Daycare Application Home > Daycare Application Step 1 of 17 - Admission Policy and Procedures 0% This field is hidden when viewing the formSchool Year2025-2026Start Your New Student ApplicationYour Name(Required) Your First Name Your Last Name Your Email(Required) Your Phone(Required)Admission Policy and Procedures(Required) Admission Policy and Procedures 1. Ambassador Christian Academy operates under the Statement of Faith and its desire for every parent to partner with the school in pursuing our mission{"Mission"} of developing their child so that he/she will become an effective Christian, living according to Biblical standards. 2. Ambassador Christian Academy does not discriminate on the basis of race, color, gender, national or ethnic origin in its admission policies and practices. 3. While Ambassador Christian Academy implements a curriculum and promotes an environment designated to meet the diverse needs of each student. 4. Ambassador Christian Academy strives to meet the needs of every student entrusted to its care. Ambassador Christian Academy may not possess the resources to provide for students who have: Displayed significant emotional or disciplinary problems. A physical handicap, which would impair the learning process under normal educational conditions A learning disability for which our program is not staffed 5. For parents seeking funding through a State Voucher System, the following information applies: Daycare students must be at least 12 months and walking. Pre-School students must be ages 2-3 years old before August 1. Pre-Kindergarten students must be at least 4 years old by August 1. Admission Policy Each student applying for 12 Months - Pre-K 4 Program must submit: Application for Admission Financial Packet Parent/Guardian Commitment Form Medical Alert Form A copy of the applicant's Birth Certificate A copy of the applicant's Immunization Record Student Physical (Needed before student can begin) Custodial Documentation/ Restraining orders, if applicable Please note that both parents are allowed to visit student at school and participate in activities unless otherwise noted in court documents. Update 2/27/2022 MC 1. A final decision regarding admission will be made and the parent of the prospective student will be notified. 2. For enrollment to be finalized, arrangements for tuition payments must be completed with the Finance office. I have read and I agree to the Admission Policy and Procedures.(Required) Applications will be processed in the order in which they are received, only after all procedures have been followed and all paperwork has been submitted. Please fill out the application completely and accurately. Student InformationEarly Education Option Student is Applying For:(Required)Early Education Option Student is Applying For:12 months - 23 Months (TTT)2-Year-Old Pre-School (TT2)3-Year-Old (TT3)4-Year-Old/ Pre-Kindergarten (PreK-4)School Year(Required)Student's Legal Name(Required) Student's Legal First Name Student's Legal Middle Name Student's Legal Last Name Student's NicknameStudent's Address(Required) Student's Address Student's Address Line 2 Student's City Student's StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Student's State Student's Zip Code Phone Number(Required)Student's Date of Birth(Required) MM slash DD slash YYYY Student's Age(Required)Student's Gender(Required)Student's GenderMaleFemaleHow did you become interested in ACA?(Required)How did you become interested in ACA?FriendPastorRelativeAdvertisementOtherWhy do you wish to send your child to Ambassador Christian Academy?(Required)Describe your child's interests, talents, and abilities:(Required) Parent / Guardian InformationFather's Name Father's First Name Father's Last Name Father's Cell NumberFather's Email Father's OccupationFather's WorkplaceFather's Work PhoneMother's Name Mother's First Name Mother's Last Name Mother's Cell NumberMother's Email Mother's OccupationMother's WorkplaceMother's Work Phone Family BackgroundMarital Status(Required)Marital StatusMarriedDivorcedSingle ParentLiving with GuardianWho has custody for decision making?(A copy of the custodial documentation is required)Who has custody for decision making?JointFatherMotherCustodial Documentation Drop files here or Select files Max. file size: 256 MB. Are there any additional siblings who attend Ambassador Christian Academy?(Required)Are there any additional siblings who attend Ambassador Christian Academy?NoYesPlease list additional siblings that attend Ambassador Christian Academy:First Additional Sibling's Name First Additional Sibling's First Name First Additional Sibling's Last Name First Additional Sibling's GradeFirst Additional Sibling's GradeKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeAdd Second Sibling Add Another Sibling Second Additional Sibling's Name Second Additional Sibling's First Name Second Additional Sibling's Last Name Second Additional Sibling's GradeSecond Additional Sibling's GradeKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeAdd Third Sibling Add Another Sibling Third Additional Sibling's Name Third Additional Sibling's First Name Third Additional Sibling's Last Name Third Additional Sibling's GradeThird Additional Sibling's GradeKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeAdd Fourth Sibling Add Another Sibling Fourth Additional Sibling's Name Fourth Additional Sibling's First Name Fourth Additional Sibling's Last Name Fourth Additional Sibling's GradeFourth Additional Sibling's GradeKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade Notify In Case of Emergency(Parents are always called first, please list another person)First Emergency Contact's Name(Required) First Emergency Contact's First Name First Emergency Contact's Last Name First Emergency Contact's Phone(Required)First Emergency Contact's Relation to Student(Required)First Emergency Contact's Address(Required) First