Reapply to Plaza Heights Christian Academy - Plaza Heights Christian Academy

STUDENT INFORMATION

How many children are reapplying for the 2023-2024 school year at PHCA? PRESCHOOL-Please apply on Preschool application. (REQUIRED)

CHILD #1

Child #1 Full name (REQUIRED)

First M.I. Last

Child #1 Preferred name

Has child #1 made a profession of faith? (REQUIRED)

To be eligible for enrollment, students entering kindergarten should be five by August 1st; students entering first grade should be six by August 1st. Students applying for kindergarten and first grade must attach a copy of their state certified birth certificate with this application.

Child #1 Date of Birth (REQUIRED)

Child #1 Age of Student

Child #1 Gender

Child #1 Grade Applying For: (REQUIRED)

Child #1 - Will require Before/After Care: (REQUIRED)

CHILD #1 MEDICAL INFORMATION

Child #1 - Food Allergies? (REQUIRED)

Child #1 Explanation of Food Allergies (if applicable)

Child #1 Primary Care Physician Name: (REQUIRED)

Child #1 Primary Care Physician Phone Number: (REQUIRED)

Child #1 Primary Care Physician Address: (REQUIRED)

Child #1 Primary Dentist Name: (REQUIRED)

Child #1 Primary Dentist Phone Number: (REQUIRED)

Child #1 Primary Dentist Address: (REQUIRED)

Child #1 Insurance Provider Name: (REQUIRED)

Child #1 Insurance Policy Number: (REQUIRED)

Child #1 Insurance Group Number: (REQUIRED)

Child #1 Preferred Hospital:

Child #1 Please list any medication that your child will need to keep in the office medical cabinet, if no medications will stay in the office type N/A: (REQUIRED)

Plaza Heights Christian Academy is often asked for aggregate data by various agencies, including the federal government, accrediting associations, and colleges/universities for grants and research. In order to respond to these requests, we ask that you answer the following questions:

Please select one or more of the following racial categories to describe Child #1 (REQUIRED)

CHILD #2

Child #2 Full name (REQUIRED)

First M.I. Last

Child #2 Preferred name

Has child #2 made a profession of faith?

To be eligible for enrollment, students entering kindergarten should be five by August 1st; students entering first grade should be six by August 1st. Students applying for kindergarten and first grade must attach a copy of their state certified birth certificate with this application.

Child #2 Date of Birth (REQUIRED)

Child #2 Age of Student

Child #2 Gender (REQUIRED)

Child #2 Grade Applying For: (REQUIRED)

Child #2 - Will require Before/After Care: (REQUIRED)

CHILD #2 MEDICAL INFORMATION

Child #2 - Food Allergies? (REQUIRED)

Child #2 Explanation of Food Allergies (if applicable)

Child #2 Primary Care Physician Name: (REQUIRED)

Child #2 Primary Care Physician Phone Number: (REQUIRED)

Child #2 Primary Care Physician Address: (REQUIRED)

Child #2 Primary Dentist Name: (REQUIRED)

Child #2 Primary Dentist Phone Number: (REQUIRED)

Child #2 Primary Dentist Address: (REQUIRED)

Child #2 Insurance Provider Name: (REQUIRED)

Child #2 Insurance Policy Number: (REQUIRED)

Child #2 Insurance Group Number: (REQUIRED)

Child #2 Preferred Hospital:

Child #2 Please list any medication that your child will need to keep in the office medical cabinet, if no medications will stay in the office type N/A. (REQUIRED)

Plaza Heights Christian Academy is often asked for aggregate data by various agencies, including the federal government, accrediting associations, and colleges/universities for grants and research. In order to respond to these requests, we ask that you answer the following questions:

Please select one or more of the following racial categories to describe Child #2 (REQUIRED)

CHILD #3

Child #3 Full name (REQUIRED)

First M.I. Last

Child #3 Preferred name

Has child #3 made a profession of faith? (REQUIRED)

To be eligible for enrollment, students entering kindergarten should be five by August 1st; students entering first grade should be six by August 1st. Students applying for kindergarten and first grade must attach a copy of their state certified birth certificate with this application.

