STUDENT ENROLLMENT '26-'27

STUDENT ENROLLMENT '26-'27

Darren Patterson Christian Academy
(719) 395-6046 office@dpcaweb.org www.dpcaweb.org

DPCA believes in the value of all human life and admits students of all beliefs and backgrounds. DPCA does not discriminate on the basis of gender, race, or national or ethnic origin.
PARENT / GUARDIAN CONTACT INFORMATION

Complete for both parents/guardians.
Family Name
How many children are you registering?
Parent / Guardian #1 (PRIMARY)
Name

First NameMiddle InitialLast Name
Relationship to Student
Employer
Occupation
Work Address
Home Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address (include PO Box if applicable)
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian #2 (Secondary)
Name

First NameMiddle InitialLast Name
Relationship to Student
Employer
Occupation
Work Address
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address (include PO Box if applicable)
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student(s) reside with:

Other
If 'Other', please describe:
If you are new to DPCA, how did you hear about us?
If referred, please name:

Emergency Contacts

In an emergency DPCA will always contact parents/guardians first. Please list persons to contact if parents cannot be reached.
Emergency Contact #1
Full Name
Relationship
Phone
Format: (000) 000-0000.
Address
Emergency Contact #2
Full Name
Phone
Format: (000) 000-0000.
Address
Relationship

FAMILY MEDICAL PROVIDERS

Complete once for your family. If providers differ for individual children, please note below.
Family Doctor
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Doctor's Address
Preferred Hospital & Address
Hospital Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Dentist
Dentist Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Dentist's Address
Family Eye Doctor
Eye Doctor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Eye Doctor's Address
Notes - if any provider differs for a specific child

PICK-UP AUTHORIZATION
DPCA/Busy Bees will not release your child(ren) to persons not listed below. Photo ID may be required. Parents may revise this list at any time by notifying the office. If a non-listed person arrives without prior written or phone authorization, you will be notified immediately.
I AUTHORIZE the following persons to pick up my child(ren):
Authorized Person #1—Full Name
Relationship
Phone
Format: (000) 000-0000.
Authorized Person #2—Full Name
Relationship
Phone
Format: (000) 000-0000.
Authorized Person #3—Full Name
Relationship
Phone
Format: (000) 000-0000.
Authorized Person #4—Full Name
Relationship
Phone
Format: (000) 000-0000.
The following persons are NOT AUTHORIZED to pick up my child(ren):
Please print clearly:
Parent/Guardian Signature:
Printed Name:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

TUITION INFORMATION & PAYMENT PLAN
Payment Plan Selection
Registration fee: $115/family. Homeschool: $65/course (max $115). Additional fees may apply for field trips, pictures, lunches, and supplies. Tuition includes $55 toward individual school supplies. $50 fee for change of payment plan.
Tuition Assistance Deadlines — Returning Family: June 1, 2026 | New Family: August 15, 2026 | See website for details.

MANDATORY VOLUNTEER COMMITMENT
DPCA asks that each family contribute either (1) a minimum of 6 hours of volunteer service during the year, or (2) a $200 payment in lieu of volunteer hours. Please indicate your choice below.
Preferred volunteer area/interest (optional):

EMERGENCY MEDICAL TREATMENT AUTHORIZATION
I/We, the parent(s)/guardian of the above-noted children, hereby give permission to Darren Patterson Christian Academy/Busy Bees Preschool to secure emergency medical treatment in the event of an injury, accident, or emergency. A conscientious effort will be made to contact parent(s)/guardian(s) regarding any injury and treatment.

In the event that parent(s)/guardian(s), other named persons, or physicians cannot be contacted, school officials, emergency personnel, and/or hospital physicians are authorized to take whatever action is deemed necessary for the health and safety of the student. I/We will not hold the school, emergency personnel, or hospital physician responsible for emergency care and/or transportation.

