Campus KISSIMMEE CAMPUSPOINCIANA CAMPUSHIGH SCHOOL NEPTUNELEARNING CENTER
Grade Entering Pre-KKindergarten1st2nd3rd4th5th6th7th8th9th10th11th12th
Scholarship Step Up for Students (SUFS)Family Empowerment Scholarship (FES)McKay ScholarshipGardiner Scholarship
Academic Achievement Accessible Scholarship Foundation (AAA)
Date Submitted
Phone
2nd Phone
Student's LEGAL Name
Sex MaleFemale
Birthdate
Age 3456789101112131415161718192021
Social Security #
Street Address
Apt #
City
State
Zip
Place of Birth
Previous School
School District
US Citizen* YesNo
Year Entered the U.S.*
Number of Years in U.S. Schools*
Number of Years in Schools outside the U.S.*
Special Service TestingSpeechADHDLearning DisabilitiesEmotional Impairment
Special Services ReceivedSpeechBilingual/ELSSpecial EducationCounseling
Ethnic Background: American Indian / AlaskanHawaiian / Pacific IslanderAsianWhiteAfrican AmericanHispanic / Latino
Languages Spoken in Home 1*
Languages Spoken in Home 2*
Languages Spoken in Home 3*
Student Living WithBoth ParentsMother OnlyFather OnlyMother and StepfatherFather and StepmotherGuardian
Mother's Name*
Place of Employment*
Cell Phone*
Business Phone*
Fax*
Drivers License #*
Email Address*
Father's Name*
Name
School
Name of Church
Years attending
Pastor Name
(List 3 neighbors or relatives who will assume temporary care of your child if parents can’t be reached)
Name*
Cell*
Relationship*
Emergency Care and Pick-up Permission:
In case of accident or serious illness, I request that the school contact me. If the school is unable to reach me, I authorize the school to make whatever arrangements deemed necessary.
I request that my child participate in any health appraisal activities conducted in school by a Public Health Nurse. The activities may include screening for vision and hearing problems and scoliosis. I understand that there is no charge for these services.
I have been informed that CPCA admits students of any race, color, national, and ethnic origin to all rights, privileges, programs and activities generally accorded or made available to students at the school.
Concerning special services received must be attached to the application form to be placed on the school waiting list. At enrollment time copies of the following items must be submitted: Birth certificate, Immunization records, Physical exam and social security card. There is a fee for cancellation or withdraw of your child before the End of school year.
Central Pointe Christian Academy complies with applicable State law that prohibits discrimination against a student in the full utilization of or benefit from the School, or the services, activities, or programs provided by the School because of race, color, national origin, or sex. There is a $500 withdraw /cancellation fee before December and $450.00 after December and I agree to pay it when I sign this form.
How did you hear about our school
Why do you want your student to attend Central Pointe Christian Academy?
