HCCA Enrollment Form
This form is the first step to enroll. One form per student.
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Email *
Today's date *
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Which program are you enrolling in? *
Which School year are you wanting to enroll? *
Name (First, Middle, and Last)  of Student: *
Birthdate of student *
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Student's Address *
Student's Gender *
Grade student will be in for 2025-2026 school year: *
If entering preschool which class are you selecting:
Clear selection
If choosing preschool how many days are you interested in?
Clear selection
If Preschool or Kindergarten, please select one:
Clear selection
Before and/or After Care
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Does your child have Asthma? *
List any allergies your child may have:  *
Father/Guardian's Name, Home Address and Cell Number *
Father's Employer, Work Address and Work Phone # *
Mother/Guardian's Name, Home Address and Cell Number *
Mother's Employer, Work Address and Work Phone *
Marital Status of Parent's (Check all that apply)
Student Lives with (Check all that applies) *
Required
Who has custody of the Student: *
Who is financially responsible for the Student? *
Emergency Contact for the Student, must be different than mother and father.    (Name, relationship and phone #): *
Family Doctor (Name and Number) and Choice of Hospital: *
Is Your Child receiving medical treatment? If so, what kind? *
Is your child immunocompromised? *
Has your child been vaccinated and up to date? If no, why? *
Siblings Names and Ages: *
Does at least one parent have a church affiliation: *
Name of Church, Phone # and Pastor *
Church Attendance: *
Required
Name of School the Student Last Attended and Grade: *
Has the Student Repeated a Grade? If so, why? *
Has the student been disciplined beyond regular classroom discipline and or has student been suspended? *
Has your student been in trouble with the law or with illegal substances? If so, please explain. *
Has your student ever been referred for testing or placed in a special Program?  Does your student have an IEP? *
Check all that apply to the Student:
Why do you want your child to attend a Classical Christian School? *
How did you hear about HCCA and become interested? *
List any awards or honors this Student has received. *
Please list the name and phone number for the following people who knows the student well (not including a relative):  A teacher, A Pastor and a Friend. *
Enrolling Parent's Signature (May type initials) and date: *
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