Enrollment Application

Application & Schedule

Schedule Preference*

Desired Start Date* Please select your preferred start date.

How did you hear about us?

Student Information

First Name*

Middle Name

Last Name*

Preferred Name/Nickname

Date of Birth*

Gender*

Home Address*

City*

State*

Zip Code*

Primary Language Spoken at Home*

Secondary Language (if applicable)

Previous School/Daycare (if applicable)

Current Grade (for School Age Program)*

Program Specific Information

Infant Feeding

Details about feeding preferences (breastmilk, formula type) will be collected via the Infant Feeding Form, which will be included in your confirmation email.

Development

Is your child potty trained?
Yes No In Progress

What does your child say/do for potty needs?

Does your child need help with:
Dressing/Undressing Eating Washing Hands

VPK specific policies, like attendance, will be covered in the final acknowledgements section.

Important VPK Information

Florida's Voluntary Prekindergarten (VPK) is a state program providing free tuition for VPK hours. To receive this funding, you must first apply for and receive a Certificate of Eligibility (VPK Voucher) from your county's Early Learning Coalition (ELC).

Please ensure you have applied for or obtained your VPK voucher if you wish to use state funding. You can typically apply online:

Orange County ELC Website: https://elcoforangecounty.org/
Statewide Family Portal (Application): https://familyservices.floridaearlylearning.com/

You can complete our school enrollment form now. If you enroll without a VPK voucher, standard private tuition rates will apply for the program hours. Final enrollment using VPK funding depends on providing the official Certificate of Eligibility.

All About Your Child

Help us get to know your child better! (These questions are based on the "All About" form in the enrollment packs).

What are your 3 most basic priorities regarding the total education of your child?

What would you like your child to learn about God?

Play Habits / Likes & Dislikes:

Fears or Anxieties:

Eating Behaviors / Special Diet (Non-Allergy related):

Any home situation details helpful for transition (optional):

How does your child primarily communicate their needs/wants?

How does your child feel about starting school/childcare?

What special accomplishments (e.g., dressing self, tying shoes, specific skills) is your child currently working on?

Parent/Guardian Information

Primary Parent/Guardian

First Name*

Last Name*

Relationship to Student*

Email*

Cell Phone*

Employer

Work Phone

Student lives with this Parent/Guardian

Secondary Parent/Guardian (Optional)

First Name

Last Name

Relationship to Student

Email

Cell Phone

Employer

Work Phone

Student lives with this Parent/Guardian

Are there any legal custody arrangements or court orders we should be aware of?

If yes, please be prepared to provide copies of legal documentation during your enrollment meeting.

Emergency Contacts & Authorized Pick-Up

Please list at least two emergency contacts (other than parents/guardians listed above) who are authorized to pick up your child in an emergency if parents cannot be reached.

Emergency Contact #1

Full Name*

Relationship to Student*

Phone Number*

Alternate Phone

Authorized to pick up child daily/regularly (in addition to emergencies)*

Emergency Contact #2

Full Name*

Relationship to Student*

Phone Number*

Alternate Phone

Authorized to pick up child daily/regularly (in addition to emergencies)*

Additional Authorized Pick-Up Persons

List anyone else authorized to pick up your child regularly (if not listed above). Parents/Guardians are automatically authorized.

Full Name

Relationship

Phone

Health & Medical Information

Copies of the official Florida Physical (DH 3040) and Immunization (DH 680) forms must be provided separately before your child's start date.

Physician's Name*

Physician's Phone*

Dentist's Name

Dentist's Phone

Does your child have any allergies (food, environmental, medication, etc.)?*

Does your child require an EpiPen for allergies?
Yes No

Does your child have any chronic illnesses, medical conditions, disabilities, or special healthcare needs we should be aware of (e.g., asthma, seizures, diabetes, vision/hearing impairment)?*

Is your child currently taking any medications regularly?

Does your child require meal modifications or substitutions due to a medical condition or disability diagnosed by a doctor?
Yes No

If yes, the required **Medical Statement Form** (to be completed by your healthcare provider) will be attached to your confirmation email.

Do you request meal modifications due to dietary preferences (e.g., religious, vegetarian, non-dairy milk substitute) not related to a medical disability?
Yes No

If yes, the **Dietary Preference Form** will be attached to your confirmation email. Please note accommodation of non-medical preferences is encouraged but not guaranteed.

Transportation

Will your child require transportation services provided by Highland Christian Academy (e.g., for School Age Program)?
Yes No

If Yes, specify School Name for pickup/dropoff:

I give permission for my child to be transported by Highland Christian Academy as needed for the program. I understand HCA will take necessary safety precautions. * (Required if Yes to needing transport)

Faith Information (Optional)

Church Name (if attending)

Denomination

Why have you chosen a Christian education for your child?

Is either parent a member of First Baptist Church of Apopka?
Yes No

Financial Information

Person Responsible for Payment*

Payment Plan Preference* Tuition is typically due in advance.

Highland Christian Academy participates in the Child Care Food Program (CCFP). An application form for this program will be included in your confirmation email after submitting this initial enrollment information.

Agreements & Permissions

Please review and acknowledge the following policies and permissions.

I agree to read the Parent Handbook (link opens new tab) and abide by all policies and procedures of Highland Christian Academy.*

I acknowledge I have reviewed or will review the school's policies regarding Discipline, Health, Suspension/Expulsion, and Financial Obligations as outlined in the Parent Handbook and/or Enrollment Pack materials.*

I understand that Bible stories, prayer, and Christian character training are integral parts of the daily program at Highland Christian Academy, including the definition of marriage as the union of one man and one woman.*

I give permission for my child to participate in classroom food-related activities and celebrations (allergies noted previously will be considered). You may uncheck this if you prefer your child not participate.

Photo/Video Release Permission*

I acknowledge receipt of information regarding the Influenza Virus via the Florida DCF "The Flu - A Guide for Parents" brochure. (View Brochure)*

I acknowledge receipt of information regarding vehicle safety via the Florida DCF "Distracted Adult" brochure. (View Brochure)*

I acknowledge I have read and understand the specific VPK Attendance Policy regarding absences and tardiness as required by the program. (Details in VPK Enrollment Pack) * (Required for VPK)

I acknowledge that the Consent For Treatment Form requires notarization. I understand I must download this form, have it notarized, and submit the physical copy to the HCA office before my child's start date. A copy will also be attached to my confirmation email.*

I give permission for my family's contact information (Parent Names, Email, Phone) to be included in the school directory shared with other enrolled HCA families. (Uncheck to opt-out)

I give general permission for my child to participate in local walking field trips (e.g., to a nearby park). (Separate permission forms will be sent home for any trips requiring vehicle transportation)

I authorize Highland Christian Academy to request academic and health records from my child's previous school/childcare provider (if applicable).

Additional Information

Additional Notes or Comments

Submit Application

I certify that all information provided in this online application is true and accurate to the best of my knowledge.*

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Upon submission, please check your email for confirmation and instructions regarding additional required forms.

Highland Christian Academy

1. Select Program

2. Choose Application Method

Online Enrollment Application

Application Instructions

Application & Schedule

Student Information

Program Specific Information

Infant Feeding

Development

Important VPK Information

All About Your Child

Parent/Guardian Information

Primary Parent/Guardian

Secondary Parent/Guardian (Optional)

Emergency Contacts & Authorized Pick-Up

Emergency Contact #1

Emergency Contact #2

Additional Authorized Pick-Up Persons

Health & Medical Information

Transportation

Faith Information (Optional)

Financial Information

Agreements & Permissions

Additional Information

Submit Application

Documents Required Before Start Date