EXCEL Success Academy Student Enrollement Form

Student Admission Information

WELCOME! to the EXCEL Success Academy Admissions Portal. We are so glad that you have chosen us as your school of choice, to secure your child's academic success. ESA is a Christian, values-based school and is a leader in, "Mentorship, Motivation and Innovative Education." Your signature will be required on this form. All additional documents required later on, can be submitted or upload via this online form under the button handle: "Student Personal Data" Welcome to the ESA Family. Thank you. - ESA Admissions Team
- Child's Full Name
  
  First NameLast Name
- Child's Date of Birth
  
  MonthDayYear
  Date
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Region/ Constituency
- Child lives with:
- What is the child's or family Religion?
- Nationality?
- Place of Birth?
- Gender?
- Name of School they currently attend?
- Name of Parent/Guardian Completing Form:
  
  First NameLast Name
- Nationality:
- LOCAL PARENTS/ Guardians must upload the following.
- SPECIAL NOTE: Foreign Nationals
  
  Please be advised that Parents of ALL foreign national students, MUST show LEGAL documents below:
- Type a question
- Relationship to Child:
- Email
  example@example.com
- Phone number where parent/guardian can be reached while child is in care:
  
  Area CodePhone Number
- Address of Parent/Guardian (if same as child's type N/A)
  
  Street Address
  
  Street Address Line 2
  
  CityDistrict/Constituency
- Name of 2nd Parent/Guardian :
  
  First NameLast Name
- Relationship to Child:
- Email
  example@example.com
- Phone number where parent/guardian can be reached while child is in our care:
  
  Area CodePhone Number
- Address of Parent/Guardian (if same as child's type N/A)
  
  Street Address
  
  Street Address Line 2
  
  CityDistrict/Constituency
  
  Zip Code
- Please 'UPLOAD' a copy or picture of the following documents. (Tick to confirm uploads)
- Birth Certificate
  
  Browse Files
  
  Cancelof
- Immunization Card
  
  Browse Files
  
  Cancelof
- Passport Pictures
  
  Browse Files
  
  Cancelof
- Student Recommendation Letter
  
  Browse Files
  
  Cancelof
- Academic Report Card (2018,2019,2021 or SEA Results sheet)
  
  Browse Files
  
  Cancelof
- **PLEASE WALK WITH ALL ORIGINALS FOR VERIFICATION** (for ESA Orientation event)
- Information for the responsible individual to call in case of emergency if parents/guardian cannot be reached:
- Name
  
  First NameLast Name
- Address
- Relationship to Child
- Phone Number
  
  Area CodePhone Number
- I authorize the school to release my child to leave the center ONLY with the following persons. Children will only be released to a parent or guardian or to a person designated by the parent/guardian after verification of ID.
- Name
  
  First NameLast Name
- Relationship to Child
- Phone Number
  
  Area CodePhone Number
- Name
  
  First NameLast Name
- Relationship to Child
- Phone Number
  
  Area CodePhone Number
- Transportation and Field Trips We do not transport children except in the event of an emergency. We take children on field trips or international travel as only as part of our ESA-CCE Global Influencers program
- I give consent for my child to be transported and supervised by the school's employees for emergency care, field trips or travel program:
- I give consent for my child to participate in the following water activities:
- I understand that the following meals are provided by the parent (or The Academy) and served to my child while in care:
- EXCEL Success Academy is a NON-PROFIT educational institution and operates on the generous support in cash or kind of it's contributors, sponsors and volunteerism.
- In the event I cannot be reached ti make arrangements for emergency medical care, I authorize the person in charge to take my child to:
- Name of Physician/Doctor
- Name of Emergency Care Facility
- Address
- Address
- Phone Number
- Phone Number
- I give consent for the facility to secure any and all necessary emergency medical care for my child. Signature of parent or legal guardian:
- List any special needs that your child may have, such as environmental allergies, food allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregivers should be aware of: (If none, type N/A)
- Health Care Professional's Statement- MUST be completed and turned in BEFORE the child's first day of school (Mandatory for students with specific medical conditions or learning disabilities)
- Browse Files
  
