ACC New Student Application

1
Child #1 Name* This field is required.
First Name
Middle Name
Last Name
2
Is Child #1 a returning student at The Academy?
YesNo
3
Child 1 - Gender* This field is required.
Male
Female
4
Child 1 - Date of Birth* This field is required.
Date
Month
Day
Year
5
Child 1 - Applying for Which Grade?* This field is required.
3 Year Old Preschool
Transitional Kindergarten
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
6
Student Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Parent/Guardian #1 Name
First Name
Last Name
8
Parent/Guardian #1 AddressOnly if Different from Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
9
Parent/Guardian #1 Phone Number
Area Code
Phone Number
10
Parent/Guardian #1 EmailWe use email as a primary method of communication. Please provide an address that you check regularly and to which you are responsive.
example@example.com
11
Parent/Guardian #1 Work Phone
Area Code
Phone Number
12
Will the Parent/Guardian #1 be receiving Academy mail/billing?* This field is required.
Yes
No
13
Parent/Guardian #2 Name
First Name
Last Name
14
Parent/Guardian #2 AddressOnly if Different from Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
15
Parent/Guardian #2 Phone Number
Area Code
Phone Number
16
Parent/Guardian #2 Alternate Phone Number
Area Code
Phone Number
17
Parent/Guardian #2 EmailWe use email as a primary method of communication. Please provide an address that you check regularly and to which you are responsive.
example@example.com
18
Parent/Guardian #2 Work Phone
Area Code
Phone Number
19
Parent/Guardian #2 Marital Status
Married
Widowed
Separated
Divorced
Remarried
20
Does the Parent/Guardian #2 live with student?* This field is required.
Yes
No
21
Will the Parent/Guardian #2 be receiving Academy mail/billing?* This field is required.
Yes
No
22
Church Attendance - Parent/Guardian #2
Regular
Seldom
Never
23
Will other children in the family be attending The Academy?* This field is required.
Yes
No
24
Child #2 Name
First Name
Last Name
25
Is Child #2 a returning student at The Academy?
YesNo
26
Child 2 - Gender
Male
Female
27
Child 2 - Date of Birth
Date
Month
Day
Year
28
Child 2 - Applying for Which Grade?
3 Year Old Preschool
Transitional Kindergarten
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
29
Child #3 Name
First Name
Last Name
30
Is Child #3 a returning student at The Academy?
YesNo
31
Child 3 - Gender
Male
Female
32
Child 3 - Date of Birth
Date
Month
Day
Year
33
Child 3 - Applying for Which Grade?
3 Year Old Preschool
Transitional Kindergarten
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
34
Child #4 Name
First Name
Last Name
35
Is Child #4 a returning student at The Academy?
YesNo
36
Child 4 - Gender
Male
Female
37
Child 4 - Date of Birth
Date
Month
Day
Year
38
Child 4 - Applying for Which Grade?
3 Year Old Preschool
Transitional Kindergarten
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
39
Emergency Contact 1* This field is required.
First Name
Last Name
40
Student's relationship to Emergency Contact 1?* This field is required.
41
Emergency Contact 1 Phone Number* This field is required.
Area Code
Phone Number
42
Emergency Contact 2* This field is required.
First Name
Last Name
43
Student's relationship to Emergency Contact 2?* This field is required.
44
Emergency Contact 2 Phone Number* This field is required.
Area Code
Phone Number
45
Have your academic goals changed for your child/children or have there been any significant changes in your child's life this past year?* This field is required.(Please designate using child's name if registering more than one child)
46
The following important medical information will help The Academy serve your child. Has your child/children had any of the following:
Premature birth
Asthma
Other medical conditions
47
Please list any medical or food allergies(Please designate using child's name if registering more than one child)
48
Does your child have normal vision?* This field is required.
Yes
No
49
Date and location of last eye exam(Please designate using child's name if registering more than one child)
50
Does your child have normal hearing?* This field is required.
Yes
No
51
Has your child been diagnosed with ADD or ADHD? (If so, you will need to provide the office a copy of the diagnosis sheet)* This field is required.
Yes
No
52
Is your child taking medication for ADD/ADHD? If so, please list the type of medication taken.(Please designate using child's name if registering more than one child)
53
Are your child's immunization up to date? (You will need to provide a copy of your child's immunization record to the school office)* This field is required.
Yes
No
54
Has your child been hospitalized in the past 12 months?* This field is required.
Yes
No
55
If yes, please explain.(Please designate using child's name if registering more than one child)
56
Has your child been diagnosed with depression or other mental health conditions?* This field is required.
Yes
No
57
If yes, please explain.(Please designate using child's name if registering more than one child)
58
If someone other than the mother or father will be financially responsible for your child/children's tuition, please list their name.
First Name
Last Name
59
I am aware of and will comply with the policies outlines in the current Tuition & Fee Schedule.* This field is required.
Yes
No
60
I will support the administration and teachers through respect, frequent communication, and volunteer efforts at school functions.* This field is required.
Yes
No
61
I will support the academic success of my child by ensuring that he or she remains current in class requirements, including but not limited to class attendance with minimal absences, class participation, daily homework assignments, test & quiz preparation, and class projects.* This field is required.
Yes
No
62
I am aware of and will comply with the student dress code.* This field is required.
Yes
No
63
Thank you for submitting your Returning Student Application for the upcoming school year! To complete your application, a $50/student Registration Fee must be received by ACC to hold spots for your student(s). Due to excessive fees from PayPal, we will no longer be taking deposits through that method.

You may submit the fee via cash or check (payable to ACC) to the attention of Sarah Mayberry. If you wish to pay the fee via credit card, please call Sarah Mayberry at the school (910-754-9637).

We are so excited to have you as a continued part of our Eagle family!
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