Author: EUCC-HP

Excel Christian Academy
Admissions Information Packet
2023/2024
Bridgette Cannon, M.Ed., Chief Education and Enrichment Administrator

Discover the Joy of a Quality Education!

Excel Christian Academy
734 Apple St.
Burlington, N. C. 27217

CHANCELLOR
REV. LARRY E. COVINGTON
PRINCIPAL/DIRECTOR
BRIDGETTE CANNON
OFFICE 336-229-1982
FAX 336-904-2361
E-MAIL bcannon@ebenezerucc.com

Dear Potential Parents,
Thank you for your interest in Excel Christian Academy. It is our vision to provide the best educational experience within a Christian environment for each of our students. We take great pride in the fact that our students excel above their peers of the same age both academically and socially. We strive to create a unique learning environment that is rich in biblical teachings and developmentally appropriate practices.
Please take a moment to peruse the enclosed information. Feel free to contact me with any questions that may arise or to schedule a tour of our facility. It is our prayer that we may be able to provide service for you and your family’s child care needs.
Again, I thank you for your interest and eagerly wait to hear from you.
Sincerely Yours,
Bridgette Cannon
Principal/Director
Discover the Joy of a Quality Education!

Excel Christian Academy
Prospective Parent Questionnaire (Optional)
How did you hear about ECA? (Please circle all that apply)
From your visit to Excel would you…
Tell others? Yes No
Want to enroll your child(ren)? Yes No
Do you have any other comments about your visit?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
We would like to thank you for your participation in this survey.
We value your opinion and hope that Excel Christian Academy can exceed your expectations!

EXCEL CHRISTIAN ACADEMY
New Student File Requirements
Date:
Student Name:
Use this checklist to make sure all necessary forms are completed and all fees are paid. Please make sure that the following forms and applicable items are turned in to the administration office.
** For the safety of our students and in conformance with state regulations no student will be admitted to ECA without an up-to-date physical and immunization records.

	Item	Requirement	Comments	Date Returned
	Application for Admission
	Children’s Medical Report**
	Immunization History**
	Emergency Care Information
	Discipline &Behavior / Management Policy
	Enrollment Agreement
	Financial Agreement
	Travel and Activity Authorization
	Authorization for Student Pick Up
	Photograph/Film Release
	Playground Permission Form
	Parent Volunteer Application
	Birth Certificate
	Recent Photo
	Registration Fee
	Book/Materials Fee

Date Application Completed____________________ Date of Enrollment________________ CHILD’S APPLICATION FOR ENROLLMENT To be completed, signed, and placed on file in the facility on the first day and updated as changes occur and at least annually
CHILD INFORMATION: Date of Birth: ____________________
Full Name:______________________________________________________________________________________________________________
Last First Middle Nickname
Child's Physical Address:__________________________________________________________________________________________________
FAMILY INFORMATION: Child lives with: ___________________________________________________
Father/Guardian’s Name __________________________________________________________ Home Phone______________________
Address (if different from child’s) ____________________________________________________ Zip Code _________________________
Work Phone____________________________________________________________________ Cell Phone________________________
Mother/Guardian’s Name __________________________________________________________ Home Phone_______________________
Address (if different from child’s) ____________________________________________________ Zip Code __________________________
Work Phone_____________________________________________________________________ Cell Phone_________________________
CONTACTS:
Child will be released only to the parents/guardians listed above. The child can also be released to the following individuals, as authorized by the person who signs this application. In the event of an emergency, if the parents/guardians cannot be reached, the facility has permission to contact the following individuals.
________________________________________________________________________________________________________________________
Name Relationship Address Phone Number ________________________________________________________________________________________________________________________
Name Relationship Address Phone Number ________________________________________________________________________________________________________________________
Name Relationship Address Phone Number
HEALTH CARE NEEDS:
For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan must be completed by the child’s parent or health care professional. Is there a medical action plan attached? Yes__ No__

Rev. 2/933/27 DFS 0369D
Children’s Medical Report 10 NCAC3U .0801(3)
G.S. 110-9(1)

