Eagles on the Rock -- Enrollment Form

Eagles on the Rock Bilingual Academy Admission Information

Please complete the form below to finalize enrollment with our school.
Part I (Child Info)
Child Full Name *

First Name Middle Name Last Name
Child Birth Day *

Child Address *

5.) Days and Times Needed for Care

A.M.

P.M.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Part V (Medical Information)
Authorization for Emergency Medical Attention

In the event I cannot be reached to make arrangements for medical care, I authorize the person in charge to take my child to:
Physician *
Emergency Care Facility *
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Clear
Vaccine/Vision/Hearing Information
Requirements for Vaccine Exclusion

I have attached (below) a signed and dated affidavit stating that I decline immunizations for reason of conscience, including religious belief, on the form described by Section 161.0041 Health and Safety Code submitted no later than 90 days after the affidavit is notarized. I have attached (below) a signed and dated affidavit stating that the vision or hearing screening conflicts with the tenets or practices of a church or religious denomination that I am an adherent member of.
Upload any and all vaccine, hearing, and vision records for your child.

Browse Files

Cancel of

Part VI (Privacy & Signature)
Gang Free Zone

Under the Texas Penal Code, any area within 1,000 feet of a child care center is a gang-free zone, where criminal offenses related to organized criminal activity are subject to harsher penalties.
Privacy Statement

HHSC values your privacy. For more information, read our privacy policy online at: https://hhs.texas.gov/policies-practices-privacy#security
Child's Parent or Legal Guardian *

Hey Clear
Part VII (Tuition & Payment)
Tuition/Payment

I agree that payment is due on or before the 1st of every month. I understand that 30 days in advance written notice must be given if I decide to discontinue Eagles On The Rock Academy. Without notice, 1 month tuition will be charged. In addition, agree to pay any outstanding balance.
Current Tuition Amount (monthy) *
Please outline below whom is responsible for payment of tuition and fees. *

First Name Last Name
familyGUID
childGUID
Should be Empty:

Eagles on the Rock Bilingual Academy Admission Information