Pick-up Form : Excel Adventist® Academy Missouri City TX

Please include each child. A parent or legal guardian must complete this form. List below the persons(s) able to pick up your child/children from Excel Adventist Academy. Your child/children’s teacher, principal, or school staff will only release your child/children to the listed individual(s). Anyone picking up your child/children that is not known or recognized (including yourself) will need to provide a driver's license as proof of identity.

Student 1 Name

Student 1 Grade

Student 2 Name

Student 2 Grade

Student 3 Name

Student 3 Grade

Student 4 Name

Student 4 Grade

Father/Guardian Name

Father/Guardian Home Number

Father/Guardian Work Number

Father/Guardian Cell Number

Mother/Guardian Name

Mother/Guardian Home Number

Mother/Guardian Work Number

Mother/Guardian Cell Number

EMERGENCY CONTACT

Parents cannot be listed as emergency contacts. List the names of at least one person who you want to be contacted in the event of an emergency or illness if the parent/guardian cannot be reached. Persons listed should be able to assist in locating the parent/guardian and at least one person listed must be local and able to take responsibility for the child in cases where the parent/guardian cannot be located.

Emergency Contact 1 Name

Relationship to child/children

Emergency Contact 1 Phone

Other number where emergency contact can be reached

Emergency Contact 2 Name

Relationship to child/children

Emergency Contact 2 Phone

Other number where emergency contact can be reached

STUDENT PICK UP CONTACTS

I give permission for the following individual(s) to pick up my child/children from Excel Adventist Academy. I understand that a driver's license will be required as proof of identity. I also understand that my child/children will not be released to any individual(s) not on this list. Print names clearly. If you need to add names to this list later, please contact the office to submit an amended list.

ADDITIONAL PEOPLE WILL NOT BE ADDED TO THIS LIST UNLESS SUBMITTED IN WRITING – NO PHONE CALLS PLEASE.

Pickup Contact 1 Name

Pickup Contact 1 Relationship

Pickup Contact 1 Home Phone

Pickup Contact 1 Cell Phone

Pickup Contact 2Name

Pickup Contact 2 Relationship

Pickup Contact 2 Home Phone

Pickup Contact 2 Cell Phone

Father/Guardian Electronic Signature

Date of Father/Guardian Electronic Signature

Mother/Guardian Electronic Signature

Date of Mother/Guardian Electronic Signature

RESTRICTIONS

IF ANYONE IS LEGALLY BARRED FROM PICKING UP YOR CHILD/CHILDREN, WE MUST HAVE A COPY OF THE RESTRAINT ORDER OR CUSTODY AGREEMENT IN YOUR CHILD/CHILDREN’S FILE FOR ENFORCEMENT.

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.

Enrollment Requirements for Returning Students

A completed Application Returning Form.
Updated Immunization Record
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. Screenings may be given by the student's primary doctor or Pinewood Screening Services on campus visit.

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 New Student Application Returning Student Application Consent to Treatment Financial Agreement and Policy Statement Photography/Video Release Form Acknowledgement Form/Parental Agreement Computer Systems Acceptable Use Policy

Excel Adventist^® Academy

Mount Up With Wings Like Eagles

Pick-up Form