I/We give permission to administer the following to the above-noted child(ren) as needed (please initial each item, or write 'No' and initial):

Rows	NSAIDs (Tylenol / Ibuprofen)	Tums / Pepto-Bismol / Antidiarrheal	Cough Drops
Initial:

Parent/Guardian Signature:
Printed Name:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

SCREENING & SUNSCREEN PERMISSION
From time to time DPCA/Busy Bees is contacted by local health services to provide free screenings. We will email parents with dates once confirmed (TBD = dates to be determined).
I give permission for the following screenings:

Please Initial for your choice:

Rows	Yes	No
Developmental / Social / Emotional
Hearing
Vision
Dental

No — I DO NOT give permission for any screening on my child(ren)
Signature
Printed Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sunscreen Permission

As parent(s)/guardian(s), I/we give permission for staff members of DPCA/Busy Bees to apply sunscreen (15 SPF and higher) to my/our child(ren) during outdoor activities.Sunscreen may be applied to exposed skin including face, neck, ears, nose, shoulders, arms, and legs.
Please Select One
Signature
Printed Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

STATEMENT OF AUTHORIZATION

As parent(s)/guardians of the student(s) noted in this packet, I/we give the following permissions (please initial each item):

Rows	Initial
Outdoor Equipment: My/our child(ren) may use all outdoor equipment in the DPCA/Busy Bees yard under direct staff supervision and participate in all school activities
Walking Field Trips: My/our child(ren) may participate in walking field trips supervised by DPCA/Busy Bees staff. I/we understand that details will be provided prior to each trip.
Audio-Visual: My/our child(ren) may watch short curriculum-related audio-visual clips on occasion.
Photography/Media: DPCA/Busy Bees may take photos of my/our child(ren) for use in the classroom, website, promotional materials, and social media.
Complaints: I/we understand that complaints may be filed with the state licensing board after discussing concerns with DPCA/Busy Bees directors. I/we may also contact the Head of School at office@dpcaweb.org.
Immunizations: I/we have received the Colorado immunization information and have filed paperwork showing my/our child(ren) are properly immunized OR have submitted an authorized exemption form.

Signature
Printed Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

PARENT-STUDENT AGREEMENT

In registering for enrollment at Darren Patterson Christian Academy/Busy Bees Preschool, I/we the parent(s)/guardian understand and agree to the following.

Both parent and Middle School students please initial each numbered item.

Rows	Parent/Guardian #1	Junior High Student
1. Enrollment Discretion DPCA is a private religious organization. Approval for initial or continuing enrollment is at the sole discretion of DPCA administration. The privilege of enrollment may be withdrawn if, in the best judgment of school staff, the school is not able to provide the levels of academic, emotional, community, behavioral, or spiritual support needed. Enrollment may be granted on a probationary basis; final decisions on continuing enrollment always rest with school administration.
2. Support of School Mission I/We will support and uphold school staff and the religious mission, intent, policies, rules, and requirements of DPCA. The Parent-Student Handbook is available in print (school office) or digitally at www.dpcaweb.org. Our signature(s) indicate wholehearted support for the school and its mission.
3. No Guarantee of Continuing Enrollment No guarantee of continuing enrollment during or between school years is implied. I/We acknowledge the school's disciplinary process includes provision for suspension and expulsion should administration determine behavior warrants such action.
4. Emergency Care I/We have authorized the persons listed as emergency caregivers for my/our child(ren) in the event I/we cannot be reached.
5. Website / Social Media DPCA has my/our permission in perpetuity to use photographs, videos, or other images of my/our child(ren), or quotations by my/our child(ren), in DPCA promotional materials and publications, including digital publications such as websites and social media accounts directly managed by the school.
6. Tuition I/We agree to honor the terms of my/our tuition payment agreement. Non-payment is grounds for suspension or termination of enrollment. DPCA has the right to pursue collection of unpaid balances by any and all legal means. The family registration deposit is non-refundable.
7. Disputes I/We agree to be bound by DPCA's grievance policy for resolution of all disputes and by the DPCA Arbitration and Conciliation Agreement. This Agreement shall be the sole remedy for any controversy or claim. By signing this agreement I/we expressly waive the right to file any lawsuit against the school or school employees, board members, or volunteers.
8. Severability I/We acknowledge that if any element of this agreement is judged unenforceable, each and all remaining elements remain in full force and effect.

