2018-2019 Online Enrollment
Excell Academy is an equal opportunity public charter school. No child will be denied enrollment on the basis of race, ethnicity, social-economic status, mental or physical challenges, religion, etc.
Child's Last Name *
Your answer
Child's First Name *
Your answer
Middle Initial
Your answer
Date of Birth *
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Grade Entering September 2018 *
Previous School Attended *
Name and Phone Number
Your answer
Student's Street Address *
Your answer
Apt Number
Your answer
City, State *
Your answer
Zip Code *
Your answer
Family Situation *
Who does your Child Live with?
Names and ages of other adults and/or children in the home:
example: John Doe, 12
Your answer
Have you recently moved to our district within the past 36 months for temporary or seasonal agriculture or fishing work? *
Biological Mother's Last Name *
Your answer
Biological Mother's First Name *
Your answer
Are you the child's biological mother? *
Mother's Daytime Phone Number *
Your answer
Type of Daytime Phone Number *
Required
Mother's Street Address *
Your answer
Apt #
Your answer
City, State *
Your answer
Zip Code *
Your answer
Mother's Place of Employment *
Your answer
Mother's Place of Employment Phone Number *
Your answer
Mother's Email Address
Your answer
Biological Father's Last Name *
Your answer
Biological Father's First Name *
Your answer
Father's Daytime Phone Number *
Your answer
Type of Primary Phone Number *
Required
Father's Street Address *
Your answer
Apt #
Your answer
City, State *
Your answer
Zip Code *
Your answer
Father's Place of Employment *
Your answer
Father's Place of Employment Phone Number *
Your answer
Father's E-mail Address
Your answer
Legal Guardian First Name (IF OTHER THAN BIOLOGICAL PARENTS)
Your answer
Legal Guardian Last Name (IF OTHER THAN BIOLOGICAL PARENTS)
Your answer
Legal Guardian Daytime Phone
Your answer
Legal Guardian Street Address
Your answer
Apt #
Your answer
City, State
Your answer
Zip Code
Your answer
Emergency Contact Name #1 *
(other than parent(s) or a doctor)
Your answer
Emergency Contact #1 Relationship *
(other than parent(s) or a doctor)
Required
Emergency Contact #1 Telephone Number *
Your answer
Emergency Contact #1 Street Address *
Your answer
Apt #
Your answer
City, State *
Your answer
Zip Code *
Your answer
Emergency Contact Name #2 *
(other than parent(s) or a doctor)
Your answer
Emergency Contact #2 Relationship *
(other than parent(s) or a doctor)
Required
Emergency Contact #2 Telephone Number *
Your answer
Emergency Contact #2 Street Address *
Your answer
Apt #
Your answer
City, State *
Your answer
Zip Code *
Your answer
Emergency Contact Name #3 *
(other than parent(s) or a doctor)
Your answer
Emergency Contact #3 Relationship *
(other than parent(s) or a doctor)
Required
Emergency Contact #3 Telephone Number *
Your answer
Emergency Contact #2 Street Address *
Your answer
Apt #
Your answer
City, State *
Your answer
Zip Code *
Your answer
Person(s) Authorized to Pick up Child from School *
Please note that it always required for a parent/legal guardian to notify Excell Academy when an authorized person will be coming to pick up your child. Students will not be released unless a phone call has been received.
Your answer
By submitting my electronic signature, I hereby agree that I must call Excell Academy to notify them that someone other than myself will be picking up my child, my child will not be released to an authorized person until I have notified Excell Academy, and proper identification must be provided by the authorized person at the time of pick up. *
Your answer
Person(s) NOT Authorized to Pick up Child from School
Excell Academy does not release students to ant person without parent consent and notification. Please list name of any person(s) who are unauthorized to pick up your child from school. A court order must be provided if a biological parent is listed.
Your answer
Please tell us why you would like your child to attend Excell Academy for Higher Learning. *
Your answer
Release of Previous School Records *
Family Involvement Agreement (Policy) *
Families are an integral part of the success of Excell Academy and its students. Educational research shows that students are happier, healthier, and more successful academically and socially when their families (especially) parents and/or guardians are actively involved in the child/children’s school life. Active involvement at Excell Academy includes, but is not limited to, participation/volunteering in three or more of the following areas with the highlighted areas being mandatory:
Homework Policy *
Students will have homework daily, with the exception of some weekends. The child’s teacher(s) will send work home for the child to complete. Families must agree to help supervise and/or guide their child with his/her homework. If no work is sent home, families must read to or listen to their child read for at least 15 minutes.
Uniform Policy *
Every student of Excell Academy must wear the complete required uniform daily. If student is unable to wear the appropriate school uniform because of an emergency, a note must accompany him/her with an explanation. There will be a fee assessed for each time your child is out of uniform.
Mandatory Parent Empowerment Workshops *
Excell Academy requires all parents/guardians to attend the mandatory Parent Empowerment Gathering (PEG) workshops . Parents are required to attend at least 3 of 5 two-hour sessions. Parents with students who exhibit excessive behavioral challenges will be required to attend all of the 5 sessions. These workshops are designed to ensure that parents/guardians and Excell Academy staff members are working together towards a common goal. Parents/guardians will be notified in advance of the dates and times of these sessions. Childcare is available upon request.
Medical Emergency/Liability Waiver *
I hereby give my permission for Excell Academy for Higher Learning staff members to procure all necessary medical help for my child or ward while this person is under the supervision of Excell Academy for Higher Learning and grant permission to its representatives to authorize competent medical persons to do all things reasonably necessary to take care of any injury or sickness. There is no health or medical insurance provided by Excell Academy. The signing of this form acknowledges that the student’s parent/guardian accepts responsibility for payment of any emergency medical treatment.
Medical Records and Birth Certificate Requirement *
No student will be admitted to Excell Academy for Higher Learning untill all of her/his immunizations are updated and a copy of these records have been sent to Excell Academy's office. Birth Certificates are required.
Field Trips *
Field trips are an important part of Excell Academy for Higher Learning. Your electronic signature below authorizes your child to attend field trips that are developed as a part of Excell Academy. I acknowledge and accept that my child's participation in Excell Academy field trips are entirely voluntary and all risks are voluntarily assumed by my child and me. I understand that school rules and regulations are in effect at school field trips. I also will ensure that my child understands that it important for their safety, and for the safety of the group, that all rules and instructions given by the field trip supervisors are obeyed. You will be notified in advance of field trips that will take place during the school year.
Your answer
Please take a few minutes to describe your child so that we may better understand his or her learning preferences. *
What academic areas does your child enjoy the most / least? Does he or she prefer a structured environment or more choice? Does your child prefer to work with others or in small groups?
Your answer
By signing your electronic signature below, you are officially enrolling your child at Excell Academy for the 2017-2018 school year. Acceptance into the school is based on the Excell Academy's Equitable Lottery process. *
Your answer
Today's Date *
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