Preschool Enrollment

Welcome

Thank you in advance for choosing TCA Preschool for your child to learn and grow!

My student is enrolling in:(Required)

K2

K3

K4 VPK

Preschool enrollment applications will not be accepted if they are incomplete. All items listed below must be submitted with the application in order for your child to be accepted into our program. No exceptions can be made.

For your convenience, you can save and continue this application at a later time while you work on putting together all of the necessary documentation.

K2/K3 Checklist

Complete Student Information
Complete Family Information
Parental / Guardianship (court forms if applicable)
Tuition Preference
Contract
Original Immunization Form (DH 680)
Original Physical Form (DH 3040)
Copy of Birth Certificate
Financial Agreement Form
$100 Application Fee

K4 VPK Checklist

Complete Student Information
Complete Family Information
Parental / Guardianship (court forms if applicable)
Tuition Preference
VPK Voucher
Contract
Original Immunization Form (DH 680)
Original Physical Form (DH 3040)
Copy of Birth Certificate
Financial Agreement Form
$100 Application Fee

This enrollment application does not automatically mean your child is accepted into our program. We must review the application and make sure all fields are filled in and all required attachments have been submitted along with the application.

Family Information

Parent's Relationship to Each Other:(Required)

(If divorced, a copy of the Divorce Decree noting guardianship, days of visitation, etc, must accompany this form.)

Parent 1 Information

Name(Required)

First Last

Relationship to Child

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Employer

Work Phone

Parent 2 Information

Name(Required)

First Last

Relationship to Child

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Employer

Work Phone

Emergency Pick-Up Persons

List two local persons other than father and mother / legal guardians who will assume responsibility for your child in an emergency if parents cannot be reached.

First Contact

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Alternate Phone

Second Contact

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Alternate Phone

Emergency Medical Information

Consent(Required)

In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize Trinity Christian Academy Preschool to arrange transportation for my child via emergency vehicle to an Emergency Room.(Required)

Doctor Name

First Last

Preferred Hospital

Hospital Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Hospital Phone

Special Instructions

Please list all allergies and exact reaction to allergies if applicable

Any additional medical information?

In addition, the insurance information requested below can provide necessary information for treatment of your child.

Medical Insurance Carrier

Policy #

Insured's Name

First Last

Authorized Pick-Up List

Authorized Pick-Up List Consent

I authorize that my child to be released by Trinity Christian Academy Preschool to the following persons, in addition to those already listed as an emergency contact. (A photo ID is required upon pick-up.) If you need to add / delete a pick-up contact, you may come to the preschool office and fill out an authorized form or update your information in the Brightwheel application prior to pick-up.

Name(Required)

First Last

Relationship to Child(Required)

Phone(Required)

Name

First Last

Relationship to Child

Phone

Name

First Last

Relationship to Child

Phone

Name

First Last

Relationship to Child

Phone

Name

First Last

Relationship to Child

Phone

Name

First Last

Relationship to Child

Phone

Photo Release

Photos will be taken during the school year for various reasons such as promoting the school through our school website (trinitychristianacademy.com), Facebook, through power point presentations during school events, and in our school yearbook. In order to do this, we will need your permission to use your child’s photo. Please check one of the following:

Photo Release Consent(Required)

I give permission to Trinity Christian Academy Preschool to use my child’s photo.

I do NOT give permission for Trinity Christian Academy Preschool to use my child’s photo.

Child Abuse Policy

Consent(Required)

In accordance with s. 39.201 of the Florida State Statues, all child care personnel are mandated by law to report their
suspicions of child abuse, neglect, or abandonment to the Child Abuse Hotline 1-800-962-2873.

I have read and understood the policy mentioned.(Required)

Parent 1 / Guardian Initials:(Required)

Parent 2 / Guardian Initials:

Late Pick-Up Policy

Late Pick-Up Policy Consent(Required)

Though we understand things may come up unexpectedly and may cause you to be late picking up your child, our program does not allow late pick ups. Any time your child is picked up late you will be assessed a fee of $1.00 per minute.

I have read Trinity Christian Academy Preschool’s Late Pick-Up Policies and understand I will be assessed an additional fee if my child is picked up late in more than two occasions.(Required)

Parent 1 / Guardian Initials:(Required)

Parent 2 / Guardian Initials:

Parent Authorization and Agreement

Parent Authorization and Agreement Consent(Required)

I have received the TCA Preschool Parent/Student Handbook and agree to read it in its entirety, and to adhere to the policies of TCA Preschool/Florida League of Christian Schools (FLOCS).

I have received a copy of the” Child Care Facility Brochure “Know Your Child Care Facility, The Influenza Virus”, “ A Guide for Parents”, “Distracted Adult Brochure”, “Ryla Wilson Act”, “Getting In Getting Out Brochure”

I have read the TCA Preschool Illness and Medication Distribution Policy and agree to adhere to and follow the practices and policies as stated.

I have read the TCA Preschool Discipline Policy and agree to adhere to and support the practices and policies as stated

I have received, read, understand, consent to and support all of the authorizations, pledges and agreements as stated above and as required by Trinity Christian Academy Preschool’s handbook, policies and procedures. If I have questions, it is my responsibility to seek clarification from Preschool Administration.

Your signature below indicates that you have received the above items and that the information on this enrollment form is complete and accurate. I hereby grant permission for the staff of this facility to have access to my child’s records.

Parent 1 / Guardian Signature(Required)

Date(Required)

Parent 2 / Guardian Signature

Date

Welcome

K2/K3 Checklist

K4 VPK Checklist

Student Information

Family Information

Parent 1 Information

Parent 2 Information

Emergency Pick-Up Persons

First Contact

Second Contact

Emergency Medical Information

Student Medical History

Authorized Pick-Up List

Photo Release

Child Abuse Policy

Late Pick-Up Policy

Parent Authorization and Agreement

Trinity Christian Academy

Hours