Online Enrollment Application

Please list all persons that you have authorized to pick-up your child from the premises of EL Bethel Christian Academy; only the persons listed on this form will be allowed to take your child from this school. If for some reason you or anyone listed below are unable to pick-up your child please call the school office and notify the school staff of who will be picking up your child for that day. This individual must provide the school staff with proper I.D. at which time a photocopy of the I.D. will be placed in the student’s file. For your student’s safety, we will not release them if this procedure is not followed.

I, *

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Do authorize the following people to pick up my child on a daily or emergency basis. I also take responsibility to contact the school to let them know of any changes in this vital matter.

Authorized Person's Name #1 *

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Last

Address *

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State

Zip Code

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Phone Number *

Authorized Person's Name #2 *

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Last

Authorized Person's Name #3 *

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Last

Address *

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Zip Code

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Address *

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Phone Number *

Late Fee will be applied after 3:15 p.m.

Enclose the following with your application for each student:

____1. Application filled out completely

____2. Application Fee & Transcripts for High School Students

____3. A copy of Student’s Birth Certificate

____4. A recent photograph

____5. Request for Release Form

____6. IMPORTANT: By Law, We must have on file the student’s up-to-date health records-which includes health exam form and immunization records recorded on form 680. These should be included in their school records which we are requesting. However, for all 7th graders: All 7th graders entering school now must receive a Hepatitis B Vaccine, a second dose of MMR, and tetanus-diphtheria booster. This must be recorded on the new 680 form by a doctor or health clinic. We cannot accept 7th grade students without this original form or a temporary medical exemption from the doctor or health clinic showing you are in the process of completing shots.

Medical History / Consent for Treatment

It is mandatory that pupils who show symptoms of communicable disease be excluded from class until re-admission is
acceptable to school authorities. Your cooperation will be greatly appreciated. Thank You! Please check all of the following that apply. Has student ever had or have?

Online Application for Enrollment Form

daily pick up / emergency authorization

Medical History / Consent for Treatment

Personal Record

Student's Information