  Cancelof
- Does your child have diagnosed food allergies?
- Allergy Plan Submitted on
  
  MonthDayYear
  Date
- My child is up to date on their required vaccinations and will have their immunization record turned into the school BEFORE the first day of school:
- ADDITIONAL SCHOOL SERVICES: These services are not included in your general Tuition fee. These services are optional, co-curricular programs for holistic student development. Please Tick, the desired box and in your Welcome and Orientation Email a invoice with, detail cost will be provided.
- PLEASE NOTE, FOR SERIOUS INQUIRES, PLEASE READ CAREFULLY!!!
  As a non-profit primary and secondary school, our mission and goal is to provide quality, equitable and affordable education for all students. Our standard fees listed below are for financial stable families. However, we recognize that not everyone is positioned to afford these rates. Therefore we have provided a 'Tuition Scale Means Assessment' which will determine the best flexible and affordable tuition fee according to your financial means.
  
  TUITION:
  
  One-time FEES:
  
  Registration: $250
  
  Refundable Security Deposit: $4,000 (per yr.)
  
  Online school:
  
  Forms 1-3: $4,000 per term
  
  Forms 4-5: $5,000 per term
  
  *****************************************************
  The Tuition Scale Means Assessment (seen below), will give you an idea on what your term fees may look like hypothetically, if upon submission and approval: our Finances & Sponsorship Committee, offers families a special DISCOUNTED TUITION RATE. These fees are subject to change, on an annual review basis.
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- School policies can be found in the ESA Parent Handbook available on our website and at our office. Please review our ESA operational policies.
- Receipt of ESA Operational Policies- I acknowledge receipt of the facility's operational policies, including those for:
- EXCEL Success Academy reserves the right to place children in any classroom and to refuse the requests of acceptance of students, per annum or that are not in the best interests of the child's development or of this Academy.
  
  I understand that after-school programs and registration fee are non-refundable. Tuition is due by the 30th of each month. A 30 day notice must be given to the Director/ Principal if your child is to withdraw temporaily or permanantly from The Academy. Parents are responsible for tuition regardless of absences.
  
  I acknowledge that a staff member has provided me with a copy of the Parent Document and discussed the contents with me.
  
  I agree to abide by the rules, policies, standards, and procedures including payment of all tuition and fees owed.
  
  I understand that the following documents, as applicable, MUST be on file with the school before my child's first day.
  
  I acknowledge that failure to turn in all required documents and payments for Admissions, could result in my child's inability to attend The Academy.
  
  - Completed admission form (this form)
  
  - 1 Passport Size Photo of Student
  
  - Most current copy of the child's immunization records (primary school)
  
  - Signed copy of the health-care professional's statement or exemption
  
  - Signed copy of my child's Food Allergy Emergency Plan (if needed) Authorization to dispense medication form (if needed)
  
  - Copy of Parents/ Guardians Picture ID
  
  - Copy of Proof of Address
  
  - Job Letter with (contact number of Employer as a reference)
  
  - Full Payment - First Term, Registration Fee & School Fees for first Term.
  
  *************************************************************
  
  NOTE: This Registration Form is a LEGALLY BINDING document and can be used in a legal proceeding where necessary.
  
  Please NOTE the following details below:
  
  - Tuition Fees are NON – REFUNDABLE.
  
  - Security Deposits are REFUNDABLE ONLY in the graduating Year of either primary or secondary school students respectively.
  
  - Due Date for tuition fees are to be made on or before the 30th of every month.
  
  - A LATE FEE of 1/3 of the tuition fee is to be paid in FULL within seven days.
  
  - Failure to pay will result in your child getting barred from attending classes until Full payment of Tuition and Late Fee is paid.
  
  - If payment is not made within/ or on the seventh day, the school CAN & WILL legally pursue the parent or legal guardian for the Tuition payment.
- Signature of Parent or Legal Guardian:
- As the Child's Parent or Legal Guardian I FULLY Agree with the terms above.
- Date
  
  MonthDayYear
  Date
- Signature of Center Director:
- Date
  
  MonthDayYear
  Date
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Student Admission Information

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