SGBA Application 2026-2027

SUMMER GROVE BAPTIST ACADEMY
Child's Name
Date Registered

MonthDayYear
Date
What class are you enrolling in?
What program are you are enrolling in?
Will your child be staying for Lunch Bunch (extended hours) on Tuesday, Wednesday, and Thursday from 12-2?
Are you enrolling in SGBA'S El Espanol Program?
Please select one:
Address

Street Address

CityState / Province

Postal / Zip Code
Child's Date of Birth

MonthDayYear
Date
Age on September 30th
(3 and 4 year olds MUST be potty trained)
Signature of person completing application
Father's Name
Occupation
Employer
Work Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Best method of contacting parent
Email
example@example.com
Does this child live with this parent?
If no, is this parent allowed to pick child up from school?
Mother's Name
Occupation
Employer
Work Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Email
example@example.com
Best method of contacting parent:
Does this child live with this parent?
If no, is this parent allowed to pick child up from school?
Are you a member of a local church?
Is there a court ordered custody agreement? If yes, please attach copy of agreement for our files.
Upload Custody Agreement (if applicable)

Cancelof
Please list other children in your family who have attended SGBA:
Name
Name
Name
Please list individuals who have permission to pick your child up from SGBA:
1.
Phone
Format: (000) 000-0000.
Relationship to child
2.
Phone
Format: (000) 000-0000.
Relationship to child
3.
Phone
Format: (000) 000-0000.
Relationship to child
*Please make these persons aware that they must show an ID before child may leave. We will keep a copy of ID on file after the first pick-up.
Medical Information
Physician's Name
Phone #
Format: (000) 000-0000.
Food Allergies
Seasonal Allergies
Physical Limitations
Hearing/Vision/Speech Difficulties
Any other special need/condition we should be aware of
Date

MonthDayYear
Date
Emergency Contact if parents cannot be reached:
Name
Phone
Format: (000) 000-0000.
Relationship to child
Name
Phone
Format: (000) 000-0000.
Relationship to child
You must submit a copy of up to date immunization records before your child can attend SGBA.

I understand the staff at Summer Grove Baptist Academy will exercise all reasonable care in supervising my child. However, the staff and Summer Grove Baptist Church cannot be held responsible for accidents which may occur. In the event that my child should need emergency medical care/treatment, and I nor my emergency contacts can be reached, I give permission that 911 may be called and medical services rendered. I understand that I will be financially responsible for any medical care given. I also authorize my child to be transported by car or emergency vehicle if need be.
Signature
SUMMER GROVE BAPTIST ACADEMY
Should be Empty:

SUMMER GROVE BAPTIST ACADEMY

Medical Information

SUMMER GROVE BAPTIST ACADEMY