K3 and K4 Pre-Registration

PK3 and PK4 Pre-Registration* for Full Day Program

*required field

Thank you for your interest in Eagle's Landing Christian Academy. Please complete the following form in order to pre-register your child for grades PK3 and PK4.

*Students must be potty trained

Student Information

* First Name
Middle Name
* Last Name
Suffix

Preferred Name

* Gender
* Date of Birth		(mm/dd/yyyy)

* Home Address

* City
* State

* Zip Code

* Country

* Phone Number	(xxx-xxx-xxxx)
* Phone Type

Proposed Entry to Eagle's Landing Christian Academy

* Grade

* Year

If you are interested in applying to ELCA for more than one child, please list additional names and the grades for which your children are applying in the box below.

Family Information (for household in which the student primarily resides)

Parent/Guardian #1 Information:

* Relationship to Student

* Title


* First Name

Middle Name
* Last Name
Suffix

* E-Mail

Parent/Guardian #2 Information:

Relationship to Student

Title


First Name

Middle Name
Last Name
Suffix

E-Mail

Voluntary Information

For accurate record keeping and effective support of our entire student body, please complete the following optional information.

Racial/ethnic background

If Multiracial, please specify

How did you hear about us? (Check all that apply)	Friends Internet Media Siblings Saw Campus Applied Previously Other (Please specify below)
If "Other," please specify

Other Services Requested

Please check below other services you may need for your child:

Summer Program

Care during school breaks

Specific Information Request

By submitting this request form, you will receive information about our application process and upcoming events via email. Note that the ELCA student application is available online. Please specify any additional information that you would like to receive through the U.S. mail.

Thank you for requesting information about ELCA. If you have any questions about the Admissions process, please feel free to contact our office at (678)-818-1072.

When you are finished, please click "Send Form" to complete this form.