Preschool Student Application

Preschool Student Application
Student's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
MM-DD-YYYY
Members of Awaken Las Vegas and those with siblings currently enrolled in Awaken Christian Academy will receive enrollment priority.
Do you currently have a student enrolled at ACA?*

YesNo
Please list names and grades*
Do you actively attend and support Awaken Las Vegas or another church? Please specify if another:*

Awaken Las VegasAnother church
Please Specify*
PROGRAM INFORMATION AND TUITION RATES:
Application Fee: $50.00 (assessed at enrollment)

Registration Fee: $225.00 (assessed annually)

3-year-old program: students must be 3 years and potty trained at time of enrollment.

4-year-old program: students must be 4 years old and potty trained by September 30, 2023.

School Hours: 7:30am 5:00pm
Full Day Curriculum:8:00am 3:00pm
Half Day Curriculum:8:00am 11:30am
Select a Program*

Full DayHalf Day
Full Day Options*

5 Full Days $8,000 annual tuition ($800 monthly payment) M-F3 Full Days $5,150 annual tuition ($515 monthly payment) M-W-F2 Full Days $3,550 annual tuition ($355 monthly payment) T-Th
Half Day Options*

5 Half Days $5,400 annual tuition ($540 monthly payment) M-F3 Half Days $3,350 annual tuition ($335 monthly payment) M-W-F2 Half Days $2,400 annual tuition ($245 monthly payment) T-Th
The annual registration and one-time application fees are non-refundable. For your convenience, the yearly tuition is divided into 10 monthly payments (Aug-May). Please note there are no refunds or tuition reductions for absences, holidays, winter break, spring break, or any temporary reductions in days or hours of attendance. I understand that acceptance and/or enrollment in the Preschool program does not constitute acceptance into Awaken Christian Academy.
Father's/Guardian's Signature*

Clear
Date*

MonthDayYear
Date
Mother's/Guardian's Signature*

Clear
Date*

MonthDayYear
Date
STUDENT INFORMATION:
Gender*
Age*
Parents are:*

MarriedDivorced
Joint Custody?*

YesNo
Which parent has primary physical custody?*
Please note: A copy of the Custody Agreement is required upon acceptance.
FATHER/Guardian Information:
Father's Name*

First NameLast Name
Address*

Street Address

CityState

Zip Code
Father's Email*
example@example.com
Home Phone
Please enter a valid phone number.
Father's Cell Phone*
Work Phone
Employer
Occupation
Mother/Guardian Information:
Mother's Name*

First NameLast Name
Address*

Street Address

CityState

Zip Code
Mother's Email*
example@example.com
Home Phone
Mother's Cell Phone*
Work Phone
Employer
Occupation
NON-DISCRIMINATORY POLICY
CCCPS and ACA admits students of any race, color, national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. The school does not discriminate on the basis of race, color, national or ethnic origin in administration of its education policies, admissions policies, scholarship and loan programs, athletic and other school-administered programs.
The two factors most influencing us to apply to Awaken Christian Academy Preschool:*

LocationReputationChristian PhilosophyDispleasure of Local SchoolsRecommendations from Awaken Families
Describe your expectations in regard to your child's education.*
Has your child attended school before?*

YesNo
School Name*
Address*

Street Address

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Has your child ever been suspended from any school or asked to leave?*

YesNo
If yes, please explain:*
I/We hereby authorize ACAPS to obtain all information and files from all previous schools as needed.*

YesNo
Has the applicant received special help for a learning difficulty or been tested for such?*

YesNo
Please provide documentation:*

pdf, doc, docx, jpg, png
Cancelof
Has the applicant been diagnosed with ADD, ADHD, or a learning disability?*

YesNo
Please provide documentation:*

pdf, doc, docx, jpg, png
Cancelof
Is the applicant presently taking any medication?*

