UNITED CHRISTIAN ACADEMY - Preschool Enrollment Application 2025-26

UNITED CHRISTIAN ACADEMY
225 Crusader Court P.O. Box 486 Stanardsville, VA 22973
Students Full Name
Students Preferred Name
Address

Home Address

Street Address Line 2

CityState / Province

Zip
Students Date of Birth

MonthDayYear
Date
Mothers/Legal Guardian Name
Phone Number
Fathers/Legal Guardian Name
Phone Number
Email addresss for communicating school information
example@example.com
In Case of an Emergency List names and numbers of those individuals that can be contacted in case of an emergency when you cannot be reached
Name
Phone Number
Name
Phone Number
Adults who have Permission to Pick-up your Child from Preschool
Name
Relationship to Student
Name
Relationship to Student
Name
Relationship to Student
Number of days your child will attend Preschool each week (check one)

2 days3 days5 days
Please list any known allergies
Should be Empty: