Preliminary Enrollment Form
Be sure to submit a new form for each child you enroll.
Student Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
Date
Which grade are you enrolling your child in?
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does your child have any known allergies? If so please list them and give a detailed description of the necessary treatment plan in the even they are exposed to an allergen:
*
Does your child have any conditions or diagnosis that require medical care, attention or treatment? If so, please give a detailed description here:
*
Does your child require the administration of medication during his/her school day? If so, please list the medications and their instructions here:
*
Does your child have any social, emotional or behavioral challenges that might require additional support from teaching staff? If so, please explain:
*
Parent Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Grandmother
Grandfather
Stepmother
Stepfather
Legal Guardian
Parent Email
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Address (if different from students)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Grandmother
Grandfather
Stepmother
Stepfather
Legal Guardian
Parent Email
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Address (if different from student's)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact #1 (other than parents)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to child
*
Emergency Contact #2 (other than parents)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to child
*
Please let us know if there is any other information pertinent to your child regarding school enrollment:
*
Preliminary Enrollment AgreementThis Preliminary Enrollment Agreement (“Agreement”) is entered into between the undersigned parent/guardian (“Parent”) and Evergreen Christian Academy, LLC (“ECA”). By submitting this form and paying the Preliminary Enrollment Fee, Parent acknowledges and agrees to the following:Preliminary Enrollment Fee and Seat HoldParent understands that the Preliminary Enrollment Fee reserves the student’s place in the class, pending program finalization and official enrollment.Refund PolicyParent understands that the Preliminary Enrollment Fee is non-refundable, except in the rare event that the program does not proceed as planned for the upcoming school year. In that case, all Preliminary Enrollment Fees will be refunded in full.Parent Participation and At-Home InstructionParent understands that ECA operates as a parent-involved program and that there is a minimum 40-hour volunteer requirement during the school year, or Parent understands that Parent may be billed in lieu of volunteer hours. Parent also understands that families are responsible for completing remaining educational hours at home in accordance with program expectations.Additional Terms at Official EnrollmentParent understands that additional terms, policies, and conditions will apply at official enrollment, including but not limited to tuition agreements, school-year policies, behavioral expectations, and handbook acknowledgements.By signing below, Parent confirms that Parent has read and agrees to the Preliminary Enrollment Agreement above.
*
Printed/Typed Name
*
First Name
Last Name
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