2020-2021 Voluntary Pre-K Online Enrollment Registration
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.
Your child must be Four years old by September 1, 2020 to attend the Voluntary Pre K Program at Excell Academy.
Child's Last Name *
Child's First Name *
Middle Initial
Please select one of the following progrmas *
Last School/Daycare attended *
Name and Phone Number
Has your child completed an Early Childhood Screening? If so, where? *
Name and Phone Number
Public School District in which you live in *
How did you hear about Excell Academy? *
Family Situation *
Who does your Child Live with?
Required
Student's Street Address *
Apt Number
City, State *
Zip Code *
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 *
Biological Mother's First Name *
Are you the child's biological mother? *
Mother's Daytime Phone Number *
Type of Daytime Phone Number *
Mother's Street Address *
Apt #
City, State *
Zip Code *
Mother's Place of Employment *
Mother's Place of Employment Phone Number *
Mother's Email Address
Biological Father's Last Name *
Biological Father's First Name *
Father's Daytime Phone Number *
Type of Primary Phone Number *
Required
Father's Street Address *
Apt #
City, State *
Zip Code *
Father's Place of Employment *
Father's Place of Employment Phone Number *
Father's E-mail Address
Legal Guardian First Name (IF OTHER THAN BIOLOGICAL PARENTS)
Legal Guardian Last Name (IF OTHER THAN BIOLOGICAL PARENTS)
Legal Guardian Daytime Phone
Legal Guardian Street Address
Apt #
City, State
Zip Code
Emergency Contacts
Emergency Contact Name #1 *
(other than parent(s) or a doctor)
Emergency Contact #1 Relationship *
(other than parent(s) or a doctor)
Required
Emergency Contact #1 Telephone Number *
Emergency Contact #1 Street Address *
Apt #
City, State *
Zip Code *
Emergency Contact Name #2 *
(other than parent(s) or a doctor)
Emergency Contact #2 Relationship *
(other than parent(s) or a doctor)
Required
Emergency Contact #2 Telephone Number *
Emergency Contact #2 Street Address *
Apt #
City, State *
Zip Code *
Emergency Contact Name #3 *
(other than parent(s) or a doctor)
Emergency Contact #3 Relationship *
(other than parent(s) or a doctor)
Required
Emergency Contact #3 Telephone Number *
Emergency Contact #3 Street Address *
Apt #
City, State *
Zip Code *
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.
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. *
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.
Home Environment
Parents are *
Names and ages of Siblings *
Name, DOB, School Attending
Other adults in the household *
Name, Relationship
Social/Emotional Development
Previous Educational Experiences *
Do you consider your child to be *
Does your child have playmates? If so, what ages/gender? *
Check the word(s) that describe your child *
Required
What makes your child frustrated or upset? *
Describe discipline used at home *
Describe any fears your child may have and how you have dealt with them *
What are your child's favorite play activities? *
Describe any special interest of your child *
Activities that your child is cautious about *
Child is *
Other comments about your child's developments
Behavior: *
Students are expected to maintain good behavior at all times during the Kindergarten Readiness Program. If the behavior is not appropriate, students will be given two warnings along with a conference with parents. If after the warnings the behavior does not improve the child(ren) may be asked to leave the program. Excell Academy will not tolerate inappropriate/misbehavior in the Kindergarten Readiness program. By signing the following electronically, I agree to comply with the above behavior policy at Excell Academy for Higher Learning.
Consent for NON Prescription Medicine *
I hereby give Excell Academy permission to apply any of the following external preparations that are checked, in accordance with directions for use on the appropriate container.
Required
Is your child on an IEP (Individualized Education Plan) *
Please select any special development needs your child may have that we should be aware of *
Required
Students must be completely toilet trained to attend the program
Is your child bladder trained? *
Is your child bowel trained? *
Any concerns in this area? *
Does your child take a regular nap? If so, what time? *
Is there anything unusual about your child's appetite? *
Favorite Foods *
Food Dislikes *
Any usual eating habits *
Food allergies *
Your Expectations
What do you want most out of your child's experience at Excell Academy? *
Areas of Development you want to see emphasized *
Any other information your consider important for Excell Academy to know?
Submitting your Application
By signing your electronic signature below, you are enrolling your child into Excell Academy. If you have selected to attend the extended day program, fees must be paid in order to reserve enrollment. *
Today's Date *
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