Emergency Contact's Street Address First Emergency Contact's Address Line 2 First Emergency Contact's City First Emergency Contact's StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific First Emergency Contact's State First Emergency Contact's Zip Code Second Emergency Contact's Name(Required) Second Emergency Contact's First Name Second Emergency Contact's Last Name Second Emergency Contact's Phone(Required)Second Emergency Contact's Relation to Student(Required)Second Emergency Contact's Address(Required) Second Emergency Contact's Street Address Second Emergency Contact's Address Line 2 Second Emergency Contact's City Second Emergency Contact's StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Second Emergency Contact's State Second Emergency Contact's Zip Code Permission To Pick Up FormStudent's Name(Required) First Last Student's Class(Required)School Year(Required)Parent's Name(Required) First Last Parent's Phone Number(Required)Add those whom you are giving permission to pick-up your student. (Must be 18 years of age or older with proper identification.)First Permission to Pick-up Name First Last First Permission to Pick-up PhoneFirst Permission to Pick-up AgeFirst Permission to Pick-up Relation to StudentAdd Second Permission to Pick-up Name Add Second Permission to Pick-up Name Second Permission to Pick-up Name First Last Second Permission to Pick-up PhoneSecond Permission to Pick-up AgeSecond Permission to Pick-up Relation to StudentAdd Third Permission to Pick-up Name Add Third Permission to Pick-up Name Third Permission to Pick-up Name First Last Third Permission to Pick-up PhoneThird Permission to Pick-up AgeThird Permission to Pick-up Relation to StudentAdd Fourth Permission to Pick-up Name Add Fourth Permission to Pick-up Name Fourth Permission to Pick-up Name First Last Fourth Permission to Pick-up PhoneFourth Permission to Pick-up AgeFourth Permission to Pick-up Relation to Student Fire Safety Protection/Parent’s Notice Dear Parent(s) or Legal Guardian(s), I understand that this day care ministry is not licensed under the laws of Indiana. I understand that this day care ministry complies with the State rules concerning sanitation and fire safety for the primary use of the structure in which it is conducted. Under Indiana law, a child care ministry may choose not to provide certain fire safety protections if the parent(s) or legal guardian(s) of each child is notified about the absence of the fire safety protections. The purpose of this notice is to advise you that this child care ministry does not have the same level of fire safety protection as a licensed childcare center. Although the child care ministry does not have to comply with the same sanitation, life and fire safety rules as a licensed day care center, we do substantially comply. This child care ministry has also chosen to provide smoke detectors, fire alarms, fire extinguishers and evacuation notices, as required for a licensed day care center. I understand that it is my responsibility to ensure that the nutritional and health needs of my child is being met while he/she is at the day care ministry. This notice does not absolve a day care ministry from liability for injury to a child while the child is at the day care ministry, if the cause of the injury is due to negligence or wrongdoing on the part of the day care ministry and or employee of the day care ministry. Name of Student(Required) First Last Name of Parent / Legal Guardian of Student(Required) First Last Today's Date(Required) MM slash DD slash YYYY Signature of Parent / Legal Guardian of Student(Required) Parent Partnership Commitment FormAs parent or legal guardian of the above applicant, I agree to cooperate with Ambassador Christian Academy in the enforcement of the rules and regulations of the institution and to meet the terms of the agreement about expenses, business details, attendance policy, parent and student behavior, civility requirements and so forth, as outlined by Ambassador Christian Academy. My failure to adhere to this commitment may jeopardize my child’s enrollment status at ACA. In addition, I give permission for my child to take part in all school activities including sports programs and school sponsored trips away from the school premises. I absolve the school from liability in the event my child is injured at school or during any school activity. I agree with the school’s effort to train my child in Bible and will encourage my child in this and in all other phases of instruction.Signature of Parent / Guardian of Student for Parent Partnership Commitment Form(Required) Discipline & Guidance Policy Provider Name: Ambassador Christian Academy It is very important for a child's development to be nurtured through caring, patience and understanding. However, while caring for your children, we may have to respond to your child's misbehavior. Hitting, kicking, spitting, hostile verbal behavior and other behaviors which will hurt another child are not permitted. In response to these behaviors, we will not use: Threats or bribes Physical punishment, even if requested by parent Deprive your child of food or other basic needs Humiliation or isolation In response to misbehavior, we will: Respect your child Establish clear rules Be consistent in enforcing rules Use positive language to explain desired behavior Speak calmly while bending down to your child's level Give clear choices Redirect your child to a new activity Move your child to a time-out chair for no longer than one minute per year of our child's age, if necessary. Time out is only used if a child is out of control, and only until child regains control. If your child's behavior is very disruptive or harmful to himself or other children. We will discuss the issue with you privately. If the situation can be resolved, the child may remain enrolled. We will recommend that the child take a break from childcare. If