Child #3 Date of Birth (REQUIRED)

Child #3 Age of Student

Child #3 Gender (REQUIRED)

Child #3 Grade Applying For: (REQUIRED)

Child #3 - Will require Before/After Care: (REQUIRED)

CHILD #3 MEDICAL INFORMATION

Child #3 - Food Allergies? (REQUIRED)

Child #3 Explanation of Food Allergies (if applicable)

Child #3 Primary Care Physician Name: (REQUIRED)

Child #3 Primary Care Physician Phone Number: (REQUIRED)

Child #3 Primary Care Physician Address: (REQUIRED)

Child #3 Primary Dentist Name: (REQUIRED)

Child #3 Primary Dentist Phone Number: (REQUIRED)

Child #3 Primary Dentist Address: (REQUIRED)

Child #3 Insurance Provider Name: (REQUIRED)

Child #3 Insurance Policy Number: (REQUIRED)

Child #3 Insurance Group Number: (REQUIRED)

Child #3 Preferred Hospital:

Child #3 Please list any medication that your child will need to keep in the office medical cabinet, if no medications will stay in the office type N/A: (REQUIRED):

Plaza Heights Christian Academy is often asked for aggregate data by various agencies, including the federal government, accrediting associations, and colleges/universities for grants and research. In order to respond to these requests, we ask that you answer the following questions:

Please select one or more of the following racial categories to describe Child #3 (REQUIRED)

CHILD #4

Child #4 Full name (REQUIRED)

First M.I. Last

Child #4 Preferred name

Has child #4 made a profession of faith? (REQUIRED)

To be eligible for enrollment, students entering kindergarten should be five by August 1st; students entering first grade should be six by August 1st. Students applying for kindergarten and first grade must attach a copy of their state certified birth certificate with this application.

Child #4 Date of Birth (REQUIRED)

Child #4 Age of Student

Child #4 Gender (REQUIRED)

Child #4 Grade Applying For: (REQUIRED)

Child #4 - Will require Before/After Care: (REQUIRED)

CHILD #4 MEDICAL INFORMATION

Child #4 - Food Allergies? (REQUIRED)

Child #4 Explanation of Food Allergies (if applicable)

Child #4 Primary Care Physician Name: (REQUIRED)

Child #4 Primary Care Physician Phone Number: (REQUIRED)

Child #4 Primary Care Physician Address: (REQUIRED)

Child #4 Primary Dentist Name: (REQUIRED)

Child #4 Primary Dentist Phone Number: (REQUIRED)

Child #4 Primary Dentist Address: (REQUIRED)

Child #4 Insurance Provider Name: (REQUIRED)

Child #4 Insurance Policy Number: (REQUIRED)

Child #4 Insurance Group Number: (REQUIRED)

Child #4 Preferred Hospital:

Child #4 Please list any medication that your child will need to keep in the office medical cabinet, if no medications will stay in the office type N/A: (REQUIRED):

Plaza Heights Christian Academy is often asked for aggregate data by various agencies, including the federal government, accrediting associations, and colleges/universities for grants and research. In order to respond to these requests, we ask that you answer the following questions:

Please select one or more of the following racial categories to describe Child #4 (REQUIRED)

CHILD #5

Child #5 Full name (REQUIRED)

First M.I. Last

Child #5 Preferred name

Has child #5 made a profession of faith? (REQUIRED)

To be eligible for enrollment, students entering kindergarten should be five by August 1st; students entering first grade should be six by August 1st. Students applying for kindergarten and first grade must attach a copy of their state certified birth certificate with this application.

Child #5 Date of Birth (REQUIRED)

Child #5 Age of Student

Child #5 Gender (REQUIRED)

Child #5 Grade Applying For: (REQUIRED)

Child #5 - Will require Before/After Care: (REQUIRED)

CHILD #5 MEDICAL INFORMATION

Child #5 - Food Allergies? (REQUIRED)

Child #5 Explanation of Food Allergies (if applicable)

Child #5 Primary Care Physician Name: (REQUIRED)

Child #5 Primary Care Physician Phone Number: (REQUIRED)

Child #5 Primary Care Physician Address: (REQUIRED)

Child #5 Primary Dentist Name: (REQUIRED)

Child #5 Primary Dentist Phone Number: (REQUIRED)

Child #5 Primary Dentist Address: (REQUIRED)

Child #5 Insurance Provider Name: (REQUIRED)

Child #5 Insurance Policy Number: (REQUIRED)

Child #5 Insurance Group Number: (REQUIRED)

Child #5 Preferred Hospital:

Child #5 Please list any medication that your child will need to keep in the office medical cabinet, if no medications will stay in the office type N/A: (REQUIRED):

Plaza Heights Christian Academy is often asked for aggregate data by various agencies, including the federal government, accrediting associations, and colleges/universities for grants and research. In order to respond to these requests, we ask that you answer the following questions:

Please select one or more of the following racial categories to describe Child #5 (REQUIRED)

HOME INFORMATION FOR ALL STUDENTS REAPPLYING

Within what public school district do you reside?

Based upon your residence, what public school building would your children be required to attend IF they were going to a public school?

