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HCA Enrollment Contract
This application will not be accepted until it is entirely complete.
This is a contract between the parent(s) of the child enrolled in the preschool and Harvest Christian Academy for childcare services.
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* Indicates required question
Email
*
Your email
Enrollment Application
Child's Name:
*
(First, Middle, Last, "Nickname")
Your answer
Birth Date:
*
MM
/
DD
/
YYYY
Sex:
*
Choose
Male
Female
Child's living arrangements:
*
Choose
Mother
Father
Both Parents
Grandmother
Grandfather
Guardian
Time your child will arrive at our school:
*
This can be an approximate time.
Note: Children may not arrive after 9:30 am without a prior phone call and a doctor's note at drop-off.
Time
:
AM
PM
Time your child will be picked up from our school:
*
This can be an approximate time.
Time
:
AM
PM
Days your child will attend:
*
We are closed on weekends.
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Meals your child will participate in:
*
All meals are included in the cost of tuition and provided by the center.
Breakfast
Lunch
Afternoon Snack
Required
Mother/Guardian Information
(Father info is in the next section. Do not leave anything blank. Type "N/A" if it is not applicable.)
Name:
*
(First and last name)
Your answer
Email:
*
Your answer
Address:
*
Street Address, City, State, Zip
Your answer
Cell Phone:
*
Include the area code.
Your answer
Social Security Number:
*
Full social security number is required for every parent signing this contract.
Your answer
Employer:
*
Your answer
Employer Phone:
*
Include the area code.
Your answer
Employer Address:
*
Street Address, City, State, Zip
Your answer
Father/Guardian Information
(Father or second parent/guardian only. Type "N/A" if it is not applicable. You will provide information for authorized pick-ups in the next section.)
Name:
*
(First and last name)
Your answer
Email:
*
Your answer
Address:
*
Street Address, City, State, Zip
Your answer
Cell Phone:
*
Include the area code.
Your answer
Social Security Number:
*
Full social security number is required for every parent signing this contract.
Your answer
Employer:
*
Your answer
Employer Phone:
*
Include the area code.
Your answer
Employer Address:
*
Street Address, City, State, Zip
Your answer
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