we are unable to resolve the issue, you may be asked to make other child care arrangements. As a parent, you may have some concerns or wish to offer suggestions. Using the lines below, we may modify the above plan with agreed upon suggestions. Student's Name(Required) First Last Student's Date of Birth(Required) MM slash DD slash YYYY Additional techniques to be used with my child:Parent / Guardian's Name(Required) First Last Today's Date(Required) MM slash DD slash YYYY Parent / Guardian's Signature(Required) Medical Treatment Authorization FormThis form grants temporary authority to a designated adult to provide and arrange for medical care for a minor in the event of an emergency, where the minor is not accompanied by either parents or legal guardians, and it may not be feasible or practical to contact them.MinorFull Legal Name(Required) First Middle Last Student's Home Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Student's CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth(Required) MM slash DD slash YYYY Gender(Required)GenderFemaleMaleInformation for Medical TreatmentPhysician's Name(Required) First Last Physician's Location of Practice(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country of Physician's Location of PracticeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Physician's Phone NumberMedical Insurer/Health Plan:(Required)Policy#:(Required)Allergies to Medications:Allergies (Other):Please note ALL conditions for which the child is currently receiving treatment:Note any other significant medical information:AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S) I do hereby state that I have legal custody of the aforementioned Minor. I grant my authorization and consent for Ambassador Christian Academy (hereafter "Designated Adult") to administer general first aid treatment for any minor injuries or illnesses experienced by the Minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designed Adult to summon any and all professional emergency personnel to attend, transport, and treat the minor and to issue consent for any X-ray, anesthetic, blood transfusion, medication , or other medical diagnosis , treatment , or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist , hospital , or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Designated Adult in the exercise of his or her best judgment upon the advice of any such medical or emergency personnel. Today's Date(Required) MM slash DD slash YYYY This authorization is effective through:(Required) MM slash DD slash YYYY Parent / Legal Guardian's Name(Required) First Last Parent / Legal Guardian's Signature(Required)Witness Name(Required) First Last Witness Signature(Required) Civility PolicyWe are committed to the highest standards of academic and ethical integrity, acknowledging that respect for self and others is the foundation of educational excellence. As such, we will cultivate an environment of mutual respect and responsibility. Whether we are students, faculty, or staff, we have a right to be in a safe environment, free of disturbance and civil in all aspects of human relations. This policy requires mutual respect, civility, and orderly conduct among Ambassador Christian Academy students, parents, employees, and the public. Civility does not deprive any person of his/her right to freedom of expression but serves only to maintain, to the extent possible and reasonable, a mutually respectful, safe, and harassment-free workplace for students and staff. In the event that this policy is not adhered to by a parent, guardian, or spokesperson for a parent, Ambassador Christian Academy reserves the right to immediately release the student of that family. I acknowledge that I have read, understand, and agree to the Ambassador Christian Academy Civility Policy.Signature of Parent / Guardian of Student for Civility Policy(Required) Choice Scholarship Financial Understanding AgreementAs a participant in the State of Indiana’s Choice Scholarship program. I understand that all or a portion of my child’s tuition cost will be funded through a Choice Scholarship Voucher. I further acknowledge I understand that I will be responsible for paying the costs of tuition for all days that my child was in attendance, if I choose to transfer or withdraw my child from Ambassador Christian Academy BEFORE October when the state funds the first half of my child’s tuition costs.Signature of Parent / Guardian of Student for Choice Scholarship Financial Understanding Agreement(Required) Chirp Physical and Shot Record SystemI understand that the annual physical and immunization records that I am required to submit for my child with this application, will be transferred by the school into the Chirp system. Ambassador Christian Academy does not, and will not pull shot records and/or physicals directly from Chirp, in lieu of parents having to provide the requested hard copies for registration.Signature of Parent / Guardian of Student for Chirp Physical and Shot Record System(Required) Photo ReleaseI give my permission for my child’s photo to be used on the school’s website or other school promotional materials.Do you give permission?(Required) Yes No Initials of Parent / Guardian of Student for Photo Release(Required) Permission to TravelI give my permission for my child to travel by bus or van for gym, chapel, and other school programs.Do you give permission?(Required) Yes No Initials of Parent / Guardian of Student for Permission to Travel(Required) Medical AlertMedical Conditions(Required)Please Check All Boxes That Apply Has No Known Allergies Is Allergic To: (Medical Documentation Required) Special Treatment Needed (Medical Documentation Required) Upload Medical Documentation Drop files here or Select files Max. file size: 256 MB. Additional DocumentsUpload any additional documents needed Drop files here or Select files Max. file size: 256 MB, Max. files: 10.