I/We have read this agreement carefully. I/We warrant that ALL persons with parental, custodial, or guardianship interest in the child(ren) named herein have signed below.
Signature (Guardian #1)
Printed Name (Guardian #1)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Middle School Student Signature (if applicable)
Student Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

OUTDOOR EXPEDITIONS WAIVER — ACKNOWLEDGEMENT & ASSUMPTION OF RISK

WARNING: There are significant elements of risk in adventure activities including hiking, backpacking, camping, rock climbing, XC skiing, snow sports, and field trips. Please read carefully before signing.
I/We am/are aware that my/our child(ren)'s participation in DPCA activities is purely voluntary. DPCA will always endeavor to plan activities with recommended safety guidelines and experienced leaders. Risks include but are not limited to: travel in remote wilderness; rustic living; use of liquid fuel stoves/lantems; transportation in private vehicles/vans/buses; wilderness first aid; work projects using hand and power tools; extreme weather; moving water; high altitudes; steep terrain; falling; animal hazards; dehydration; broken bones: concussions; property damage; death or permanent disability.

Please initial beside each item to indicate understanding and approval:

Rows	Initial
My/our child(ren) will follow all directives from the instructor, understanding that welfare of the group depends on it.
My/our child(ren) will display an attitude of cooperation, even with seemingly trivial or unpleasant tasks.
My/our child(ren) and I/we will carefully read all DPCA program information, complete required forms, and abide by their terms.
DPCA staff are available to answer questions about the nature and physical demands of activities and associated risks.
DPCA cannot assure participant safety or eliminate risks. All participants share responsibility for their own well-being.
Equipment is provided 'AS-IS'. Students agree to aid in inspection and notify DPCA of any apparent defects.
Information provided is not complete. Other unknown/unanticipated activities, risks, and outcomes may exist.
I/We understand my/our child(ren) participate voluntarily with knowledge of risks, and cannot cause harm to self or others.

Release and Indemnity: I/We agree (1) to release and not sue DPCA with respect to any and all claims for injury, damage, death, or other loss connected with my/our child(ren)'s enrollment or participation in DPCA activities; and (2) to defend and indemnify DPCA with respect to any and all such claims. This agreement is governed by Colorado substantive law. Any mediation or proceeding must be filed only in Chaffee County, Colorado.
Parent/Guardian #1 Signature:
Printed Name:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian #2 Signature:
Printed Name:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

HANDBOOK ACKNOWLEDGEMENT
I hereby acknowledge that I have read and thoroughly reviewed a copy of the Darren Patterson Christian Academy Handbook. I understand that the provisions of the Handbook are the most current and supersede all previous policies, manuals, or handbooks issued by DPCA.

I understand that the Handbook provisions are subject to modification at any time at the sole discretion of DPCA, with or without notice. I agree to comply with any such modification upon publication.

I acknowledge DPCA's nondiscriminatory policy: Darren Patterson Christian Academy believes all human life is created by God and has inherent value, and therefore admits students of all beliefs and backgrounds, and employs staff without regard to gender, race, national, or ethnic origin.

Handbook available online with this link or in hard copy at the school office.
Parent Signature
Parent Printed Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Middle School Student Signature (if applicable)
Student Printed Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Rows	Select
4 Mornings/Week (T/W/Th/F 7:45am - 11:45am)
4 Full Days/Week (T/W/Th/F)
2 Mornings/Week (T/Th 7:45am-11:45am)
2 Mornings/Week (W/F 7:45am-11:45am)
2 Full Days/Week (T/Th)
2 Full Days/Week ((W/F)

Rows	Select
4 Mornings/Week (T/W/Th/F 7:45am - 11:45am)
4 Full Days/Week (T/W/Th/F)
2 Mornings/Week (T/Th 7:45am-11:45am)
2 Mornings/Week (W/F 7:45am-11:45am)
2 Full Days/Week (T/Th)
2 Full Days/Week ((W/F)