Name of Child_______________________________________________Birthdate______________________
Name of Parent or Guardian__________________________________________________________________
A. Medical History (May be completed by parent)
1. Is child allergic to anything? No___ Yes___ If yes, what?
2. Is child currently under a doctor's care? No___ Yes___ If yes, for what reason?
3. Is the child on any continuous medication? No___ Yes___ If yes, what? 4. Any previous hospitalizations or operations? No___ Yes___ If yes, when and for what? 5. Any history of significant previous diseases or recurrent illness? No___ Yes___ ; diabetes No___Yes___; convulsions No___ Yes___; heart trouble No___ Yes___; asthma No___ Yes___. If others, what/when?
6. Does the child have any physical disabilities: No___ Yes___ If yes, please describe:
Any mental disabilities? No___ Yes___ If yes, please describe:
Signature of Parent or Guardian_____________________________________________Date____________
Address of Parent of Guardian________________________________________________________________
B. Physical Examination: This examination must be completed and signed by a licensed physician, his authorized agent currently approved by the N. C. Board of Medical Examiners (or a comparable board from bordering states), a certified nurse practitioner, or a public health nurse meeting DHHS standards for EPSDT program. Height _________% Weight __________%
Head____________ Eyes_____________ Ears_____________ Nose___________ Teeth__________Throat_________ Neck_________ Heart_________Chest_________Abd/GU_______________Ext__________
Neurological System___________________________Skin__________________Vision____________Hearing_________ Results of Tuberculin Test, if given: Type__________date__________ Normal___Abnormal_________follow up________
Developmental Evaluation: delayed________age appropriate___________
If delay, note significance and special care needed;__________________________________________________
__________________________________________________________________________________________
Should activities be limited? No___ Yes___ If yes, explain:______________________
Any other recommendations:_________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Date of Examination__________
Signature of authorized examiner/title___________________________________Phone #_______________
DCD 0108
12/99

Rev. 2/933/27 DFS 0369D
Children’s Medical Report 10 NCAC3U .0801(3)
G.S. 110-9(1)

C. Immunization History: The day care operator or health official must enter the date immunization was received in the space below or attach a copy of the immunization record. G.S. 130A-155(b) requires all day care facilities to have this information on file. / Enter date of each does – Month/Day/Year
VACCINE	#1	#2	#3	#4	#5
*DTP/DT (circle which)
*POLIO
**HIB
*MMR (combined doses)
Measles (single dose)
Mumps (single dose)
Rubella (single dose)
Other Hep.B

Excel Christian Academy

01/01/2002

01-01-08

Excel Christian Academy
Playground Permission Form
My Child, ______________________________________________, has permission to use any of the Excel Academy church property for recreation, rest, and snack/lunch times while a student at ECA. I understand this includes all of the property outside the fenced area as well as the property inside the fence.

Excel Christian Academy

Statement of Receipt of Policies and Procedures
I acknowledge that I have received a copy of the Excel Christian Academy Student/Parent Handbook.
I have received and read a copy of Excel Christian Academy’s Shaken Baby Syndrome/Abusive Head Trauma Policy.
I am in receipt of the North Carolina Child Care Law and Rules.
I am in receipt of Excel Christian Academy’s Smoking and Tobacco Restriction Policy.
I acknowledge that I have read and understand all policies and procedures detailed in the handbook and have no questions.
I am in agreement with and consent to abide by all of Excel Christian Academy’s policies and procedures.
Parent Signature Date
Director’s Signature Date