YesNo
If yes, please explain*
Medical Information and Emergency Medical Contacts
Primary Physician Name*
Primary Physician's Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Medical Insurance Company*
Primary Insurance's Phone*
Policy #*
Name of Preferred Hospital*
Preferred Hospital's Phone*
Known Allergies
Special Medical Conditions
Describe any illness, diseases, or physical disabilities that have affected or may affect your child's general health, or participation in the school's programs. Are there currently any behavioral, psychological, or educational evaluations, treatments, or interventions?*
Describe your child. Include your parental perspective on your child, your child's strengths and abilities, special areas of interest as well as areas of concern, and his/her relationship with God. We appreciate your assistance in helping us to know your child better.*
Parent/Guardian agrees the provider may consult with the child's nurse or attending physician in regards to child's health as needed. In the event that we should have questions regarding the health of the enrolling/enrolled child, we may contact your primary physician, preferred hospital, or a local health entity for information.
In an emergency, I give my authorization to my child's health provider and any local physician, dentist or hospital to provide medical care and/or transport my child at my expense.*

First NameLast Name
Signature*

Clear
Pick-Up Information
Name of Pickup Contact 1*
Relationship to Pickup Contact 1*
Phone Number for Pickup Contact 1*
Please enter a valid phone number.
Name of Pickup Contact 2
Relationship to Pickup Contact 2*
Phone Number for Pickup Contact 2*
Please enter a valid phone number.
Name of Pickup Contact 3
Relationship to Pickup Contact 3*
Phone Number for Pickup Contact 3*
Please enter a valid phone number.
Emergency contacts, other than parents
Emergency Contact 1*
Phone
Cell*
Emergency Contact 2*
Phone
Cell*
Media Consent: I grant permission to Calvary Chapel Christian Preschool/Awaken Christian Academy and its staff to photograph and videotape me/my child(ren) and to copyright, use and/or publish the photographs/videos and audiotapes in any school publications and public relations material, including the website.

I agree to abide by the standards set forth in the student handbook and those decisions made by the administration of Calvary Chapel Christian Preschool.

I have answered the above questions in truth and to the best of my ability. I hereby certify that the facts contained in this enrollment application are true and complete to the best of my knowledge.

A$50.00 fee is due upon submission of this application. Enrollment fees are due upon acceptance. I understand that ALL FEES ARE NON-REFUNDABLE.
Father's/Guardian's Signature*

Clear
Date*

MonthDayYear
Date
Mother's/Guardian's Signature*

Clear
Date*

MonthDayYear
Date
Permission To Release Information

I understand that during the time my child is in the facility, the director may be asked for information regarding my child.
Select One*

I hereby give permission to release information to official persons only, who identify themselves, such as health care personnel, welfare, or other governmental officials.I do not give permission to release information about my child as set forth in the aforementioned. I understand that the State of Nevada Child Care Licensing Unit has access to my child's record as the licensing agent and may view the record upon facility inspection.
Signature of Parent/ Guardian*

Clear
Date*

MonthDayYear
Date
I am aware that I have the right to request and view any complaints the facility has received for the month my child(ren) enrolled in and the previous 12 months.*

YesNo
Signature of Parent/ Guardian*

Clear
Date*

MonthDayYear
Date
As part of Calvary Chapel Christian Preschool’s Pest Management Program, pesticides are occasionally applied to prevent, repel, or kill pests that could be hazardous to the health of your child. You have the right to be informed 48 hours prior to any pesticide application made to the school grounds and/or buildings. In certain instances, pesticides may be applied without prior notice, but you will be provided notice following any such application. If you need prior notification, please complete the information below.

If you have questions regarding this notification you may reach the school office at 702-248-8879.
Please Check One:

I wish to be notified prior to a scheduled pesticide treatment inside the building.I wish to be notified prior to a scheduled pesticide treatment outside the building.Both of the Above.I do not need to be notified.
Parent/Guardian Signature

Clear
The following must accompany this application:
- $50 non-refundable application fee
- Copy of Birth Certificate
- Current Immunization Records
The following is required at the time of enrollment:
- $225 Registration Fee
- Health Statement signed by a physician
- Pesticide Notification
- Parent Handbook Acknowledgement
- Consent to Treat
- Copy of most current Custody Agreement, if applicable
Applications and fees are only held for the school year being applied for. Applications and fees must be resubmitted for each school year. Consideration for acceptance for the fall school year begins each February. Applications that do not have the above-mentioned documents attached will be considered incomplete and will not be processed.

