Excel Adventist^® Academy

Mount Up With Wings Like Eagles

New Student Application

Date of Application

Student's Full Legal Name

Student's Middle Name

Current Age

Date of Birth

Student's Gender

Male Female

Place of Birth

Date of SDA Baptism

Office Use Only - NAD ID

Ethnic Origin (For Federal and North American Division purposes only)

FAMILY INFORMATION

Student living with (Check all that apply) Both Parents Father Mother Stepfather Stepmother Guardian Grandparent(s) Aunt/Uncle

Other (please explain)

Who can receive report cards? Both parents Father Mother

Guardian (name)

Parent or Guardian with whom the student is living

FATHER'S INFORMATION

Father's Full Name

Is father financially responsible?

Yes No

Father's Home Address

Father's Home Number

Father's Work Number

Father's Mobile Number

Father's Email

Father's Marital Status

FATHER'S CHURCH AFFILIATION

Father's Denomination

Father's Church Name

Is Father a baptized member?

Yes No

Languages father uses at home

MOTHER'S INFORMATION

Mother's Full Name

Is mother financially responsible?

Yes No

Mother's Home Address

Mother's Home Number

Mother's Work Number

Mother's Mobile Number

Mother's Email

Mother's Marital Status

MOTHER'S CHURCH AFFILIATION

Mother's Denomination

Mother's Church

Is Mother a baptized member?

Yes No

Languages mother uses at home

LIST OTHER CHILDREN IN THE FAMILY

Child 1 Name

Child 1 Gender

Male Female

Child 1 Age

Name of school Child 1 is attending

Child 2 Name

Child 2 Gender

Male Female

Child 2 Age

Name of school Child 2 is attending

Child 3 Name

Child 3 Gender

Male Female

Child 3 Age

Name of school Child 3 is attending

Child 4 Name

Child 4 Gender

Male Female

Child 4 Age

Name of school Child 4 is attending

Student Medical Information

a) Indicate the student's physical challenge(s) Vision Speech Hearing Heart

b) Any known allergies

c) If on regular medication, please specify

d) In the event of sudden illness or accident requiring attention, school personnel are authorized to administer first aid and if necessary, take child for emergency treatment to a doctor's office or hospital.

As a parent or guardian, indicate your approval of student's treatment by typing your name below. This serves as your electronic signature.

Hospital Preference

Hospital Number

Family Physician Name

Family Physician Address

Family Physician Number

Emergency/ Pickup Contact Information

Please give the names of local relatives or friends who have consented to assume the responsibility of your child in case of illness, accident, or in the event of a major disaster until you can be reached. Listing their names here indicates they are authorized to take the students from campus if necessary. (Identification required at time of pickup)

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Home Phone Number

Emergency Contact 1 Mobile Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Home Phone Number

Emergency Contact 2 Mobile Phone Number

Emergency Contact 3 Name

Emergency Contact 3 Relationship

Emergency Contact 3 Home Phone Number

Emergency Contact 3 Mobile Phone Number

Emergency Contact 4 Name

Emergency Contact 4 Relationship

Emergency Contact 4 Home Phone Number

Emergency Contact 4 Mobile Phone Number

School Last Attended

Previous School's Name

Previous School's Address

Previous School's Phone Number

Previous School's Fax Number

Has this student been previously identified as qualifying for a gifted education program?

Yes No

If yes, What kind?

When?

Where?

By Whom?

Has this student been previously identified as qualifying for a special education program?

Yes No

If yes, What kind?

When?

Where?

By Whom?

Has this student ever had an Individual Education Plan (IEP)?

Yes No

Please explain why you want your child to attend Excel Adventist Academy

How did you hear about Excel Adventist Academy?

Required Documents:

Please provide the following original documents to the Registrar's Office: Birth Certificate, Hospital statement, Notarized statement, Passport or Visa (to verify date of birth) Immunization Record Last Report Card Vision-Hearing Screenings required by Texas state law for students who will be 4-years-old by September 1, and those who are entering Kindergarten, 1st, 3rd 5th, or 7th grades.

Upon submission of this New Student Application, move forward to complete following required forms: Consent to treat form Financial Agreement and Policy Photo /Video Release Handbook Acknowledgement/Parental Agreement Form Computer Systems Acceptable Use Policy Pick-up and After School Program Registration - MUST BE COMPLETED FOR EVERY FAMILY

STUDENT CONTRACT

I agree to uphold the school's regulations. I pledge my cooperation with and loyalty to the school and its employees. I pledge to abide and to be in harmony with the school's Christian principles.

Date

Student's Electronic Signature

PARENT CONTRACT

I hereby agree to support school regulations and to help my child observe them; to help my child in their educational goals; to supply physical examination reports for this student, a) entering school for the first time, b) at grade seven (this should include the scoliosis examination) c)at other grades, when required; and to accept all financial obligations for this student.

Date

Parent's Electronic Signature

Continue to next form Consent to Treatment.

Enrollment Requirements for New Students

A completed New Student Application.
Birth Certificate, Hospital Statement, Notarized statement, Passport or Visa (to verify birth date)
Immunization verification for all students as required by Texas Law. Students MUST have all vaccinations required for the appropriate age level.
Cumulative records and the student checkout sheet from the previous school attended.
Last report card (original)
Medical Exam
Vision/Hearing Screenings required by Texas state law for all first-time students ages 4 years (by September 1) through 8th grade. Screenings may be given by the student's primary doctor or Pinewood Screening Services on campus visit.

Download a hard copy of the application.

All applicants files will be reviewed before admission. Full acceptance is not granted until all application documents have been submitted.

Supporting documents can be faxed to 281-835-1275, or mailed to:

P.O. Box 2240
Missouri City, TX 77489

Related Information

Admissions Request Information Returning Student Application Consent to Treatment Financial Agreement and Policy Statement Photography/Video Release Form Acknowledgement Form/Parental Agreement Computer Systems Acceptable Use Policy Pick-up Form