Sprouts Christian Academy - School Application Form

School Application Form

Please do not submit this unless you have completed a consultation with Mrs. Andrea at Sprouts. If you need to schedule a consultation, please call 901.486.4100
Please provide the DATE of your Consultation

MonthDayYear
Date
Parent/Guardian's Information
Parent/Guardian's Name - Primary*

First NameLast Name
Relationship to Student
Phone Number*
Please enter a valid phone number.
Parent/Guardian's Name - Secondary*

First NameLast Name
Relationship to Student
Phone Number*
Please enter a valid phone number.
Student Information
Student Legal Name*

First NameLast Name
Student's Preferred Name:*
Date of Birth*

MonthDayYear
Date
Age
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My student lives with: *
The following individual(s) has permission to pick up my student (please separate each person by a comma) - we request a photo ID from unfamiliar people*
Current Grade Level Language Arts (Grammar)
Current Grade Level Math
Current Grade Level Reading
Student's Start Date at Sprouts*

MonthDayYear
Date
School Last Attended (if applicable)
School Phone
Please enter a valid phone number.
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the reason the student left the school? (if applicable)
EMERGENCY CONTACTS

In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person 1*

First NameLast Name
Emergency Phone Number 1*
Please enter a valid phone number.
Emergency Contact Person 2*

First NameLast Name
Emergency Phone Number 2*
Please enter a valid phone number.
Emergency Contact Person 3*

First NameLast Name
Emergency Phone Number 3*
Please enter a valid phone number.
Medical

If your child has immunization records, please upload them. If you have received a letter from the child's physician that they may attend school, please provide it here.
Clinic Name*
Pediatrician Name*
Pediatrian Address & Phone*
File Upload

Cancelof
If the student has any allergies (food or medicine), please list them below:
Does the student currently take any medications? If yes, please list them below:
*Please note, the school is not responsible for administering medications
Sprouts Christian Academy does not administer any medication/antibiotics at any time. I agree to make arrangements to do this before/after school or come during the day to give it to my student.*

YesNo
Does the student have any medical conditions that you would like to declare?
In the event that I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to contact my students pediatrician.*

YesNo
I give consent for my student to obtain emergency medical care.*

YesNo
I give consent for my student to be transported for necessary medical treatment if I am unable to be contacted.*

YesNo
I give consent for necessary emergency treatment when my student is in the care of the above listed physician or hospital and I will be responsible for all charges incurred.*

YesNo
Medical Questionnaire Signature

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Approvals

My student has permission to participate in the following activities:
I give my permission for my child to participate in the following Water activities: (mark each that are allowed)*

Sprinklers in the yardSplash PadWater Inflatable (slide)Swim in the pool
Play in a Bounce house?*

YesNo
Is your child able to swim without assistance?*

YesNo
Does your child have any physical, health, behavioral, or other condition that would put them at risk while doing water play?*

YesNo
Do you give the school permission to apply sunscreen to your student?*

YesNo
Do you give the school permission to apply insect repellant to your student?*

YesNo
Do you give the school permission to apply anti-itch cream to your student?*

YesNo
I understand and agree to the following: If I would like sunscreen, insect repellant, or anti-itch cream applied to my student then I must provide it. It must be in the original container with my child's name on it.*

YesNo
I give permission for my child's photo to be taken and used in the following ways: (mark each that you consent)*

To send to meto publish on the schools facebook pageto use on the schools websiteInside the classroomFor craft and projects
Food

Parents are responsible for feeding their child breakfast before school and providing their child's lunch every day. We encourage parents to provide a healthy lunch. Carbonated beverages and candy are not allowed. Unfortunately we do not have the facilities to reheat or refrigerate food, so all foods must be able to be eaten straight from the lunch box. The school is not responsible for the nutritional value of the lunch each child brings to school. If your child has food allergies that other students need to be aware of, then please let us know. The school provides a daily snack and water for all children. Snacks follow licensing guidelines of nutritional needs for children. If your child has a dietary restriction or allergy, please be sure to let us know.
I agree to provide a daily lunch for my child*

YesNo
I agree to let the school know of any food restrictions*

YesNo
Reminders
ASSESSMENT. The school requires new students or a transferee to take an assessment in Language Arts, Math, and Reading so that we may properly purchase curricullum at their current learning level.

CONSULTATION. Before completing this form, please be sure to complete a consultation with Mrs. Andrea at the school.

REQUIREMENTS. It is important to complete all fee's as discussed with Mrs. Andrea before school starts. Failure to do so may delay the student from coming to school.

MEDICAL CLEARANCE. The school requires all students to have a yearly physical exam. For new students, medical clearance from their doctor is required.

BEHAVIOR. Parents and Students must agree and abide by the Student Conduct Rules listed in the School Guidelines Book.
Enrollment Contract

If you have any questions about the financial contract, please refer to the Guidelines or connect with Mrs. Andrea at 901.486.4100. Each of the items below must be agreed upon in order for your student's place to be secure.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature

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School Application Form

Parent/Guardian's Information

Student Information

EMERGENCY CONTACTS

Medical

Approvals

Food

Reminders

Enrollment Contract