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ECA Interest Inventory

Dear family,
Thank you for your interest in Eagle Creek.  Soon after we receive this form, we will reach out to you.

Notes: 
- If your child has attended Mommy & Me classes, please complete this form. 
- If your child has attended Eagle Creek for early childhood or K-5 classes during the summer or school year, please do not submit this form.

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Today's date *
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What is your child's name? *
What is the first name we should use when talking to your child? (What does your child go by?) *
Child's birthday with year *
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If applicable, what grade is your child in right now?
Parent or Guardian #1's first and last name *
Parent or Guardian #1's phone number *
Parent or Guardian #1's email address *
Parent or Guardian #2's first and last name *
Parent or Guardian #2's phone number *
Parent or Guardian #2's email address *
Which of the following programs interest you? *
Required
When would you like your child to start at ECA? *
Eagle Creek goes through 5th grade. Until what age or grade do you plan to keep your child at Eagle Creek? *
What are you looking for in a school? What do you hope Eagle Creek offers?  *
Please share the names of the daycares and schools your child has attended, including the approximate dates. (We will not contact these places without talking to you first.)
What is your child's primary language? *
If your child speaks other languages, please provide details.
Has your child ever been seen by a specialist or been tested for emotional, social, behavioral or academic purposes? *
If your child has ever been seen by a specialist or tested for emotional, social, behavioral or academic purposes, please provide details.
Is your child above-level in reading, writing, math, science, technology, art, music, sports or any other school discipline? *
If your child is above-level, please provide details. 
Does your child have any delays or special needs? *
If your child has any delays or special needs, please provide specifics.
Does your child have an IEP, a 504 plan or any similar plan pending or in place?  *
If your child has an IEP, a 504 plan or any similar plan pending or in place, please provide details.
Does your child have an aide during the school day? *
Does your child have any allergies or medical conditions? *
If your child has any allergies or medical condtions, please provide details.
If your child has siblings, how old are they, and where do they attend daycare or school? (We will not contact these places without talking to you first.) *
School year: If your child will be in a toddler, preschool or Young Fives class, please tell us your preferred schedule.  *
School year: If your child (any age or grade) will be in before-care, please indicate the days and times. Select all that apply. *
School year: If your child (any age or grade) will be in after-care, please indicate the days and times. Select all that apply. *
Summer Camp: If your child will be in a 3 & 4 year-old preschool room, please tell us your preferred schedule.  *
Summer Camp: If your child will be in a 3 & 4 year-old preschool room, your child must attend for at least 5 weeks (out of 12) during the summer. The weeks are not required to be consecutive. Do you agree to this?  *
Summer Camp:  If your child (any age or grade) will be in before-care, please indicate the days and times. Select all that apply. *
Summer Camp: If your child (any age or grade) will be in after-care, please indicate the days and times. Select all that apply. *
Eagle Creek offers financial aid, special discounts and merit awards for children in kindergarten through 5th grade during the school year. Is your family seeking any of these? *
If you are seeking financial aid, a special discount or a merit award, please provide a few details. You will have a chance to explain in depth during the process.  *
How did you first hear about Eagle Creek Academy? *
What are the other ways you learned about Eagle Creek, if any?
If you know any Eagle Creek families or staff members (past or present), please let us know so we may thank them for any help they have provided.
Thank you for your interest in Eagle Creek Academy! We will contact you shortly.
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