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EXCEL CHRISTIAN ACADEMY
EMERGENCY CARE INFORMATION
Name of child's doctor ________________________ Address/Phone _____________________________
Name of child's dentist ________________________ Address/Phone _____________________________
Hospital preference ___________________________
In case of emergency if parents (or guardian) cannot be contacted, call:
Name ________________________Relationship_______________________ Phone________________
Upon signing this application, I agree that ECA may authorize a physician to provide emergency care in the event that neither the family physician nor I can be contacted immediately.
MEDICAL INFORMATION
For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan must be completed by the child’s parent or health care professional. Is there a medical action plan attached? Yes__ No__
Does your child have any known allergies (such as dust, drugs, plants, animals, food, etc.)? If yes, please identify. ______________________________________________________________________________
Is your child under the care of a doctor for ongoing medical difficulties? If so, please explain. _____________________________________________________________________________________
Is your child on daily medication prescribed by a doctor? If so, please explain. _____________________________________________________________________________________
Has applicant been recommended for or undergone any developmental or educational testing to determine the existence of ADD, ADHD, learning disabilities, or any other emotional, physical, or learning difficulties? Has applicant utilized services of a counselor in private practice, psychiatrist, or clinical psychologist? ( )Yes ( )No
If so, please describe and list name of institutions/ individuals whose services were/are being utilized. (ECA requires access to information concerning testing results and recommendations.)
____________________________________________________________________________________________________________________________________________________________________________
Does your child have a history of seizures? ( ) Yes ( ) No
Does your child have any physical handicaps? ( ) Yes ( ) No
Please give any information concerning your child which will be helpful to us and will impact on your child's experience at ECA such as play, eating and sleeping habits, special fears, special likes and dislikes etc.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I certify that all statements made above are true to the best of my knowledge and belief.
Date ____________Signature of Parents/Guardian _____________________________________________
In applying for admission, I authorize other schools/daycare, counselors or physicians to release and share with ECA information and records regarding my child's educational, developmental and behavioral progress.
I, as the director, do agree to provide transportation to an appropriate medical resource in the event of an emergency. In an emergency situation, a responsible adult will supervise other children in the facility. I will not administer any drug or medication without specific instructions from the physician or the child's parent, guardian, or full time caregiver Provisions will be made for adequate and appropriate rest and outdoor play. (Applicable to preschool only.)
Date _________________ Signature of Director______________________________

AUTHORIZATION FOR STUDENT PICK-UP
Student(s) Name(s): ________________________________________Grade:___________
________________________________________Grade:___________
________________________________________Grade:___________
Parent/Guardian Name:______________________________________________________
Home Phone:_________________________ Work Phone:___________________
Cell Phone:___________________________
The following person(s) are authorized to pick up my child(ren) from the Excel Christian Academy. If other than a parent or guardian, or if staff does not know person, some form of picture ID must be shown.
Parent/Guardian Signature___________________________________________Date_________________

Name:	Address:	Phone:
Name:	Address:	Phone:
Name:	Address:	Phone:
Name:	Address:	Phone:
Name:	Address:	Phone:
Name:	Address:	Phone:

Excel Christian Academy Financial Information
(Effective January 1, 2023 Tuition fees are as listed below)
Application Fee
(The payment of this non-refundable fee must accompany application and does not guarantee acceptance or placement).
Full Day PreK K3, K4, K5 Tuition 7:00am – 5:30pm
Tuition is due on Friday prior to the week of services or the first day of every month. Any tuition payment received after Friday or the 5th of the month will be charged a $10.00 late fee. A student may be asked to withdraw from school if payments are in arrears.
Cash for books, materials, and registration fees are the only forms of payment we accept. We will not accept personal checks. Once your child is enrolled we will set up a credit account for tuition to be paid.
A $10.00 discount will apply to tuition payments paid in cash.
Additional Non-Refundable Fees Required (Books & materials)
K3………………………………………………………………………………….$125.00
K4/K5…………………………………………………………..…………….……$125.00
Summer Activity Fee…………………………………………………….………$140.00
Multiple Program Discount
There is a multiple program discount of 20% per child for those with children in both preschool and afterschool.
After School Care 2:30pm– 5:30 p.m.
There is a non- refundable application fee in the amount of $75.00.
Late Pickup Fee After 3:00pm (NC PreK) 5:30 p.m..……………….…………………………...….…… $ 20.00 per minute, per child
Transportation Fee
Transportation from local schools…………………………………. $40.00 per week, per child

