2026-27 Preschool Application

UNITED CHRISTIAN ACADEMY

225 Crusaders Court
Stanardsville, VA 22973

434-985-2947 ucacrusaders.com
UCA Preschool Enrollment Application
Student Information
Student name*

First NameMiddle InitialLast Name
Student's birthdate (MM/DD/YY)*

MonthDayYear
Sex*

MALEFEMALE
Age as of August 1, 2026*
Days Attending*

2 Days3 Days5-½ Days5 Days
Student's Religious Background
Current Church Attending*
City/State*
Church Attending*
Regularly attending?*
Parent/Guardian Information
Check here if Parent/Guardian information has been entered for a previous child
Current Church Attending*
City/State*
Regularly Attending?*
Have student's parents (either or both) professed to have a personal relationship with Jesus Christ?*
Father's name*
Phone*
Employer*
Occupation*
Father's Marital Status*
Mother's Name*
Phone*
Employer*
Occupation*
Mother's Marital Status*
If parents are unmarried, separated or divorced, who has custody of the child during the school year?

If parents have joint or primary/secondary custody, describe the terms of the custodial arrangement and provide the address of the joint/secondary parent:
**If a court has issued an order regarding child custody, parents must provide a copy of the order to the school.
Emergency Contact Information
Primary Emergency Contact Person*
Relationship*
Daytime Phone*
Secondary Emergency Contact Person*
Relationship*
Daytime Phone*
Physician*
Phone Number*
Medical conditions*
Dentist*
Phone number*
Dental considerations (braces, brackets, etc.)*
about child's medical conditions will be explained on the medical authorization & release form)
Student's Educational Background
Name and address of student's current school or the school student last attended
Administrator's name
Dates attended
School phone number
Do you as parent/guardian have reason to suspect a reading or learning disability in your child? If yes, explain*
Has your child ever been diagnosed with special needs? If yes, explain*
Has your child ever been recommended for, referred to, or received behavioral or psychological counseling? If yes, explain*
Has your child ever been arrested or charged with a civil infraction or a crime other than a traffic violation? If yes, explain*
Has the student ever been suspended from, expelled from, or asked not to return to school for any reason? If yes, explain.*
List any other factors in your child's life that would be helpful for the school to know (absence or death of a parent, traumatic incidents/accidents, etc.)*

Application Acknowledgment and Non-Binding Statement
By submitting this application to United Christian Academy, I understand and agree that this application does not constitute acceptance, enrollment, or a commitment to pay tuition.
I understand that if my child is admitted to United Christian Academy, I will receive additional documentation, including an Enrollment Agreement, Handbook Agreement and Student Information Form, which must be completed to confirm my child's acceptance and enrollment for the 2026-2027 school year. The Enrollment Agreement will outline all tuition, fees, and binding school policies.
Future Enrollment Agreement Acknowledgment
I understand that admission, if granted, is contingent upon execution of the United Christian Academy Enrollment Agreement, which includes additional policies related to tuition, conduct, liability, and dispute resolution.
Tuition & Enrollment Documentation Acknowledgment
I understand that all tuition rates and fees will be communicated in the Enrollment Agreement provided upon acceptance.
If my child is accepted into United Christian Academy, I understand and agree that:
- The enrollment fee is due immediately upon acceptance to reserve my child's spot and is non-refundable; and
- The curriculum and book fee must be paid by June 1, or my child's reserved spot may be surrendered.
I understand that payment of these fees is required to secure enrollment and that additional tuition and fees will be outlined in the Enrollment Agreement.
I further understand that, in order to finalize my child's enrollment, I will be required to submit the following documentation, as applicable:
- A copy of my child's birth certificate
- A completed School Entrance Health Form
- Vaccination records (or approved exemption documentation, if applicable)
- Previous school records, if applicable
I acknowledge that enrollment is not finalized until all required documentation and fees have been submitted and accepted by United Christian Academy.
Parental Support Statement
I have read and agree with the following statement:
United Christian Academy desires a respectful, cooperative, and Christ-centered partnership with parents. If a parent has a question or concern regarding a school policy or an event involving their student, the parent is expected to first communicate with the student's teacher or the administration, as appropriate. Every effort will be made to resolve concerns and maintain clear and positive communication.
Parental support is an essential part of the educational process. If, in the sole discretion of the administration, a parent fails to support the school's staff, policies, or procedures - including the Code of Conduct, which is based on the school's Statement of Faith - or engages in behavior that is disruptive to the academic, social, or spiritual environment of the school, the administration reserves the right to deny admission or discontinue the student's enrollment.

Parent/Guardian Acknowledgment
By submitting this application, I affirm that the information provided is accurate and complete to the best of my knowledge, and that I have read, understand and agree to the above statements
Date*

MonthDayYear
Date
Custodial Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Custodial Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Should be Empty:

UCA Preschool Enrollment Application

Student Information

Student's Religious Background

Parent/Guardian Information

Emergency Contact Information

Student's Educational Background

Application Acknowledgment and Non-Binding Statement

Future Enrollment Agreement Acknowledgment

Tuition & Enrollment Documentation Acknowledgment

Parental Support Statement

Parent/Guardian Acknowledgment