EXCEL CHRISTIAN ACADEMY Student Application Form

EXCEL CHRISTIAN ACADEMY Student Application Form

Please fill out your details to apply for admission.
Student Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Parent Email Address*
example@example.com
Parent best contact number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Previous School or Educational Background*
Why are you interested in this school?*
What grade are you interested in*
What year are you interested in*
Please list any special awards or recognitions your child has received*
Does your child play sports*
List sports*
Does your child have special talents or like to perform (music, drama/theater, art)*
List items*
Has your child been evaluated for special services such as speech/language, OT/PT or other special needs services?*
Does your child have an IEP*
Has the applicant ever attended a school or program designed for students with specific academic or other needs? (Such as a program for the gifted, special learning, ESE, etc.)*
Was the student allowed to re-enroll in the previous school?*
Does the student have any food allergies or other medical or drug-related concerns?*
Current allergies and or medications*
If registering mid-year, could the student continue at the currently enrolled school at the time of withdrawal?*
Has the student ever been homeschooled?*
If yes, what grades?*
Has the student had any discipline or emotional problems, or been suspended, expelled, or withdrawn from school?*
If yes, please provide details.*
Please list the names of family members who attend or have attended Excel Christian Academy. Indicate graduation date with an asterisk (*)
- Parent/Guardian 1*
- Parent/Guardian 1 Address*
  
  Street Address
  
  Street Address Line 2
  CityState / ProvincePostal / Zip Code
- Parent/Guardian 1 phone #*
  Please enter a valid phone number.Format: (000) 000-0000.
- Parent/Guardian Occupation *
- Parent/Guardian 2 Name*
- Parent/Guardian 2 Address (if different than Parent 1 address)*
  
  Street Address
  
  Street Address Line 2
  CityState / ProvincePostal / Zip Code
- Parent/Guardian 2 phone #*
  Please enter a valid phone number.Format: (000) 000-0000.
- Parent/Guardian 2 Occupation*
- Who is the responsible party for tuition payments?*
- Child resides with whom?*
- Legal custody*
- Parent Signature*
  
  Clear
- Parent/Guardian *
- Date*
  
  MonthDayYear
  Date

Payment

Please complete payment before submitting your application. Please click on the payment link to make payment before submitting your application. https://square.link/u/UG7NOnnQ
I confirm I made the payment via the link below - The NON REFUNDABLE application fee is $100.00 *
https://square.link/u/UG7NOnnQ
Payment Confirmation
Release of Records
I release all records found in my child's file to Excel Christian Academy and Preschool. Please email records to enrollment@excelonline.org.
Signature*

Clear
Date*

MonthDayYear
Date
Current School Name*
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Fax*
School Person of Contact*
Please upload your child's birth certificate, current immunization and annual physcial.*

Cancelof
I understand that in order for my student file to move to the enrollment committee for consideration, I must have completed the application, paid the application fee, submitted school records (entirety), disclosed accurate information, and my student should have a shadow day. Shadow days can be waived if the child is out of town.
Should be Empty:

EXCEL CHRISTIAN ACADEMY Student Application Form

Payment

Release of Records