North River Charter Academy Preschool - Enrollment Application

Enrollment Application

North River Charter Academy Preschool
VPK Program - Opening Fall 2026

Hours of Operation: 7:00 AM - 6:00 PM
- Date of Application*
  
  MonthDayYear
  Date
- Preferred Start Date*
  
  MonthDayYear
  Date
- Child's Name*
  
  First NameMiddle NameLast Name
- Nickname (If Applicable)
- Sex*
  
  MaleFemale
- Date of Birth*
  
  MonthDayYear
  Date
- Social Security Number
- Primary Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Does the child's sibling(s) attend Parrish Charter Academy OR North River Charter Academy?*
  
  Yes - Parrish Charter AcademyYes - North River Charter AcademyNo
- If "YES," please list all sibling names and grades.
- Does your child have any allergies or other medical conditions?*
  
  YesNo
- If "Yes," please list allergies/conditions and provide 3-step medical plan details (ex. 1. administer epi-pen, 2. call parent, 3. call 911)
- May your child participate in food-related activities in the classroom?*
  
  YesNo
- From:*
- To:*
- Days of the Week*
  
  MondayTuesdayWednesdayThursdayFriday
- Child lives with:*
  
  Both ParentsMotherFatherGrandparentsOther
- Please explain any custody/visitation arrangements:
- Mother's Information
- Mother's Name*
  
  First NameLast Name
- Mother's Date of Birth*
  
  MonthDayYear
  Date
- Mother's Social Security Number
- Mother's Marital Status*
  
  MarriedDivorcedWidowedSingle
- Mother's Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Mother's Email Address*
  example@example.com
- Mother's Cell Phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Mother's Work Phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Mother's Home Phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Mother's Employer*
- Employer's Address*
- Father's Information
- Father's Name*
  
  First NameLast Name
- Father's Date of Birth*
  
  MonthDayYear
  Date
- Father's Social Security Number
- Father's Marital Status*
  
  MarriedDivorcedWidowedSingle
- Father's Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Father's Email Address*
  example@example.com
- Father's Cell Phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Father's Work Phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Father's Home Phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Father's Employer*
- Father's Address*
- My child will only be released to the following custodial parent(s) or legal guardians:*
  
  MotherFatherLegal Guardian
- Please note that any court-ordered custody arrangement paperwork must be provided to the North River Charter Academy Preschool upon admission.
- Please list all non-custodial people who are authorized to pick up your child.
- Authorized Pick-Up #1
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Home Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Relationship to Student
- Authorized Pick-Up #2
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Home Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Relationship to Student
- Authorized Pick-Up #3
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Home Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Relationship to Student
- By signing this portion, you agree that your child's "Authorized Pick-ups" may be contacted in the event of an emergency if the custodial parent(s) or legal guardian(s) cannot be reached. Said individuals are permitted to remove the child from the facility in case of illness, accident, if for some reason the custodial parent(s) or legal guardian(s) cannot be reached.*
- Date Signed*
  
  MonthDayYear
  Date
- Pediatrician's Name:*
- Pediatrician's Address:*
- Pediatrician's Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Dentist's Name:*
- Dentist's Address:*
- Dentist's Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Hospital Preference*
- Please list any allergies, special medication, dietary needs, or other areas of concern. If none, please write "None."*
- By signing this portion, you hereby grant permission for the staff of the North River Charter Academy Preschool to contact your child's medical personnel or obtain emergency medical care if warranted:*
- Date Signed*
  
  MonthDayYear
  Date
- Agreement Upon Termination:
  
  I hereby understand that I am required to give written notice of termination. Said notification must be dated and signed the day it is submitted. Without said notification, I realize that I will be responsible for two weeks of payment. An individual notification is required for each sibling that attends the North River Charter Academy Preschool (NRCAP).
- Child's Name
  
  First NameLast Name
- Parent Signature*
- Date Signed*
  
  MonthDayYear
  Date
- Agreement Upon Termination:
  
  I hereby understand that I am required to give written notice of termination. Said notification must be dated and signed the day it is submitted. Without said notification, I realize that I will be responsible for two weeks of payment. An individual notification is required for each sibling that attends the North River Charter Academy Preschool (NRCAP).
- Please select one:*
  
  I DO give the North River Charter Academy Preschool permission to photograph my child.I DO NOT give the North River Charter Academy Preschool permission to photograph my child.
- Child's Name*
  
  First NameLast Name
- Parent Signature*
- Date Signed*
  
  MonthDayYear
  Date
- Medical Care:
  
  I authorize North River Charter Academy Preschool (NRCAP) to give consent for any and all of my child's emergency medical care, including CPR and abdominal thrusts maneuver while under the supervision of NRCAP.
  
  I authorize any emergency transportation to transport my child from the center to to nearby hospitals if such a situation would occur.
- Child's Name*
  
  First NameLast Name
- Parent Signature*
- Date Signed*
  
  MonthDayYear
  Date
- Curriculum & Screening Your Child:
  
  NRCAP has adopted the ELLM/Plus curriculum that is recommended by the State of Florida. NRCAP also utilizes supplemental curriculum such as: Beyond Centers & Circle Time Curriculum Series, Creative Curriculum, and the Creative Curriculum. Our VPK curriculum is developmentally appropriate, designed to prepare your child for early literacy, enhance the age-appropriate progress of your child in attaining the state-adopted performance standards, and prepare them for kindergarten based on the statewide kindergarten screening. (Section 1002.67(2)(b), Florida Statutes) Moreover, we will be screening your child via the Teaching Strategies Gold and/or Ages and Stages Program, which was recommended by Dr. Reynolds, who is one of the top Early Childhood Professors in the State. Subsequent to the screening, you will receive the results of said instrument. By signing below you are giving both the NRCAP staff and director permission to screen your child using the Teaching Strategies Gold and/or Ages & Stages Program.
- Child's Name*
  
  First NameLast Name
- Parent Signature*
- Date Signed*
  
  MonthDayYear
  Date
- Thank your for completing application to North River Charter Academy Preschool!
  
  Please click the submit button only once.
  
  You will receive an email confirmation that your form was submitted successfully. Please check your SPAM folder if you do not receive it.
  
  Please find additional information online at https://www.nrcaedu.org/nrcap
- Should be Empty:

Enrollment Application

Mother's Information

Father's Information

Thank your for completing application to North River Charter Academy Preschool!

Please click the submit button only once.

You will receive an email confirmation that your form was submitted successfully. Please check your SPAM folder if you do not receive it.

Please find additional information online at https://www.nrcaedu.org/nrcap