Summer Admission Form Logo
  • Bear Valley Academy Summer Enrichment Admission Form

    You will be required to sign this form in several places. Please sign your full name which serves as your electronic signature.
  • Summer Enrichment

    Please select the program your child will attend and be in our center. Summer Enrichment hours are 9:00 am to 12:00 pm. Students 18 months through 7 years are eligible for two session options with both being held on Tuesday/Wednesday/Thursday.
  • Student Information

    Please use the child's full name (Ex. Madelyn, not Maddie)
  •  / /

  • Parent/Legal Guardian

    Parent/Legal Guardian listed here will be our first contact.
  •  -
  •  -
  • Additional Parent/Legal Guardian

    Parent/Legal Guardian listed here will be our second contact.
  •  -
  •  -
  • Authorizations

  • I hereby authorize the childcare operation to allow my child to leave the childcare operation ONLY with the following persons and the above parents/guardians marked as an authorized pick-up. Children will ONLY be released to a parent/guardian or person designated after verification of ID. In the event that a person "not listed" has to pick up my child, I understand that BVA must receive a phone call from one of the approved parents stating who that person will be. Do not leave any fields black. Each field must hae either the required information or N/A.

  •  
  • Clear
  • Transportation and Field Trips

    We do not transport children except in the event of emergency.

    We do not take children on field trips. 

  • Emergency Medical Information

  • I give consent for the child care operation to secure any and all necessary emergency medical care for my child. In the event I cannot be reached to make arrangement for emergency medical care, I authorize the person in charge to take my child to the physician or emergency medical care facility listed below.

    I authorize the individuals listed below to be called and make medical decisions for my child if the parents or legal guardians cannot be reached. I have notified said individuals about this responsibility. 

    Do not leave any fields blank. Each field must be COMPLETE with the required information. For example - Address: 555 Brown Lane, Colleyville, TX 76034

     

  •  
  • I give consent for the facility to secure any and all necessary emergency medical care for my child. 

  • Clear
  • Medical Information

    Complete as appropriate. If none, enter N/A.
  • Childcare operations are public accomodations under the Americans with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in the violation of Title III, you may call the ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY).

  • Clear
  •  / /
  • Clear
  • For additional information regarding immunizations, contact the Department of State Health Services at www.dshs.state.tx.us/immunize/public.shtm

  • Clear
  • Policies Acknowledgment

  • Bear Valley Academy's school policies can be found in the Parent Handbook on our website or in our school office. Please review our operational policies.

  • Parent or Legal Guardian Agreement

  • Bear Valley Academy reserves the right to place children in any classroom and to refuse the requests that are not in the best interests of the child, class, or program.

    I understand that the supply fee is non-refundable. Tuition is due by June 1st. Parents are responsible for tuition regardless of absences. 

    I acknowledge that a staff member has provided me with a copy of Bear Valley Academy's Parent Handbook and discussed the contents with me. I agree to abide by the rules, policies, standards, and procedures of Bear Valley Academy including payment of all tuition and fees owed.

    I understand that the following documents, as applicable, MUST be on file with the school before June 1st. I acknowledge that failure to turn in all required documents could result in my child's inability to attend the program.

    • Completed Admission Form (this form)
    • Most current copy of the child's immunization records
    • Signed copy of the Health Care Professional's Statement or exemption
    • Signed copy of my child's hearing/vision screening or exemption (if the child is 4 or older before June 1st)
    • Food Allergy & Anaphylaxis Emergency Care Plan (if needed)
    • Authorization for Dispensing Medication Form (if needed)

    Under the Texas Penal Code, any area within 1,000 feet of a child care center is a gang free zone, where criminal offenses related to organized criminal activity are subject to harsher pentalties.

    DFPS values your privacy. For more information, read their Privacy and Security Policy online at www.dfps.state.tx.us/policies/privacy.asp

  • Clear
  •  / /
  •  
  • Should be Empty: