26-27 Prince George's Christian Academy Homeschool RETURNING FAMILY Enrollment Application v.1

HOMESCHOOL EMERGENCY FORM

SY: 2026-2027
INSTRUCTIONS TO PARENTS/GUARDIANS:
(1) Complete all items on this form. Sign and date where indicated. Please mark “N/A” if an item is not applicable.
(2) If your child has a medical condition which might require emergency medical care, complete Page 2 of this form. If necessary, have your child’s health practitioner review that information.

NOTE: THIS ENTIRE FORM MUST BE UPDATED ANNUALLY.

1 PARENT/GUARDIAN'S INFORMATION
Parent/Guardian #1:*

First NameLast Name
Relationship:*
PARENT/GUARDIAN'S INFORMATION #1:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
Cell Phone Number:*
Please enter a valid phone number.
Work Phone Number:*
Please enter a valid phone number.
Employer:

2 PARENT/GUARDIAN'S INFORMATION
Parent/Guardian #2:

First NameLast Name
Relationship:
PARENT/GUARDIAN'S INFORMATION #2:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:
example@example.com
Cell Phone Number:
Please enter a valid phone number.
Work Phone Number:
Please enter a valid phone number.
Employer:

DAILY PICK-UP AUTHORIZATION
Name of Person Authorized to Pick up Student(s) (daily):*

First NameLast Name
Relationship to Student(s):*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number:*
Please enter a valid phone number.

EMERGENCY CONTACT LIST
When parents/guardians cannot be reached, list at least one person who may be contacted to pick up the child in an emergency:
Name:*

First NameLast Name
Name -BAD:*

First NameLast Name
Relationship:*
Cell Phone Number*
Please enter a valid phone number.
Work Phone Number*
Please enter a valid phone number.
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

EMERGENCY CONTACT #2
Name:

First NameLast Name
Relationship:
Cell Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

EMERGENCY CONTACT #3
Name:

First NameLast Name
Relationship:
Cell Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

HEALTH CARE
Child’s Physician or Source of Health Care:*
Phone Number:*
Please enter a valid phone number.
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Insurance Provider:*
Subscriber:*

First NameLast Name
Group #:*
Policy #:*
In EMERGENCIES requiring immediate medical attention, your child will be taken to the NEAREST HOSPITAL EMERGENCY ROOM. Your signature authorizes the responsible person at the child care facility/school to have your child transported to that hospital.
Signature of Parent/Guardian:*

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Date:*

MonthDayYear
Date

MEDICAL
Medical Condition

pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif
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Do any of your children have medical conditions/concerns the Homeschool should be aware of?*

Yes and I have added details belowNo
Additional details about medical conditions/concerns (what do we need to know about your student?):
Signature of Parent/Guardian:*

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Date:*

MonthDayYear
Date

Are you a returning family (enrolled during the past school year) ?*

YesNo

You have selected “No” in response to the question “Are you a returning family (enrolled during the past school year) ?”.

Your response indicates you are in the incorrect form. Please click to visit the link (CLICK HERE) to access the correct form for NEW FAMILIES and contact info@pgcahomeschool.org if you have any questions or concerns. Thank you.

Academic Records
Please list PREVIOUS institutions your student attended and include the name of the school, address, & contact information under the records request section of the form below if you have not already done so in a previous year.

Records Request Authorization
Have you previously submitted these records?

Yes, I have previously submitted these records.No, I have not previously submitted these records and will do so using the "Additional Documents Upload" and fields below.
Additional Documents Upload
Permission is hereby granted to:
List the name(s) of the PREVIOUS schools, their address, & contact information if you have not previously done so.
to release the following records, including but not limited to:

•Past grades
•Grades in progress at the time of leaving
•Health records
•Results of achievement and intelligence tests
•Behavior /personality ratings and other similar data
•Any materials related to student growth
•Any IEPs and 504s
•Any psychological testing or child study including the most recent:
- Educational Evaluation
- Psychological Assessment
- Social worker history
  
  Written or digital information should be sent to the attention of:
Prince George's Christian Academy Homeschool

3600 Brightseat Road

Landover, MD 20785

info@pgcahomeschool.org

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Authorization to release student’s records:

I have enrolled my student(s):
- Student Name: {name567}
  - DOB: {dateOf568}
- Student Name:{name214}
  - DOB: {dateOf215}
- Student Name:{name235}
  - DOB: {dateOf236}
- Student Name:{name256}
  - DOB: {dateOf257}
- Student Name:{name296}
  - DOB: {dateOf297}
in Prince George's Christian Academy Homeschool and authorize you to release the above-named information so that we may plan a program for the above-mentioned student(s).
Parent/Guardian's Full Legal Name*

First NameMiddle NameLast Name
Signature*

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Date*

MonthDayYear
Date

Student Code of Conduct & Dress Code
Please download and read a copy of our Doctrinal Statement, review & submit the Code of Conduct & Dress Code below and fill out the acknowledgement.
Have you download & the read the Doctrinal Statement?