Home Address of all students re-applying (REQUIRED)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

PARENT/GUARDIAN INFORMATION

Parents are (please select one): (REQUIRED)

Student lives with (please select one): (REQUIRED)

Father's Full Name (REQUIRED)

First M.I. Last

Father's Home Number

Father's Work Number

Father's Cell Number (REQUIRED)

Father's Cell Phone Carrier (i.e. AT&T, Sprint, etc) (REQUIRED)

Father's Email Address (REQUIRED)

Father's Company

Father's Occupation

Is Father a member of a church? (REQUIRED)

Name of Father's Church (REQUIRED)

Mother's Full Name (REQUIRED)

First M.I. Last

Mother's Home Number

Mother's Work Number

Mother's Cell Number (REQUIRED)

Mother's Cell Phone Carrier (i.e. AT&T, Sprint, etc) REQUIRED-Please complete the requested information:

Mother's Email Address (REQUIRED)

Mother's Company

Mother's Occupation

Is Mother a member of a church? (REQUIRED)

Name of Mother's Church (REQUIRED)

EMERGENCY CONTACT INFORMATION

Emergency Contact Name #1 (REQUIRED)

Emergency Contact Name Relationship (example: grandparent, aunt, uncle) (REQUIRED)

Emergency Contact Phone (REQUIRED)

This person can be contacted regarding medical or otherwise emergencies regarding student(s) (REQUIRED)

This person is authorized to checkout/remove your student(s) from the school campus (REQUIRED)

Emergency Contact Name #2 (REQUIRED)

Emergency Contact Name Relationship (example: grandparent, aunt, uncle) (REQUIRED)

Emergency Contact Phone (REQUIRED)

This person can be contacted regarding medical or otherwise emergencies regarding student(s):

This person is authorized to checkout/remove your student(s) from the school campus::

ACKNOWLEDGMENT SECTION

Click here to read the Athletic Waiver Form:

Indicate that you have read the Activity & Athletic Waiver Form and agree to its content: (REQUIRED)

Yes, I agree to the Activity & Athletic Waiver Form

Click here to read the Parent Student Agreement form:

Indicate that you have read the Parent Student Agreement and agree to its content: (REQUIRED)

Yes, I agree to the Parent Student Agreement Form

Many activities will be posted and/or LIVE streamed on the school's YouTube channel. Therefore, I understand and give permission that if my student is involved in an activity (ie: sports, performances like drama or music, chapel, etc.), my student(s) may be featured or shown in LionsTV broadcasting. PLEASE NOTE: If you chose not to have your student involved in the broadcasting aspect of the school, it will likely affect their participation in activities.*

Yes, we give broadcasting permission.
No, we do not give broadcasting permission.

We give permission for our child/children to be photographed for purposes of display in, but not limited to, the following: Facebook/Instagram, school publications, newspapers, bulletin boards, yearbook, and the PHCA website.*

Yes, we give media permission.
No, we do not give media permission.

CONCLUSION OF APPLICATION - READ CAREFULLY

* By providing your initials below, we the parents/guardians of this student affirm that we have given completely truthful information herein; that we have received, read, understand, and will abide by the policies of Plaza Heights Christian Academy, should our child be admitted for enrollment.

Initials for Consent (read above) (REQUIRED)

Application Date (REQUIRED)

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

PURSUING HIS CALL ALWAYS

SPECIAL NOTE: There are many required fields. Failure to enter content in those fields will result in your application not being submitted properly. Your application has not been completed until you are directed to a page with a Success message.

STUDENT INFORMATION

CHILD #1

CHILD #1 MEDICAL INFORMATION

CHILD #2

CHILD #2 MEDICAL INFORMATION

CHILD #3

CHILD #3 MEDICAL INFORMATION

CHILD #4

CHILD #4 MEDICAL INFORMATION

CHILD #5

CHILD #5 MEDICAL INFORMATION

HOME INFORMATION FOR ALL STUDENTS REAPPLYING

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

ACKNOWLEDGMENT SECTION

CONCLUSION OF APPLICATION - READ CAREFULLY

PURSUING HIS CALL ALWAYS

** SPECIAL NOTE: There are many required fields. Failure to enter content in those fields will result in your application not being submitted properly. Your application has not been completed until you are directed to a page with a Success message. **

STUDENT INFORMATION

CHILD #1

CHILD #1 MEDICAL INFORMATION

CHILD #2

CHILD #2 MEDICAL INFORMATION

CHILD #3

CHILD #3 MEDICAL INFORMATION

CHILD #4

CHILD #4 MEDICAL INFORMATION

CHILD #5

CHILD #5 MEDICAL INFORMATION

HOME INFORMATION FOR ALL STUDENTS REAPPLYING

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

ACKNOWLEDGMENT SECTION

CONCLUSION OF APPLICATION - READ CAREFULLY

SPECIAL NOTE: There are many required fields. Failure to enter content in those fields will result in your application not being submitted properly. Your application has not been completed until you are directed to a page with a Success message.