning environment.
This information in this application is true and accurate, to the best of my knowledge.
Parent/Legal Guardian 1 Signature
Type Parent/Legal Guardian 1 Name
Date 1
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
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Year
1980
1981
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Parent/Legal Guardian 2 Signature
Type Parent/Legal Guardian 2 Name
Date 2
Month
January
February
March
April
May
June
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August
September
October
November
December
Date
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1971
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1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
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1991
1992
1993
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1997
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I am a student 18 years or older.
Yes
No
Student Signature
Date
Month
January
February
March
April
May
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September
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November
December
Date
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1979
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1980
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1982
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1984
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1988
1989
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1991
1992
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1997
1998
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I have paid the $50 non-refundable application fee.
Yes
No
If you have not paid the application fee yet, please pay it as soon as possible so as to move the application process forward.
Notice Of Nondiscriminatory Policy As To Students:
Corban Academy 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 academy. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship programs, and athletic and other academy-administered programs.
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