Yes, I have download & the read the Doctrinal Statement.

PART I: Prince George's Christian Academy Homeschool - Code of Conduct
Code of Conduct

SY: 2026-2027
This Code of Conduct is created for the purpose of maintaining good conduct and instilling the values and culture in contributing and maintaining a positive environment in the school and the community.

Please read the Code to know and understand Prince George's Christian Academy's values for behavior and the dress code.

GOAL: TO CONDUCT MYSELF AS IT CONCERNS SPEECH AND BEHAVIOR IN A MANNER THAT IS CHRIST-LIKE AND GLORIFIES GOD.

DOWNLOAD THE DRESS CODE & CODE OF CONDUCT

SIGN AND SUBMIT THE DRESS CODE & CODE OF CONDUCT FORM
Have you read and acknowledged the section above?*

Yes, I have downloaded, read, acknowledged and submitted the form for the section above.

PART II: Prince George's Christian Academy Homeschool - DRESS CODE
Dress Code

SY: 2026-2027
*Student Dress Code Requirement:
TOPS – Prince George’s Christian Academy official LOGO. Short-sleeve t-shirts, longsleeve t-shirts, and hoodies.

Color: Elementary School - Burgundy| Middle & High School - Navy Blue

BOTTOMS – Sweatpants, slacks, or skirts.Color:Black or navy blue

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→ Distressed/ripped jeans are not appropriate for school.
→ Shorts should not be above the knee.
→ Tight fitting clothes are not appropriate ÿor school.
→ Inappropriate clothing or words on clothing should not be worn.
→ Do-rags or bonnets are not worn.
→ Pajama pants or tops are not worn.
→ Slippers (e.g. house shoes, UGGS, etc.) are not worn.
→ Baggy clothing or clothes that fall off the body are not appropriate for school.
→ Hats are not worn in the building.
→ Virtual students should abide by the dress code and be in an appropriate learning space at the time of their online classes. Cameras should be ON at all times.

Clear Backpack Policy
All middle and high school students are required to use clear backpacks during
group classes. Please note that all backpacks and bags, regardless of type, are subject to search upon entering the building or while on school premises if circumstances warrant it.

* Dress code violations will incur a $10 fine
Have you read and acknowledged the section above?*

Yes, I have read and acknowledged the section above.

PART III: Acknowledgement:
Acknowledgement: I/We, {parentguardian1} and {parentguardianNames57}, have discussed and explained to my/our child/ren, {name567}, {name214}, {name235}, {name256},{name296}the above guidelines in Part I & Part II and agree with these standards of expectations for behavior and attire. We will conduct ourselves appropriately and will encourage our child to conduct themselves appropriately.
Parent/Guardian's Full Legal Name*

First NameMiddle NameLast Name
Signature*

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Date*

MonthDayYear
Date

Activities Participation & Photo Release Consent Form
I, the undersigned, state I am the parent/guardian of minor student(s) listed below. I hereby request and give my consent for my child/ren to participate in the Prince George's Christian Academy HomeschoolProgram during the 2024-2025 academic year.

I hereby authorize and give my consent for my child/dren to be transported to off-site related activities (field trips, events, etc.) in transportation provided by Prince George's Christian Academy Homeschool.

Student Name: {name567}
DOB: {dateOf568}
Student Name:{name214}
DOB: {dateOf215}
Student Name:{name235}
DOB: {dateOf236}
Student Name:{name256}
DOB: {dateOf257}
Student Name:{name296}
DOB: {dateOf297}
Consent for Emergency Medical Treatment

In the event of an emergency, I hereby authorize the administration and staff of Prince George's Christian Academy Homeschool Program to take whatever steps deemed necessary to obtain emergency medical care for my child/ren.

This authorization includes:

1. Consent to transport by emergency medical vehicle to the nearest emergency medical facility.

2. Consent to any emergency medical treatment deemed necessary in the event of an emergency.

3. Consent for surgery and anesthesia in the event of life-threatening situations, as the attending physicians may deem necessary.

4. Consent for physicians, nurses, technicians, and other qualified medical personnel to administer medical and surgical treatment in emergency situations

The release of SHABACH! Ministries, Inc., its successors, assigns, representatives, employees, and agents from any financial liability incurred due to emergency treatment.

I hereby state that my child/ren is participating in the Prince George's Christian Academy Homeschool Activities Program with my full consent and permission and at my request.

Liability Waiver

I hereby release SHABACH! Ministries, Inc., its successors, assigns, representatives, employees, and agents of any and all liability of whatsoever nature, character, or origin arising out of or resulting from my child’s participation in the SHABACH! Christian Academy Program and its related activities, including events, athletics, field trips, and transportation in school assigned vehicles.

