ACA Enrollment — First Apostolic Church

Apostolic Christian Academy

an educational ministry of First Apostolic Church

Required Documents for New Students:

Birth Certificate, Immunization Record/Exemption, Social Security Card, Prior School Records, Completed Application, IEP/504 Plan if applicable, Intent to Homeschool

Required Documents for Returning Students:

Completed Application, Intent to Homeschool

You will have the option to upload these required documents at the end of the application. Students will not be able to start classes until all documentation is received.

Before completing this application, read the 2024-2025 ACA Handbook.

2024-2025 APPLICATION FOR ENROLLMENT

Student Name

First Name

Last Name

Date of Birth

YYYY

Grade

Social Security Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Father's Name

First Name

Last Name

Father's Phone Number

(###)

###

####

Mother's Name

First Name

Last Name

Mother's Phone Number

(###)

###

####

Guardian or Non-Custodial Parent (If applicable)

First Name

Last Name

Guardian or Non-Custodial Parent Phone Number (If applicable)

(###)

###

####

Last School Attended (if not ACA)

Last School Attended Phone Number

(###)

###

####

Last School Attended Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please provide the names and phone numbers of anyone allowed to pick up or check out your student from school

MEDICAL INFORMATION

All children entering school for the first time in this state shall have been immunized against diptheria, polio, rubella, tetanus, and whooping cough. IT IS mandatory that pupils who show symptoms of cummunicable disease be excluded from classes until readmmission is acceptableto school authorities. Your cooperation will be greatky appreciated.

Emergency contact if parent or guardian is unavailable

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Physician Name

First Name

Last Name

Physician Phone Number

(###)

###

####

Dentist Name

First Name

Last Name

Dentist Phone Number

(###)

###

####

Hospital Preference

Has your child been ill or hospitilized since last year?

Yes

If yes, what was the medical problem?

Student known allergies

Requires medication?

Does your child wear

Glasses

Contacts

Is there anything else related to your child's health that the school should know?

SCHOOL EMERGENCY MEDICAL AUTHORIZATION

If the student becomes seriously ill or injured at school and family cannot be reached immediately to provide instructions, school personnel will call or arrange for transportation of child to family physician. If this physician or dentist is not available, the school will call another doctor or send the child to the nearest facility for emergency care. I wll be responsible for the cost of any emergency transportation and for any subsequent emergency care. Note: Parents are repsonsible for keeping the school informed of any change in the information contained on this form.

Parent or Guardian Digital Signature

By providing my digital signature below, I agree to abide by the guidelines in the Handbook and uphold the provisions of the Medical Authorization, Statement of Cooperation and Financial Agreement.

Date

YYYY

Apostolic Christian Academy

an educational ministry of First Apostolic Church

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