Rows	Select
4 Mornings/Week (T/W/Th/F 7:45am - 11:45am)
4 Full Days/Week (T/W/Th/F)
2 Mornings/Week (T/Th 7:45am-11:45am)
2 Mornings/Week (W/F 7:45am-11:45am)
2 Full Days/Week (T/Th)
2 Full Days/Week ((W/F)

Rows	Select
4 Mornings/Week (T/W/Th/F 7:45am - 11:45am)
4 Full Days/Week (T/W/Th/F)
2 Mornings/Week (T/Th 7:45am-11:45am)
2 Mornings/Week (W/F 7:45am-11:45am)
2 Full Days/Week (T/Th)
2 Full Days/Week ((W/F)

Anything else you would like to let us know that wasn't covered with this form?
Once you have submitted this form, please drop your non-refundable registration fee of $115 for both Busy Bees and DPCA registration per family. As well as a separate check for your student deposit towards next years tuition ($65 for Homeschool per course capped at $115, and $125 per child for Busy Bees and DPCA).

Example for family with 3 children: $115 family registration fee + 3 x $125 per child towards next year's tuition. Total of $490.
Should be Empty:

STUDENT ENROLLMENT '26-'27

PARENT / GUARDIAN CONTACT INFORMATION

Parent / Guardian #1 (PRIMARY)

Parent / Guardian #2 (Secondary)

Emergency Contacts

Emergency Contact #1

Emergency Contact #2

FAMILY MEDICAL PROVIDERS

PICK-UP AUTHORIZATION

TUITION INFORMATION & PAYMENT PLAN

MANDATORY VOLUNTEER COMMITMENT

EMERGENCY MEDICAL TREATMENT AUTHORIZATION

SCREENING & SUNSCREEN PERMISSION

Sunscreen Permission

STATEMENT OF AUTHORIZATION

PARENT-STUDENT AGREEMENT

OUTDOOR EXPEDITIONS WAIVER — ACKNOWLEDGEMENT & ASSUMPTION OF RISK

HANDBOOK ACKNOWLEDGEMENT

STUDENT #1 — Individual Registration

STUDENT INFORMATION & CLASS REGISTRATION — STUDENT #1

Enrollment Information

GENERAL HEALTH - Student #1

Medical Conditions (Yes / No for each):

Alergies— Student #1

PRESCRIPTION MEDICATION PERMISSION -STUDENT #1 (IF NEEDED)

GET TO KNOW MY CHILD - STUDENT #1 (OPTIONAL)

CONSENT & SIGNATURE - Student #1

STUDENT #2 — Individual Registration

STUDENT INFORMATION & CLASS REGISTRATION — STUDENT #2

Enrollment Information

GENERAL HEALTH - Student #2

Medical Conditions (Yes / No for each):

Alergies— Student #2

PRESCRIPTION MEDICATION PERMISSION -STUDENT #2 (IF NEEDED)

GET TO KNOW MY CHILD - STUDENT #2 (OPTIONAL)

CONSENT & SIGNATURE - Student #2

STUDENT #3 — Individual Registration

STUDENT INFORMATION & CLASS REGISTRATION — STUDENT #3

Enrollment Information

GENERAL HEALTH - Student #3

Medical Conditions (Yes / No for each):

Alergies— Student #3

PRESCRIPTION MEDICATION PERMISSION -STUDENT #3 (IF NEEDED)

GET TO KNOW MY CHILD - STUDENT #3 (OPTIONAL)

CONSENT & SIGNATURE - Student #3

STUDENT #4 — Individual Registration

STUDENT INFORMATION & CLASS REGISTRATION — STUDENT #4

Enrollment Information

GENERAL HEALTH - Student #4

Medical Conditions (Yes / No for each):

Alergies— Student #4

PRESCRIPTION MEDICATION PERMISSION -STUDENT #4 (IF NEEDED)

GET TO KNOW MY CHILD - STUDENT #4 (OPTIONAL)

CONSENT & SIGNATURE - Student #4