**Submission of an application does not constitute approval of admission**
Calvary Chapel Christian PreSchool's Statement of Faith

We believe there is one living and true GOD, eternally existing in three persons: the Father, the Son, and the Holy Spirit, equal in power and glory; that this triune God created all, upholds all, and governs all.
We believe that the Scriptures of the Old and New Testaments are the Word of God, fully inspired without error in the original manuscripts, and the infallible rule of faith and practice.
We believe in God the Father, an infinite, personal Spirit perfect in holiness, wisdom, power and love; that He concerns Himself mercifully in the affairs of men; that He hears and answers prayer; and that He saves from sin and death all who come to Him through Jesus Christ.
We believe in Jesus Christ, God's only begotten Son, conceived by the Holy Spirit.
We believe in His virgin birth, sinless life, miracles and teachings; His substitutionary atoning death, bodily resurrection, ascension into heaven, perpetual intercession for His people and personal, visible return to earth.
We believe in the Holy Spirit, who came forth from the Father and Son to convict the world of sin, righteousness, and judgment, and to regenerate, sanctify and empower for ministry all who believe in Christ; we believe the Holy Spirit indwells every believer in Jesus Christ and that HE is an abiding Helper, Teacher, and Guide. We believe in the present ministry of the Holy Spirit and in the exercise of all the biblical gifts of the Spirit.
We believe that all people are sinners by nature and choice and, therefore, are under condemnation; that God regenerates by the Holy Spirit, those who repent of their sins and confess Jesus Christ as Lord; that Jesus Christ baptizes the seeking believer with the Holy Spirit in power for service, often subsequent to regeneration.
We believe that the Lord Jesus Christ committed two ordinances to the Church: 1) Baptism, and 2) The Lord's Supper. We believe in Baptism by immersion and Communion open to all believers.
We believe also in the laying on of hands for the baptism of the Holy Spirit, for ordination of pastors, elders, and deacons, and for receiving gifts of the Spirit.
We believe in the personal, visible return of Christ to earth and the establishment of His Kingdom, in the resurrection of the body, the final judgment.
We believe that God wonderfully and immutably creates each person as male or female. These two distinct, complementary genders together reflect the image and nature of God. Rejection of one's biological sex is a rejection of the image of God within that person.
We believe that the term "marriage" has only one meaning: the uniting of one man and one woman in a single, exclusive union, as delineated in Scripture.
We believe that God intends sexual intimacy to occur only between a man and a woman who are married to each other.

I/We have read and understand the above Statement of Faith.
Father (Guardian)*
Date*

MonthDayYear
Date
Mother (Guardian)*
Date*

MonthDayYear
Date
As the Parent(s) or Guardian of the student applicant named above, I/We state that we are aware of the Doctrinal Statement, Statement of Faith, and Philosophy of Awaken Christian Academy Preschool and agree that upon acceptance of the herein-named student, I/We will pledge ourselves to work with ACAPS staff, administration and faculty within these statements to the betterment of our student, and to assist and cooperate with the school in the Christian education of my/our child. I understand that the enclosed Application Fee is non- refundable. I further understand and acknowledge that continued enrollment of my/our child, if admitted to ACAPS, shall be subject to the payment of all fees and charges set forth on the schedule of fees as periodically amended by ACAPS and my/our child's compliance with ACAPS's code of conduct and policies periodically established by ACAPS.
Father (Guardian)*
Date*

MonthDayYear
Date
Mother (Guardian)*
Date*

MonthDayYear
Date
Should be Empty:

Preschool Student Application

PROGRAM INFORMATION AND TUITION RATES:

STUDENT INFORMATION:

FATHER/Guardian Information:

Mother/Guardian Information:

NON-DISCRIMINATORY POLICY

Medical Information and Emergency Medical Contacts

Pick-Up Information

Emergency contacts, other than parents