ACA Enrollment Form

Student Information

Birth Date or Due Date

Ideal Start Date

Enrollment Information

Parent/Guardian 1

Parent/Guardian 2

Household Information

Emergency Contacts and Pick Up List

Able to Pick-Up

Emergency Contact

Able to Pick-Up

Emergency Contact

Able to Pick-Up

Questions about your Child

Wait List Agreement.pdf

We have read and understand the attached Wait List Agreement. We agree to the timelines, procedures, and expectations.

We understand ACA will not accept unimmunized children. A copy of my child's shot records will be provided before starting at ACA and will be kept updated.