DREAMWORKS
Christian Academy

Online Application

We are a 501c3 Non-profit organization.

DREAMWORKS Christian Academy Application

Student Information

First name

Middle Name

Last name

Nickname/Preferred Name

Date of Birth

Month

Day

Year

Phone (1-910-xxx-xxxx)

Grade Level Completed

Parent/Guardian Information

Household 1

FIRST PARENT/GUARDIAN INFORMATION:

Full Name

Relationship to applicant (student):

Marital Status

Custodial Rights

Financial Responsibility

Phone (1-910-xxx-xxxx)

Home Address

Place of Work

Work Address

SECOND PARENT/GUARDIAN INFORMATION:

(Leave blank if not applicable.)

Full Name

Relationship to applicant (student):

Marital Status

Custodial Rights

Financial Responsibility

Phone (1-910-xxx-xxxx)

Place of Work

Work Address

Household 2

(Leave blank if not applicable.)

FIRST PARENT/GUARDIAN INFORMATION:

Full Name

Relationship to applicant (student):

Marital Status

Custodial Rights

Financial Responsibility

Phone (1-910-xxx-xxxx)

Home Address

Place of Work

Work Address

SECOND PARENT/GUARDIAN INFORMATION:

Full Name

Relationship to applicant (student):

Marital Status

Custodial Rights

Financial Responsibility

Phone (1-910-xxx-xxxx)

Place of Work

Work Address

SIBLING INFORMATION

If the student has siblings, please list them below.

List each sibling by: Name, Age, Gender, Grade, Current School)

Authorized Person(s) to Pick-up Child:

A Photo ID must be on file for all persons authorized for pick-up.

Name

Phone (1-910-xxx-xxxx)

Relationship to Child

Name

Phone (1-910-xxx-xxxx)

Relationship to Child

Student Release Authorization

In the event that DW Christian Academy is unable to contact the parent/guardian, I authorize that my child may be released to the person(s) listed above, or currently on file.

Legal Parent/Guardian sign below.

Signature

Signature field is empty.

Date picker

Health Needs/Concerns

Please list any allergies or special needs we need to be aware of:

Primary Health Insurance

Insurance Policy #

Insurance Policy Holder's Name

Primary Care Physician's Name

Primary Care Physician's Phone

Primary Care Physician's Address

Emergency Medical Authorization

I understand that in the event of an accident or illness, every effort will be made to contact the parent/guardian immediately. If parent/guardian cannot be reached, I authorize school authorities to obtain emergency care for my child.

Legal Parent/Guardian sign below:

Signature

Signature field is empty.

Date picker

PREVIOUS SCHOOL INFORMATION

School Name

Address of School

Phone # for Previous School

Starting Date

Month

Day

Year

Ending Date

Month

Day

Year

For the following question, please provide DW Christian Academy with the corresponding paperwork upon completion of this application and payment of the registration fee.*

Does the applicant (student) have or have they ever had any exceptional children paperwork or testing (IEP, 504, or Academically Gifted Plan)?

Yes

Upload here

You may submit the above documentation here or to Ms. Kellye in person.

RELIGIOUS AFFILIATION

Current Church/Congregation

Church Phone

Name of Senior Pastor

Additional Applicant Information:

Student's hobbies, sports, and special interests:

Student's scholastic, athletic, or community honors:

Has the student ever repeated a grade? If yes, which grade(s)?

Has the student ever been denied admission to a school? If yes, please explain.

Has the student ever been suspended or dismissed for academic, disciplinary, or other reasons? If yes, please explain.

Has the student ever been arrested? If yes, please explain.

Has the student ever had an illness that caused considerable absence from school? If yes, please explain.

Has the student ever been referred by a parent or school for behavioral or emotional evaluation? If yes, please explain.

EDUCARE POLICY AGREEMENTS

DW Christian Academy Cost Agreement:

The cost for attendance DW Christian Academy is located here.

(Please note, absent days do not roll over.) *Please review our Payment Policy and Schedule for more information and payment options.

Legal Parent/Guardian sign below:

Signature

Signature field is empty.

Date picker

DW Christian Academy Behavior Agreement:

I (we) understand that it is a privilege to attend DW Christian Academy. I further understand that my student is expected to be respectful of all Educare and Bladen Released Time Employees/Volunteers and the Foundation Church Property. The program has the right to remove any student from the program for disciplinary issues or for being disruptive and noncompliant with our behavior guidelines outlined in the packet.

Student & Legal Parent/Guardian

Accepts and Acknowledges the Behavior Agreement.

Legal Parent/Guardian Signature

Signature field is empty.

Date picker

COVID-19 Information:

I (we) understand that in the event my child should be diagnosed with COVID-19, the school can contact Educare and share this information. I (we) understand that in the event that a student has to be quarantined due to exposure, the student may return to Educare after 5-7 days with no symptoms.

Student & Legal Parent/Guardian

Accepts and Acknowledges the COVID-19 information statement.

Legal Parent/Guardian Signature

Signature field is empty.

Date picker

Photo Release Authorization

I, as the legal parent/guardian, give permission to Dream Works Educare to take photographs and/or videos of my child. I understand that these photographs and/or videos may be used for marketing or promotional purposes, including but not limited to social media posts and print materials.

Permission Option:

Yes, I give permission for my child's photo to be used.

No, I do not give permission for my child's photo to be used.

Additional Information:

This permission is granted without any financial compensation.
I understand that once/if my child's photograph is used, it may be publicly accessible and shared.

Legal Parent/Guardian Signature

Signature field is empty.

Date picker

Registration Fee Information

Thank you for completing your child's application for DREAMWORKS Christian Academy!

To hold your child's spot in our program, the Registration Fee must be paid within one week of submitting this application. Your child's spot cannot be held unless the Registration Fee is paid.

The Registration may be paid online or by check. And is non-refundable.

To pay online, click the Apple Pay or the Cash App links and enter the amount listed below.

To pay by check, make the check out to Educare DreamWorks. You can mail the check to:

DREAMWORKS Christian Academy

c/o Foundation Church

PO Box 922

Elizabethtown, NC 28337

or you may drop off the check at Foundation Church, 909 South Poplar St. Elizabethtown, NC 28337

If paid online, the Registration Fee is $257.50

If paid by check, the Registration Fee is $250.00

I have read and understand the terms of the Registration Fee.

For information about tuition and other costs, please see the Payment Policy.

ELECTRONIC SIGNATURE

My signature below affirms that all of the information contained in this application is correct, complete, and honestly presented. I understand that withholding or misrepresenting information in this application may jeopardize my child's admission.

I hereby grant permission for the representative of DREAMWORKS Christian Academy to examine the school records of my child and to discuss the child's record with officials of the school

Signature

Signature field is empty.

Date

Month

Day

Year

The electronic signatures in this application are treated by DREAMWORKS Christian Academy as physical, handwritten signatures on a paper form.

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