I hereby release SHABACH! Ministries, Inc., its successors, assigns, representatives, employees, and agents from insurance protection for injury incurred.

Forms:

Allergy Action Plan - Fillable

Asthma Medication Administration Form - Fillable

Medication Administration Authorization Form - Fillable
Please list any allergies and/or medications your child/ren may be on.
Allergy Action Plan File Upload

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Asthma Medication Administration Form File Upload

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Medication Administration Authorization Form File Upload

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Activities Participation & Photo Release Consent:
Dear Parent/Guardians:

During the school year, we take photographs of school activities involving students to share the school's positive vibe and updates. By which incidentally, some photographs may capture your child's participation, directly or indirectly. These photos may be published through our website, social media pages, news bulletins, billboards, ads, etc.

With this section, we seek your consent in allowing us to publish photos which may involve your child to the said platforms.

Please do provide your response by selecting your choice below and signing this form.
Select the box below.*

I grant permission to use my child/children's photograph/video described above.I do not grant permission to use my child/children's photograph/video described above.
Form Signature:*

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Date *

MonthDayYear
Date

Final Acknowledgement
Notice of Non-Discriminatory Policy:

Prince George's Christian Academy Homeschool does not discriminate on the basis of race, color, national or ethnic origin in the administration of its educational, admission, financial aid, or employment policies, or any other programs administered by the school.

Parent/Guardian Acknowledgement

I/we, the undersigned, pledge that the information given on this application is true and accurate to the best of my/ our knowledge.
I/we are aware we have to submit an application fee for the following amount via the link below (which is non-refundable) for my/our application to be complete. Please click the link below to submit your payment and remember to select "Homeschool" after selecting the amount. In the message section record "Application Fee before June 30th or After June 30th" as applicable.*
- If my/our child is accepted to Prince George's Christian Academy Homeschool (PGCAH), I/we agree to comply with all rules and regulations which the school may deem necessary for the proper operation of the school.
- I/We sincerely pledge my/our loyalty to the aims and ideals of the school and will support the school program in every way possible.
- I/we understand that the school reserves the right to dismiss any child who does not cooperate with the educational process or behavior guidelines, and to dismiss any family that does not honor the Parent/School Code of Conduct.
- I/we understand that the school reserves the right to contact my child(ren)’s former school to acquire past academic, behavioral, and financial history.
- I/we understand that upon admission of my child to PGCAH, I/we will be required to sign a contractual agreement that details my/our financial commitment to PGCAH.
- I/we understand that PGCAH operates under the umbrella of SHABACH! Ministries, Inc.
- If accepted for admission to PGCAH and I/we have an outstanding balance due to past obligations to PGCAH, my/our child will not be permitted to attend school until the debt is satisfied.
- I/we understand that all students are accepted on a nine-week probationary basis.
Prince George’s Christian Academy Homeschool Disclosure

❖ Our K-8 academy is accredited, but the homeschool program does not have an accreditation option. Most students are not negatively impacted by unaccredited courses unless they choose to return to the public school where they may have to take a subject test for every homeschool course they completed.

❖ Athletics students must still fill out this application. Academic documents, such as transcripts, are required if enrolled in the Oversight program.

❖ Application will not be accepted, and orientation meetings will not be scheduled until all documents below are submitted.

•       Immunizations Record

•       Birth Certificates (NEW FAMILIES)

•       Report cards & official transcripts (NEW FAMILIES)

• Current student photos

In instances where we are at full enrollment, applications will be held on our waiting list until a slot becomes available during the school year in which families have applied. If a slot does not become available during the school year, families are given the option of enrolling for the next school year during open enrollment season. If the family has not enrolled by June, their application and fee will be forfeited, and they must reapply.

Please sign below:
Father's Signature

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Date

MonthDayYear
Today
Father's Email (A copy of your enrollment application & checklist will be sent here):
example@example.com
Mother's Signature

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Date

MonthDayYear
Today
Mother's Email (A copy of your enrollment application & checklist will be sent here):
example@example.com
Guardian's Signature

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Date

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Today
Guardian's Email (A copy of your enrollment application & checklist will be sent here):
example@example.com
Should be Empty:

RETURNING Family Enrollment Application | SY: 2026-2027

Enrollment Application

Student #1

Student #2

Student #3

Student #4

Student #5

HOMESCHOOL EMERGENCY FORM

Academic Records

to release the following records, including but not limited to:

Written or digital information should be sent to the attention of:

Authorization to release student’s records:

Student Code of Conduct & Dress Code

Code of Conduct

Dress Code

Activities Participation & Photo Release Consent Form

Final Acknowledgement

Prince George’s Christian Academy Homeschool Disclosure