Excel Christian Academy
Enrollment Agreement
Parental Agreement
ECA seeks to maintain a positive working relationship with parents and guardians. We desire parental involvement and partnership, which is so critical in our educational and Christian setting. ECA maintains that our educational objectives cannot be fully realized without the active interest, participation, and commitment of parents and guardians. Consequently, we expect parents to be involved with teachers, staff, and administrators, and to accept their part in educational accountability. We expect parents to support the educational efforts of our teachers, to closely monitor their child's school work, to respond to communication from our faculty and administrators, to praise and encourage your child in his/her efforts at school, to provide a place and time for study at home, and to be that helper at home, if their child needs extra help.
We recognize that there may be times when issues, differing views, or concerns arise that need to be addressed. Problems not properly dealt with generally lead to greater conflict. Our administrators and faculty are available to meet with you to discuss issues related to your child which you believe need to be addressed. We value communication, objectivity, and constructive dialogue that bring about solutions and resolution to concerns. In those sometimes-inevitable situations, please be so kind as to express any concerns to the persons directly involved, such as our teachers or administrators. Generally, it is unhelpful to communicate concerns to others that are not in a position to bring closure and resolution to your concerns. Notwithstanding, our expectations are that in the event of conflict or disagreement, parents and guardians will approach issues with our staff in a positive, objective, mature; and non-adversarial manner. Disagreements are not necessarily personal, and if given the opportunity, our staff, in most cases, will be able to resolve your concerns.
Ultimately, we believe that our effectiveness as an educational institution is undermined when parents do not support our teachers and administrators. At what point a parent maintains a sustained lack of confidence in our faculty, staff, and administration, we believe that there exists a sufficient barrier to the positive and supportive working relationship that we desire. In the event of the deterioration of this positive working relationship due to an impasse which is seemingly beyond resolution, ECA reserves the right to bar a student from future enrollment at our school, and to begin the steps of transferring said student to another educational institution.
Enrollment Policies
1. ECA expects students to demonstrate consideration, mutual regard, mutual respect, and a positive attitude in dealing with peers, parents, faculty, staff, and administration.
2. Students are not allowed to leave the school grounds during school hours without permission from parents and proper school authorities.
3. The school is not responsible for the loss of personal property, whether the loss occurs by theft, fire, or any other cause.
(Continued on back)

4. ECA reserves the right to dismiss any student who is disruptive or who becomes a discipline problem, reflects adversely on the Christian principles of the school, or generally fails to cooperate with faculty and administrators.
5. Students are to dress modestly and in accordance with the information in the Parent handbook. Body piercing, with the exception of female students' pierced ears, is prohibited, as are tattoos on any of our students.
6. Any student known to deface and destroy school property will be assessed the full cost of repairs or replacement value, and be subject to disciplinary action including dismissal.
7. Students will be assessed the full replacement value in the case of damaged or lost library books and classroom textbooks.
8. A student handbook will be furnished to each student so he or she will be knowledgeable of school policy, procedures, regulations, and expectations. Parents should review handbook material with their child and sign appropriate forms.
9. ECA students will participate in various field trips during the school year. Students are expected to attend field trips with their class. Parents will be notified of each trip.
10. As parents, we agree in accordance with the Biblical principle of Matthew 18: 15.17, to bring concerns and criticisms to the person most directly involved. For issues related to the classroom or instructional program, please contact the appropriate teacher initially. If a satisfactory conclusion is not reached then please contact the administrator who will arrange a time to meet with you and the teacher together.
11. As parents we pledge our support to the teachers and staff members in maintaining good conduct and an optimum learning environment. We further agree that we will support the faculty and administration in discipline at home as needed.
12. Students are to only be in the care of ECA for 9 1/2 hours a day. Attendance longer than the allotted time will result in suspension or termination of child care services. This is for private pay and DSS.
13. Decisions made by the administration are final.
I understand that in signing this Enrollment Agreement, I accept and am supportive of the policies set forth.
Signature of Parent or Guardian Date
Child's name

Excel Christian Academy Financial Agreement
Please read the following information and sign this form indicating your agreement and understanding of the policies set forth.
Policies
1. Upon enrolling my child in the Academy, I hereby agree to pay my tuition in advance as indicated:
( ) Monthly payments are due on the 1st of each calendar month.
NOTE: An account is considered past due if payment is not received by the 5th of each month. Any payment received after the 5th of the month will incur a $10.00 late fee.
( ) Weekly payments are due on the Friday prior to the week services will be rendered.
If payment is not received on Friday, a student may not return to school until that payment has been received.
Registration fees are non-refundable and due upon receipt of Admission Forms.
A student may not be allowed to attend if tuition becomes past due.
Transcript/diploma, report cards, semester exams, or other school information shall not be issued until all financial obligations are met in full.
Due to general expenses and staff commitments, no reductions can be made in tuition due to absenteeism or lost school days due to inclement weather.
Students will not be permitted to begin a new school year or enroll in the Summer Camp Program if there is a past due balance.
All fees must be paid in full upon withdrawal of a student. Any tuition refund that may be due will be prorated based upon the number of school days, which have transpired.
Any student not picked up in the afternoon by 3:00pm or 5:30pm will be assessed a $20.00 a minute late fee that must be paid in cash prior to the child’s next day of attendance.
All fundraisers (including brochure sales, pictures, etc.) must be paid by the due date or a $20.00 late fee will be added to your account.
The Application Fee and other fees (Book & Materials, ACSI, Insurance, Summer Activity fees) are non-refundable.
By signing this form I acknowledge that I have read, understood, and agree with the provisions, and accept sole responsibility for any and all fees associated with my child's financial account.
Child's Name ____________________________
Signature of Parent or Guardian (responsible for all school fees) Date

