Kingdom Builders Preparatory Academy Registration Form

- Parents often have clues to their child's behavior and performance, which make school records and recommendations easier to understand.
- What special abilities does your child have, eg, academic, athletic, artistic, musical?
- What special concerns and medical issues would be helpful to us as we plan for your child's education?
- YesNo
- If you answered yes, please give full details including the principal's name and address of the school. Failure to answer this question accurately could result in your child's dismissal from Kingdom Builders Preparatory Academy.
- Is there anything else about your child that you would like us to know?
- Has the applicant been arrested? If Yes, please explain
- Has the applicant ever been seen by a psychologist or psychiatrist? If yes, please explain
- Has the applicant ever been enrolled in E.H, S.L.D class in public or private school?
- Has the applicant ever been diagnosed as being A.DD or A.D.H.D?
- Has the applicant ever recieved any tutoring or therapy? If yes, please explain:
- Please state why you wish for your child to attend Kingdom Builders Preparatory Academy?
- Kingdom Builders Preparatory Academy admits students of any race, color, national, or ethnic origin to al rights, privileges, programs, and activities generally accorded or made available to students at the school. Kingdom Builders Preparatory Academy does not discriminate on a basis of race, color, national or ethnic origin in the administration of its educational or admissions policies, scholarship, athletic or other school administered programs.

Required Documentation
Please attach copies of the following documents required for registration and to be submitted with this application. Your application cannon be processed until all the information is submitted with the non- refundable application fee. A school physical and immunization records wil be required upon acceptance.

1.Most recent achievement test result

2. Copy of Birth Certificate

3. Copy of Social Security Card

4. Copy of most recent report card

5. Notarized medical release form
I hereby give consent to any emergency facility and physician or paramedic to administer necessary treatment to my child in the event of an emergency at which time I am unable to do so. I give consent to transport by ambulance when the situation warrants at the discretion of the school administration. I understand this medical release applies to all school functions, field trips, sporting events as wel as the school itself. Iunderstand as a parent or legal guardian that Iam responsible for all medical charges that might be incurred for any emergency treatment.
Physician and Medical Information
Family Physician Name

First Name
Phone Number

Area CodePhone Number
Preferred Hospital
Insurance/Health Coverage (Company) for child
Policy Number
Date of Birth

MonthDayYear
Date
Medical Conditions
Allergic Reactions
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
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APPLICATION FOR ADMISSION

2025-2026 SCHOOL YEAR

Student Information

Special Circumstances-Please select any that apply

Would you like to keep your child's grandparents informed of school activities?

Required Documentation

Physician and Medical Information