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
Relationship to Student

Other
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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
Relationship to Student

Other
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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.Format: (000) 000-0000.
Medical Information
Does the student have any allergies?
If yes, please list:
Does the student have any medical conditions we should be aware of?
Please specify:
Primary Physician Name
Primary Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Health Insurance Provider
Policy Number
Consent & Agreement
Please add a checkmark to confirm your agreement:
Documents submitted (if not submitted with the enrollment form, you will have 30 days from the date of submission to submit them).

Other
Please add a checkmark to confirm your agreement.
Today's Date
Parent/Guardian Signature
School Director Signature
Should be Empty:

Dream Christian Academy

NEW STUDENT ENROLLMENT FORM

Student Information

Parent/Guardian Information

Emergency Contact Information

Medical Information

Consent & Agreement