EXCEL CHRISTIAN ACADEMY
Photograph/Film Release Form
Student(s) Name(s): Grade
Grade
Grade
Excel Christian Academy is asking for your permission to use photograph/film of your child taken
during the scheduled day. Your child’s photograph/film may be used for our newsletters, articles,
web site, or other programs related to school or church activities.
I give my permission for my child to be photographed/filmed.
Parent/Guardian Signature Date

EXCEL CHRISTIAN ACADEMY
VOLUNTEER APPLICATION
Complete a separate application for each volunteer in the family
Date:
Volunteer’s Name:
Address:
City: State: Zip Code:
Home Phone: Work Phone: Cell Phone:
Child’s Name Grade
Talents/Training/Education
Interests/Talents/Skills:
Education Degree(s):
Major Area(s) of study of training:
Level of Commitment
Describe the extent of volunteering you would prefer and to which you could make a
commitment:
Indicate any time restrictions that would apply to your volunteer efforts:
Would you be willing to assist the school as a volunteer in areas that are not directly associated
with your child’s/children classes or activities, or would you prefer to work mainly with your
child’s classroom/activities?
Prefer working with my child’s activities only
Would be willing to assist the school as a whole
Either

Volunteer Needs
Listed below you will find a listing of the volunteer needs of Excel Christian Academy. Please take a few minutes to consider how you might be able to assist in the various areas indicated. You will be contacted concerning our volunteer placement. Your willingness to serve in greatly appreciated.
Please check below to indicated the areas(s) in which you would be willing to volunteer your time/service when the need arises. You can find the job description at the end of this list.
Educational Assistance
Classroom Assistance
Administrative Assistance
Marketing/Publicity
Plant and Equipment
Job Descriptions:
Tutor: Work with individuals or small groups.
Teacher Assistant: Assist with classroom activities where the teacher deems necessary.
Art Assistant: Help with are projects one or two hours a week.
Science Assistant: Work under the supervision of the teacher on science projects during class.
P.E. Assistant: Work under the supervision of the teacher with physical fitness activities.
Computer Assistant: Assist teachers during each class scheduled time, experience would be helpful.
Music Assistant: Assist teachers with special musical performances and rehearsals and/or assist as a piano accompanist.

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1st child		$ 75.00
each additional child		$ 50.00

Current Parent
Employee
Member of Ebenezer
Former Parent
Other Word of Mouth
Ad in a Publication
Sign Outside Building
Other_____________________

Were you greeted promptly with a smile? Yes No
Did you feel that the staff was knowledgeable? Yes No
From your visit to Excel do you consider Excel to be...(circle all that apply)

Clean
Friendly
Exciting
Innovative
Responsible
Unclean
Unfriendly
Boring
Unprofessional
Negligent

		Weekly
1 child		$ 185.00
2 children		$ 280.00
3 children		$ 420.00
4 or more children		20% Discount

	AfterCare Weekly	Weekly Full Day
1 child	$100.00	$ 140.00
2 children	$152.00	$ 120.00 (per child)
3 children	$228.00	$ 100.00 (per child)
4 or more children	20% Discount	20% Discount

Tutor	Teacher Assistant
Kindergarten Teacher Assistant	Art Assistant
Science Assistant	P.E. Assistant
Computer Assistant	Music Assistant
Library/Media Assistant	Guest Speaker / Subject Area(s)

Homeroom Parent

School Newsletter Collating	Duplicating/Collating/Mailing

Writing/Editing	Computer Graphics/Layout
Scrapbook	Photographer

Plumbing	Landscaping
Electrical work	Painting