KREATIVE SUCCESS ACADEMY

KREATIVE SUCCESS ACADEMY
3000 Dunn Avenue Suite 8Jacksonville, FL(904) 864-0657admin.kre8@succesk.org
Name
Grade
Prior to Testing and Enrollment: The following items must be file before a student may take the admissions test.
Prior to Testing: The following items must be filed before a student may take the admission test. (To be checked by school officials)

Application for Admission(Completed and Signed)Academic Evaluation for Prospective Student(Completed by previous school)Academic Evaluation for Prospective Student(Completed by previous school)$25 Testing Fee
Prior to enrollment: The following items must be be on file before a student may take the admissions test. (To be checked by school officials)

Birth Certificate(Must be state issued)Social Security CardSchool Entry Health Exam FormFL Certification of Immunization FormFinancial AgreementParental Permissions and AgreementsStatement of CommitmentEnrollment Fees
If Applicable:

Is the student a legal resident of the United States? (If child was born outside of the U.S, we MUST have necessary documents on file)Is the student living with guardians(not parent)? (Please provide legal guardianship or adoption papers)
***Do Not Sign Below until Registration is completed by the office**
Parent Signature
Date

MonthDayYear
Date
Administrators Signature
Date

MonthDayYear
Date
KREATIVE SUCCESS ACADEMY
3000 Dunn Avenue Suite 8Jacksonville, FL(904) 864-0657

Application for Admission for Grades K,1,2,3,4, and 5
A. Application Cover Sheet

The application Cover Sheet MUST be becompleted for each student. The complete packet MUST include the following item:
- Application Cover Sheet
- Application for Admission
- Parent/Guardian Recommendation
- Student/ Parent Commitment
- School Records Release
- Exceptional Education Verification
  - If your child has an IEP please submit a copy
The above items are all enclosed in the order listed above and checked off
Do you have another child currently attending Kreative Success If so please list their name and grade
Academic Year and Uniform Policy

I understand that I am applying for the fall school yearI understand that the there is a school uniform policy for Kreative Success. All students will be required to comply with the uniform policy. An official uniform policy will be given to each student upon acceptance.
I am hereby submitting this application for my child to be considered as a student in Kreative Success Academy. I understand that submission of a completed application for admission does not guarantee acceptance into Kreative Success. Your Student will be required to submit a discipline record and letter of reccomendation. There are tuition costs Acceptance letters and waiting list letters will be mailed.
Parent Name
Students Name Printed
Grade Fall
Parents Signature
Date Submitted

MonthDayYear
Date
KREATIVE SUCCESS ACADEMY
Application for Admission for Grades K,1,2,3,4,and 5

B. Application for Admission School Year

Please read the instructions carefully while completing the application

1. Please read and complete ALL sections of the application. Incomplete applications will not be processed.

2. Please make sure that you have signed your application.
Name

First NameLast Name
MI
Home Address
City
State
Zip
Student Place of Birth
Student DOB:
Last 4:
State
Country
Languages spoken at home
Student Lives With
Direct all correspondence to the attention of:

Address

Street Address Line 2

CityState

Zip
KREATIVE SUCCESS ACADEMY
Application for Admission for Grades K,1,2,3,4, and 5

2. Parent/Guardian Information

Male Parent or Guardian Name
Name

First NameLast Name
MI
Phone
Home Address
City
State
Zip
Place of Employment
Address of Employment
Email
example@example.com
Fax
Female Parent or Guardian Name
Name

First NameLast Name
MI
Home Address
Phone:
City
State
Zip
Place of Employment
Address of Employment
Email
example@example.com
Fax
KREATIVE SUCCESS ACADEMY
Application for Admission for Grades K,1,2,3,4,and 5
IMPORTANT: The following information about your child will help us in the event of an emergency of any serious condition(s) your child has:Dietary Needs/Concerns ExplainAllergies (Check all that apply)

Asthma/ Breathing ProblemsHeart ConditionSeizuresDiabetesDietary Needs/ Concerns
Explain
Allergies

FoodPlantMedicationsAnimalsOther
Explain:
Does your child need special assistance or accommodations due to a health problem?

yesno
Explain
Does your child wear glasses or contact lens?

yesno
Does your child wear a hearing aid?

yesno
Is your child required to take prescription medication during the day?

yesno
If yes, please list the names of the medication(s)
Frequency of medication
NOTE: If your child is required to take medication during the school day a prescription authorization form signed by parent or guardian should be kept on file with the site administrator.
KREATIVE SUCCESS ACADEMY
Transportation

I will transport my child to and from school each day
Emergency Contact (Please provide atleast two)
Name
Relationship to Student
Phone:
Cell Phone:
Relationship to Student
Name
Phone:
Doctor Name:
Dentist Name
NOTE If no one can be reached what further instruction do you have for us if your child is sick or hurt
KREATIVE SUCCESS ACADEMY
Application for Admission for Grades K,1,2,3,4,and 5
**ANYTIME INFORMATION CHANGES, PLEASE NOTIFY OUR OFFICE IN WRITING**

6. Education History
Student currently attends
Current School Year
Students Current Grade Level
Please List all other schools this child has attended with the most recent school first:
School
Grade
Reason for leaving
School
Grade
Has your child been retained?

yesno
I have enclosed a copy of my child's most recent report card. I understand that this is a required part of this application.
Initial
Does student have, or in the past, had any special education needs. Example SLD, EH, Speech/Language, or Gifted?

yesno
If yes please explain and attach a copy of their most rececent IEP
Signature 1
Date

MonthDayYear
Date
Signature 2
Date

MonthDayYear
Date
NOTE: Signature 2 only required in case of joint custody.
Please Upload Records Here (Birth Certificate, Social Security, Shot Record, Physical)

Cancelof
Should be Empty:

KREATIVE SUCCESS ACADEMY

KREATIVE SUCCESS ACADEMY

KREATIVE SUCCESS ACADEMY

KREATIVE SUCCESS ACADEMY

KREATIVE SUCCESS ACADEMY

KREATIVE SUCCESS ACADEMY

KREATIVE SUCCESS ACADEMY

**ANYTIME INFORMATION CHANGES, PLEASE NOTIFY OUR OFFICE IN WRITING**

ANYTIME INFORMATION CHANGES, PLEASE NOTIFY OUR OFFICE IN WRITING