Admissions

Online Forms

New Student Application

Step 1 of 3

Student’s Name(Required)

First Last

Birth date(Required)

Age(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Email(Required)

Father/Guardian’s Names

First Last

Father’s phone (home)

Father’s cell phone

Father’s work phone

Mother’s/Guardian’s Names

First Last

Mother’s phone (home)

Mother’s cell phone

Mother’s work phone

Insurance Information:

Member Name

First Last

Ins. Company

Policy/Group #

Please provide a front & back copy of your insurance card. This will be kept in a secure location.

Name of Student’s Physician(Required)

First Last

Office Phone(Required)

Office Street Address(Required)

Street Address Address Line 2 City State ZIP Code

Student’s known allergies: (If severe and medication could be needed, a Medication Description Form must be completed.)

List any medications taken regularly: (A Medication Description Form must be completed.)

Date of last Tetanus shot

Any other medical information that we should know?

Emergency Contact

If we are unable to contact parents first, call:

Contact Name

First Last

Relationship

Phone (cell or home)

OTC Medication Authorization Medications Conditions/Symptoms Please write YES or NO Benadryl Allergy Symptoms Tylenol / Acetaminophen Minor aches and pains, fever Ibuprofen / Advil / Motrin Minor aches and pains, fever, cramps Tums or Pepto-Bismol Upset stomach / heartburn / diarrhea Antibacterial Ointment Skin abrasions and cuts Calamine or Cortisone Itching from bug bites, poison ivy, dry skin, etc. Sting relief Pad (could contain Lidocaine) Bee sting Vicks/ Ricola / Generic Store Brands Cough/sore throat Authorization is given for the staff of Eukarya Christian Academy to administer the above over-the-counter (OTC) medications as needed during school hours (including field trips). I understand that all of the medications will be administered according to the manufacturer’s label. On behalf of my child, I absolve Eukarya Christian Academy and its employees from any and all liability whatsoever that may result from my child taking these medications. I, the parent/guardian of said child give my permission to Eukarya Christian Academy to obtain medical assistance for my child in my absence.

Parent or Guardian Name(Required)

First Last

Parent or Guardian Signature(Required)

Date

Step 1 of 2

Student Name

First Last

One form per child please

Parent (or legal guardian) Contact

First Last

Parent Contact Email

Enter the best email to reach the parent or legal guardian in case we need additional information.

Step 1 of 2

Parents(Required)

I have read the Parent-Student Handbook and agree to review it as a family so that we understand the rules and guidelines of Eukarya Christian Academy as well as the expectations for both parents and students. My signature indicates that I am in agreement with this document and will do my best to comply with the policies as set forth.

Name(Required)

First Last

Contact Email(Required)

Parent Signature(Required)

Date

Parent Signature

Date

Step 1 of 2

FAMILY'S LAST NAME(Required)

Contact Email(Required)

Please list the individual(s) below that you give authorization to pick-up your child(ren) from school and/or school related events. These individuals may pick-up your child(ren) in the case that you are unable to pick-them up or in the case that they are taking them home for a playdate etc. If we can expect any of these people to regularly pick up your child, please indicate who they are by putting a checkmark in the space provided.

Type yes if we should expect this person regularly

Name (must match driver’s license)

Phone Number

Relationship to Child(ren)

Step 1 of 2

List the names of students enrolled in Eukarya Christian Academy:

Click the + icon to add more students

PERMISSION(Required)

As the parent or legal guardian of listed students, I give my permission for him/her to attend the field trips and activities, both on and off campus, of Eukarya Christian Academy until June 30, 2019.

NOTICE OF FINANCIAL RESPONSIBILITY(Required)

I accept responsibility for the costs related to my child attending these trips/activities. Costs for field trips will be advertised prior to each trip and are due within 30 days of notice or invoice. I understand that if payment is not received, then my child may not be able to attend future trips. Although, at this time, ECA has not had an overnight trip and reserving a bus is not a regular occurrence, there may be a time that this takes place. I understand that the staff or Board of Eukarya Christian Academy reserves the right to cancel any trip for safety or other reasons. In the event of such a cancellation, the policies of the hotels, bus companies, ticket operators and others providing services in connection with the trip will determine the amount of the refund to which I am entitled, if any.

CONDUCT(Required)

I understand that in addition to the rules and requirements established by each field trip venue, all school rules apply to each person attending each field trip (see Parent-Student Handbook for further details).

TRANSPORTATION(Required)

I understand that in accordance to the Parent-Student Handbook, students are NOT permitted to drive on field trips, regardless of parental permission. Eukarya Christian Academy is a growing school, therefore we rely on parent and/or teacher drivers in order for our students to benefit from attending field trips. I understand that a staff member, a faculty member, an administrator, or the parent of another student, may be used to transport students to and from an activity. The owner of the vehicle is required to carry bodily injury insurance and have proof of a current vehicle state inspection.

ACKNOWLEDGEMENT OF PERSONAL LIABILITY AND WAIVER(Required)

I understand that field trips and activities may expose my child to some risks and I assume any such risk that may arise there from. I accept full responsibility for all medical expenses for any injuries that might occur to my child by reason of his/her participation. By signing this form, I release Eukarya Family Center, Inc. d.b.a. Eukarya Christian Academy, its Board members, administrators, directors, faculty, staff, and volunteers (“released parties”) from and against all claims, demands, actions, complaints, suits or other forms of liability that any of them may sustain (a) arising out of my child’s failure to comply with local, state, and federal laws and Eukarya Christian Academy’s policies, procedures, and the Parent-Student Handbook; (b) arising out of any damage or injury caused by my child; or, (c) arising out of a parent/guardian/or other designated driver’s operation of a motor vehicle in relation to these trips/activities. I also agree to indemnify and hold harmless the released parties from any and all related costs, attorney fees, liabilities, settlements, and/or judgments.

MEDICAL RELEASE(Required)

I authorize a designated representative of Eukarya Christian Academy to administer general first aid treatment for any minor injuries or illnesses experienced by child(ren) listed above. If the injury or illness is life threatening or requires emergency treatment, I authorize the designated representative of Eukarya Christian Academy to summon any and all professional emergency personnel to attend, transport, and treat listed child(ren) and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. I agree to assume financial responsibility for all expenses of such care. This shall be in effect on or off the Eukarya Christian Academy campus.

Parent / Guardian Contact Email(Required)

Parent/Guardian Name(Required)

First Last

Parent/Guardian Signature(Required)

Date

Parent/Guardian Name

First Last

Parent/Guardian Signature

Date

Open Enrollment

The Admissions Process

Tuition, Payment, and Fees

Tuition Rates: Full-Time Students

Tuition Rates: Part-Time Students

Required Documents

First Time Student Enrollment Required Documents

FAMILY INFORMATION

EXTENDED CARE:

PUBLICATION/PHOTO RELEASE:

Current Students Annual Enrollment Required Documents

Insurance Information:

Emergency Contact

Summer Camp Registration

Admissions Contact

Email Us

Call Us

Get In Touch!

Additional Resources

Legal

Nondiscriminatory Policy