Canyonville Christian Academy Application Form

CANYONVILLE CHRISTIAN ACADEMY

STUDENT APPLICATION

2953 N. John Young Parkway

Kissimmee, FL 32837
Name of Child:*
Child's Age on September 1, 2024*
Child must be three or four years old by September 1, 2024 to register for the class.
Date of Birth:*

MonthDayYear
Email Address:*
example@example.com
Mother's Cell Phone:*
Father's Cell Phone:*
Parents' information
Mother's name:*
Mother's information*
Father's name:*
Father's information*
Please list other family members/people who live at home with your family
1.
2.
3.
4.
5.
Medical Facts and History
Communicable Diseases

MumpsMeaslesGerman measlesChicken measlesOther
Allergies:*
Medications:*
List any ongoing chronic medications that might impact the child's well-being while at the preschool
Medical Conditions*
Please list any existing medical conditions that may impact the child's health and well-being in the preschool
Limitations to Physical Activity*
Please list any existing medical conditions that may restrict the child's physical activity in the preschool
Special Equipment*
Please list any orthodontic devices/prosthesis, glasses etc.
Allergies*
Please list any allergies or reactions to any food, animals, pediatric asthma etc. Its very important to mention nut allergies
Special Diets*
Any special diet/supplement that are medically prescribed should be included
Behavioral/Mental Health*
Please mention any behavioral conditions or mental health diagnoses eg. Autism, ADHD etc.
Any Additional Special Needs/Accommodations/Concerns*
Please mention any other special needs your child may have that is important for us to know. All information will remain confidential.
AUTHORIZATION & RELEASE FOR EPIPENS AND INHALERS
Please check if applicable:

Epipen (Check if your child may need an Epipen administered during school hours)Inhaler (Check if your child may need an inhaler administered during school hours)
Directions for use
Please indicate dosage, frequency etc of Epipen
I, parent's name, parent/legal guardian of child's name request that the administration of the above noted medication be provided. I understand that the service will be provided by a person with no medical or nursing training. All training will be parent's responsibility. I agree to provide Little Barn Academy with an updated medical statement if there is any change in the physicians instructions with respect to medication. I hereby release Little Barn Academy, its employees and contractors from all manner of actions, causes of actions, lawsuits, damage or injuries, however caused, arising out of the administration or failure to administer medication as provided herein.Signature Date
Statement of Christian Beliefs
CANYONVILLE CHRISTIAN ACADEMY is a Christian school. For more information about the fundamentals of our faith, please visit this link:

OUR BELIEFS

In order to move forward with the application and interview process, by signing below, you agree to support our teaching of Biblical Truths.
I hereby give my permission to the staff of Little Barn Academy to photograph my child. I understand that these photographs may be posted in the academy or on Little Barn Academy's website or social media where they may be viewed by individuals other than preschool participants. I acknowledge further that parents of other preschool learners might take pictures of their own children that might include my child.
Signature

Clear
Date:

MonthDayYear
AS PARENT/GUARDIAN OF APPLICANT, I DO HEREBY GRANT PERMISSION FOR MY CHILD TO PARTICIPATE IN ALL SCHOOL ACTIVITIES, INCLUDING USE OF ALL PLAY EQUIPMENT WHICH FORM PART OF THE DAILY ROUTINE.
I hereby grant permission for my child to use all of the play equipment and participate in all of the activities of the school.
Canyonville Christian Academy endeavors to adhere to the highest standard of care while looking after your child. However, Canyonville Christian Academy cannot be held liable for any injury or loss of any nature suffered, which occurred due to events beyond its reasonable control. Canyonville Christian cannot be held liable for the actions of third parties not associated with Canyonville Christian or natural disasters.
Signature of Parent/Guardian

Clear
OUTINGS
INTERVIEW
Upon completion of this application, an interview with the director will be scheduled and conducted by appointment only.

Both parents and their preschool child must attend the interview.
2024-2025 SCHOOL YEAR RATES
Application Fee: $25

Registration: $175 (Non-Refundable)

THREE-Year-Olds Tuition: $265 per week

FOUR-Year-Olds Tuition: $250 per week

Late Tuition Payment: $25

Late Child Pick-up (after 5:30pm): $1/minute
BASIC RULES & REGULATIONS

Additional information will be found in our Parent Handbook.
• Upon acceptance, a non-refundable and non-transferable registration fee of $175 is due. The receipt of the registration fee confirms your decision to enroll your child and ensures his/her place in the Academy. The school tuition fees are paid monthly in advance.
• Tuition is due whether your child attends or not, in order to maintain your child's place in the Academy.
• All tuition fees will be paid through "ProCare", available as a phone app or online website.
• Tuition will be billed on the 20th of the month and due by the 30th for the upcoming month.
• Tuition payments that are not received by the 30th of the month will incur a $25 late fee and/or may result in disenrollment.
• One calendar month’s notice is required should your child leave the Academy.
• A late fee of $1/minute will be charged for late child pick-up.
• The school operates Monday to Friday from 7:30am to 5:30pm.
• Holiday/teacher workday closures will be noted in the parent handbook.
• Parents will provide their child's daily lunch.
• AM & PM snack will be provided.
• All children must wear the school uniform shirt and recommended bottoms.
By signing below:

I, the Parent/Guardian, hereby understand how the payment plan works and commit to adhere to the agreement of payment as stipulated above.

I hereby confirm that I have read and understood the rules and regulations of the school and will adhere to these rules at all times.

I agree to a family interview with the Academy director to discuss my child's application.

Parent/Guardian responsible for school fees:
Print Parent/Guardian Name
Signature

Clear
Date:

MonthDayYear
Print Legal Parent/Guardian Name
Witness
Total amount payable for the year = R15050

School fees only
Should be Empty:

Parents' information

Medical Facts and History

AUTHORIZATION & RELEASE FOR EPIPENS AND INHALERS

Statement of Christian Beliefs

OUTINGS

INTERVIEW

2024-2025 SCHOOL YEAR RATES

BASIC RULES & REGULATIONS

Total amount payable for the year = R15050