Excel Adventist^® Academy

Mount Up With Wings Like Eagles

Returning Student Application

Date of Application

Student's Full Legal Name

Student's Middle Name

Student's Nick 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)

UPDATE 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

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

UPDATE EMRGENCY/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

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 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.

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 New 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