Eagles on the Rock Bilingual Academy Admission Information
Please complete the form below to finalize enrollment with our school.
Part I (Child Info)
Child Full Name
*
First Name
Middle Name
Last Name
Child Birth Day
*
Child Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
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
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
Allergy List
Additional Child Notes
School Age Children (only)
5.) Days and Times Needed for Care
A.M.
P.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Child's School
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Part II (Primary Guardians)
Primary Guardian 1
*
Primary Guardian 2 (optional)
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Part III-a (Emergency Contacts)
Emergency Contact 1
*
Emergency Contact 2 (optional)
Part III-b (Authorized Pickups)
(optional)
Authorized Pickup 1
Authorized Pickup 2
Authorized Pickup 3
Authorized Pickup 4
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Part IV (Consent Information)
1.) Transportation - I give consent for my child to be transported and supervised by operation's employees
for emergency care
on field trips
2.) Field Trips
I give consent for my child to participate in field trips.
I do not give my consent.
3.) Water Activities - I give consent for my child to participate in the following water activities
water table play
sprinkler play
splashing pools
swimming pools
aquatic playgrounds
3.) Photos - I give consent for my child to be photographed for the following purposes
In Child's file (identification purposes)
Craft or art display at center or for an event at childcare
School's website
I do not give consent
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Part V (Medical Information)
Authorization for Emergency Medical Attention
In the event I cannot be reached to make arrangements for medical care, I authorize the person in charge to take my child to:
Physician
*
Emergency Care Facility
*
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Vaccine/Vision/Hearing Information
Requirements for Vaccine Exclusion
I have attached (below) a signed and dated affidavit stating that I decline immunizations for reason of conscience, including religious belief, on the form described by Section 161.0041 Health and Safety Code submitted no later than 90 days after the affidavit is notarized.
I have attached (below) a signed and dated affidavit stating that the vision or hearing screening conflicts with the tenets or practices of a church or religious denomination that I am an adherent member of.
Upload any and all vaccine, hearing, and vision records for your child.
Browse Files
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Part VI (Privacy & Signature)
Gang Free Zone
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 penalties.
Privacy Statement
HHSC values your privacy. For more information, read our privacy policy online at: https://hhs.texas.gov/policies-practices-privacy#security
Child's Parent or Legal Guardian
*
Hey
Part VII (Tuition & Payment)
Tuition/Payment
I agree that payment is due on or before the 1st of every month. I understand that 30 days in advance written notice must be given if I decide to discontinue Eagles On The Rock Academy. Without notice, 1 month tuition will be charged. In addition, agree to pay any outstanding balance.
Current Tuition Amount (monthy)
*
Please outline below whom is responsible for payment of tuition and fees.
*
First Name
Last Name
Submit
familyGUID
childGUID
Should be Empty: