Enrolling for:
*
2025-2026 RCA School year
Before and After Care (Public School Only)
Requested Start Date:
*
MM
DD
YYYY
Student's Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Sex of Child
*
Male
Female
Student's Home Address (Street, city, state, zip)
*
Primary Phone Number
*
(###)
###
####
How old will your child be on Sept 30, 2025?
*
Birth - 16 months
16 months - 30 months
30 months - 3 by Sept 30
3 - 5
6 - 11
At RCA, your child's school day will be from 8:30 am to 4:00 pm. Do you need care for Before or After School?
*
Yes, Before School Only
Yes, After School Only
Yes, Both Before and After School
No
Parent's Marital Status
*
Married
Single
Separated
Divorced
Student Lives with:
*
Both Parents
Mother
Father
Other Guardian
Who has legal custody?
*
Both Parents
Mother
Father
Other Guardian
Are there any legal documents that are to remain in the student's file?
*
Yes
No
Who is responsible for payments?
*
Both Parents
Mother
Father
Other Guardian
Parent or Guardian Name
*
First Name
Last Name
Relationship to Student
*
Mother
Father
Legal Guardian
Step-Mother
Step-Father
Grandparent
Email
*
Parent or Guardian Home Address (Street, city, state, zip), if different than above
Parent of Guardian Cell Phone
*
(###)
###
####
Employer
*
Work Number
*
(###)
###
####
Parent or Guardian Name
First Name
Last Name
Relationship to Student
Mother
Father
Legal Guardian
Step-Mother
Step-Father
Grandparent
Email
Parent or Guardian Home Address (Street, city, state, zip), if different than above
Parent of Guardian Cell Phone
(###)
###
####
Employer
Work Number
(###)
###
####
Please provide information on all previous school and/or daycare's. (Transcripts for all elementary grades not completed at RCA will need to be submitted)
Name, Relationship to child, address, and phone number:
*
Name, Relationship to child, address, and phone number:
Please list any known chronic medical conditions and/or allergies your child has (food, medicine, etc.)
Parent or Guardian Medical Care Authorization Digital Signature
*
First Name
Last Name
Date Signed
*
MM
DD
YYYY
Parent or Guardian Medical Care Authorization Digital Signature
First Name
Last Name
Date Signed
MM
DD
YYYY
How did you hear about us?
Mailer
Drove By
Yard Signs
Social Media
Internet Search
Referred by a friend
Church
School Van
Discounts
Active-duty military (5%)
Multiple child discount: Youngest child - full tuition, Each additional older child - 5% off per child
Do you authorize the use of photos of your child for marketing purpose?
*
Yes
No
Parent or Guardian Contract Agreement Digital Signature
*
First Name
Last Name
Date Signed
*
MM
DD
YYYY
Parent or Guardian Contract Agreement Digital Signature
First Name
Last Name
Date Signed
MM
DD
YYYY