Excel Christian Preschool Application

Excel Christian Preschool Application
Student Information
Applying For (Program/Class)
Student Name
Date of Application

MonthDayYear
Date
Student Address
Student City
Student State
Student Zip
Age as of Sept. 1st
Student Date of Birth

MonthDayYear
Date
Student Sex
Place of Birth
If my child is over 12 months, have they started walking and talking?
Is your child potty trained?
Are there any diagnosis and / or medical conditions of which we should be aware?
Does my child have allergies? If so, what?
Is my child on any special medication? If so, what?
What are my child's favorite things?
Who does the student reside with?
Parent Information
Natural Father’s Name

First NameMiddle NameLast Name
Father's best phone number
Please enter a valid phone number.Format: (000) 000-0000.
Father Marital Status
Father Pick-Up Allowed
Father Address (if different than student address)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Father City
Father State
Father Zip
Father Employer
Father Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Father Email
example@example.com
Mother Information
Natural Mother’s Name

First NameLast Name
Mother's best phone contact
Please enter a valid phone number.Format: (000) 000-0000.
Mother Marital Status
Mother Pick-Up Allowed
Mother Address (If different than student's address)
Mother City
Mother State
Mother Zip
Mother Employer
Mother Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mother Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mother Email
example@example.com
Household and Enrollment Details
Other Children Enrolled at ECA?
If yes, list names and grades
Who has legal custody of the child?
Required Documentation Checklist
Physical and Health Immunization Records
Upload Physical and Health Immunization Records

Upload the physical and health immunization record documents here.
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Birth Certificate

Upload the birth certificate here.
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Medical Records Authorization
I authorize the school, in collaboration with the parent or guardian as determined appropriate, to receive and review my child’s medical records for educational, health, and safety purposes.
Medical Release Authorization from Health Care Provider

Upload the birth record and immunization records here.
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What are you hoping your child will receive at Excel Preschool?
Agreements and Signatures
Parent 1 Signature – Enrollment Agreement
Initials for Statement 1 - The School is not responsible for the loss of personal property, whether the loss occurs by theft, fire, or any other cause.
Initials for Statement 2 - All students enrolled at Excel Christian Academy must have in their school file a birth certificate, school physical, valid immunization records, and current custody papers if applicable. It is the sole responsibility of the parent to provide the school with any immunization changes or updated legal documents.
Initials for Statement 3 - Excel Christian Academy admits students of any race, color, national and ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at the school.
Initials for Statement 4 -My child is permitted to take part in all school activities, including but not limited to, outside and inside activities, school sponsored events, and absolve the school and church from liability to me or my child in case of accident or injury to my child while on campus or during any school sponsored outing.
Initials for Statement 5 - As parents, we sincerely pledge our loyalty to the aims and ideals of the school.
Initials for Statement 6 - As parents, we hereby invest authority in the faculty and administration concerning the discipline of our child as necessary. We further agree that we will support the faculty and administration in discipline at home as needed.
Initials for Statement 7 - As parents, we agree, in accordance with the principle of Matthew 18:15-17, to bring any and all questions and criticisms to the person most directly involved. If we have a question about a specific classroom action or procedure, we will contact the appropriate teacher. If a satisfactory conclusion is not reached, we will then contact the school office to schedule a meeting with the appropriate administrator.
Initials for Statement 8 - I agree to resolve any concerns or questions about the school or its staff through direct, respectful dialogue with administration. We understand that creating negative or derogatory narratives on social media is harmful to our community and is contrary to our partnership, which could affect our child's continued enrollment.
Initials for Statement 9 - I agree to comply with and support the spiritual, moral, dress and disciplinary standards and policies of the school and further agree that the school has full discretion in the discipline of my child while under school supervision.
Initials for Statement 10 -I have read the FINANCIAL INFORMATION AGREEMENT and comply with those policies. I understand that failure to make payments in the required timeframe will be cause for suspension or dismissal from the program.
Initials for Statement 11 - I understand that I must transport my child in a car seat that is age appropriate each day and the staff has the responsibility to verify each child is leaving/arriving in a car seat. Failure to use a car seat will be reported to Department of Children and Families.
Initials for Statement 12 -I understand that if my child becomes ill while at preschool, the school has the responsibility to notify the parent and the parent will be required to pick up the child within 1 hour's time. Children with a fever, vomiting or green congestion will need to be symptom free for 24 hours before returning to school.
Initials for Statement 13- I understand that any person picking up my child must be listed as an authorized pick up in the student information system (Brightwheel or Gradelink) and that all persons are subject to show government identification.
Initials for Statement 14 - I understand that if I or any agent acting in my behalf or on behalf of my child brings any legal action against the school or its agents and such legal action is found in favor of the school or its agents, I will be responsible to pay all legal fees and other expenses related to such action. All disputes shall be settled in binding arbitration.
Parent 1 Date – Enrollment Agreement

MonthDayYear
Date
Hour MinutesAM/PM Option
Parent 2 Signature – Enrollment Agreement
Parent 2 Date – Enrollment Agreement

MonthDayYear
Date
Hour MinutesAM/PM Option
Parent 1 Signature – Acknowledgement of Biblical Worldview: As a Christ-centered school, a biblical worldview is the foundation of everything we do. This worldview is integrated into daily instruction across all subjects. Furthermore, all students are required to participate in weekly chapel services as a vital component of their spiritual development and our community life. We celebrate this distinctive approach to educating the whole child.
Parent 1 Date – Biblical Worldveiw

MonthDayYear
Date
Hour MinutesAM/PM Option
Parent 2 Signature – Biblical Worldview
Parent 2 Date – Biblical Worldview

MonthDayYear
Date
Hour MinutesAM/PM Option
Acknowledgment of Financial Information & Policies
Parent 1 Signature – Financial Information Acknowledgment
Parent 1 Date – Financial Information Acknowledgment

MonthDayYear
Date
Hour MinutesAM/PM Option
Parent 2 Signature – Financial Information Acknowledgment
Parent 2 Date – Financial Information Acknowledgment

MonthDayYear
Date
Hour MinutesAM/PM Option
I confirm I have paid the application fee at this link - https://square.link/u/UG7NOnnQ
Should be Empty:

Excel Christian Preschool Application

Student Information

Parent Information

Mother Information

Household and Enrollment Details

Physical and Health Immunization Records

Medical Records Authorization

Agreements and Signatures