BCA Early Childhood Program Application

Date of Application: *

Please submit the following documents with your completed application. Admission Requirements:

• Non-Refundable $175.00 Application Fee
• * Automatic Draft Form Completed
• * Tuition Agreement Form
• A copy of your student’s birth certificate
• An updated copy of Certificate of Immunization Compliance Form #121
• Health/Medical Care Plan and/or Allergy Plan (if applicable)

Please address all paperwork to admissions@brownchristianacademy.org

Admission is contingent upon space availability and favorable Play-based Observations results. Continued enrollment is contingent upon: satisfactory academic progress, acceptable conduct, upstanding business office transactions, cooperation with school policy and procedures and general decorum. I agree to comply with the rules and regulations of Brown Christian Academy regarding fees, attendance, health, clothing, and other items as specified in the Parent/Student Handbook. The information contained in the Parent/Student Handbook as well as the tuition rates are subject to change. BCA administrative staff will notify parents in writing of any changes. By signing this document, I agree to honor all terms of the contract and the written policies of Brown Christian Academy, now and in the future. Breach of this agreement in any way by the parent or student, may result in immediate termination of services. I understand the terms of this application and certify to the best of my knowledge that the information provided is accurate.

If available, please upload any applicable forms listed above:

Parent Signature: *

clear

*Not due until child has been admitted to Brown Christian Academy.

Student Information

First *

Middle *

Last *

Preferred Name: *

Date of Birth: *

Last Grade: *

Male/Female: *

Male

Female

Street Address *

City/State *

Zip Code *

Parent Information

Parent verification will be made by the birth certificate. Anyone other than the mother or father of the child must provide proof of guardianship in order to register the child.

Parent #1 *

Father

Mother

Guardian

Full Name: *

Primary Phone#: *

Work#:

Mailing Address: *

Email *

City *

State *

Zip Code *

Marital Status:

Parent #2

Father

Mother

Guardian

Full Name:

Cell#:

Work#:

Mailing Address:

City

State

Zip Code

Email Address

Sibling Information (If Applicable)

1. Name

Age

Grade

2. Name

Age

Grade

3. Name

Age

Grade

Authorized Pick Up

Parent/Legal Guardian should not be listed

	Name	Phone #	License #	Relationship
1.	Name	Phone #	License #	Relationship
2.	Name	Phone #	License #	Relationship
3.	Name	Phone #	License #	Relationship

Emergency Contact Information

	Name	Phone #	Relationship to Student
Contact 1.	Name	Phone #	Relationship to Student
Contact 2.	Name	Phone #	Relationship to Student
Contact 3.	Name	Phone #	Relationship to Student
Contact 4.	Name	Phone #	Relationship to Student

For inclement weather, high safety alert or other important announcements, BCA will utilize an automated calling system. The mobile numbers of the mother and father or legal guardian will be used unless otherwise noted. If you would like to use any number other than the mobile number of the mother and father or legal guardian, please list those numbers.

1.

2.

Health and Medical Habits

Does your child have any of the following medical concerns?

Asthma (Parent or Legal Guardian must complete the Health/Medical Plan)

Allergies (Parent or Legal Guardian must complete the Health/Medical Plan)

Environmental:

Food:

List Medications:

N/A

List Environmental, Food or List of Medications below

*If either of the above heath concerns are checked, an applicable plan must be completed.

Brown Christian Academy Statement of Faith

Having been led, as we believe, by the Spirit of God to receive the Lord Jesus Christ as our Savior, and on the profession of our faith, having been baptized in the name of the Father, and of the Son, and of the Holy Ghost, we do now, in the presence of God and angels, most solemnly and joyfully enter into covenant with one another, as one body in Christ.

We engage, therefore, by the aid of the Holy Spirit, to walk together in Christian love; to strive for the advancement of this Brown Christian Academy in knowledge, holiness, and comfort; to promote its prosperity, and spirituality.

We also engage to maintain family and sacred devotion; to religiously educate our children; to seek the salvation of our kindred and acquaintances; to walk circumspectly in the world; to be just in our dealings; faithful in our engagements; and exemplary in our deportment; to avoid all tattling, backbiting; and excessive anger; to abstain from the sale and use of intoxicating drink as a beverage; and to be zealous in our efforts to advance the kingdom of our Savior.

We further engage to watch over one another in brotherly love; to remember each other in prayer; to aid each other in sickness and distress; to cultivate Christian sympathy in feeling and courtesy in speech; to be slow to take offense, but always ready for reconciliation, and mindful of the rules of our Savior; to obey without delay.

Parent Signature: *

clear

BCA Early Childhood Program

Student's Name *

Parents, please read carefully and check the appropriate area.

1. I give permission for my child to take part in all school activities, including sports and school-sponsored trips away from school premises, and absolve the school from liability to my child or me because of any injury to my child at a school activity. *

My child MAY participate.

My child MAY NOT participate.

2. I give permission for my child to be photographed by a school representative for the purpose of being published in BCA’s media platforms, including social media, newspapers, magazines, and videos. *

My child MAY be photographed.

My child MAY NOT be photographed.

3. I have received a copy of the Mississippi State Health Department’s Child Care Regulations Summary for Parents. *

I HAVE received a copy

I HAVE NOT received a copy

4. Brown Christian Academy has the authority to obtain emergency medical treatment for my child in the case of an emergency. *

My child MAY receive treatment.

My child MAY NOT receive treatment.

Parent Signature: *

clear

New Student Registration Fee

Registration forms with deposits are required to “hold your child’s spot” until screening.

*

New Student Registration Fee ($175.00)