Dream Christian Academy 4K/Pre-Kindergarten New Student Enrollment Application

Dream Christian Academy

2025 - 2026 School Year 4K Program Admissions
NEW STUDENT ENROLLMENT FORM

4K/Pre-Kindergarten New Student Registration Form
Registration Number (Office Only)Registration Received On (Office Only)
Student Information
Name

First NameLast Name
Date of Birth: Gender (Mark with an x.) [ ]Male [ ]Female
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous School (if any):
Parent/Guardian Information
Primary Guardian Name

First NameLast Name
MotherFatherOther
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Home Address (if different from student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Guardian Name

First NameLast Name
MotherFatherOther
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.
Medical Information
YesNo
If yes, please list:
YesNo
Please specify:
Primary Physician Name
Primary Physician Phone Number
Please enter a valid phone number.
Health Insurance Provider
Policy Number
Consent & Agreement
I certify that the above information is correct to the best of my knowledge.
Birth CertificateImmunization RecordsProof of AddressOther
I give permission for my child to receive emergency medical treatment if necessary.
I understand that submitting this form does not guarantee admission or enrollment; the school will review applications and notify parents accordingly.
Today's Date
Parent/Guardian Signature

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School Director Signature

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Should be Empty:

Dream Christian Academy

NEW STUDENT ENROLLMENT FORM

Student Information

Parent/Guardian Information

Emergency Contact Information

Medical Information

Consent & Agreement