Online Application

Parent/Guardian 1 Information Parent/Guardian 2 Information

Prefix (Mr./Mrs./Ms./Dr.)required

Full Namerequired

Business/Firmrequired

Occupation/Titlerequired

Past HCA Student/Alumnirequired

Emailrequired

Address 1required

Address 2required

Cityrequired

Staterequired

Zip Coderequired

Countryrequired

Cell Phonerequired

Home Phonerequired

Siblings (Please list name(s) & age(s)

Student Information

Student First Namerequired

Student Last Namerequired

Nick Name

Genderrequired

Date of Birthrequired

Agerequired

Address (If different from above)

City

State

Zip

Country

Current Graderequired

Applying for Grade?required

Religionrequired

School Districtrequired

Current Schoolrequired

Years Attendedrequired

Current School Phone required

Current School Addressrequired

Please Tell Us About Your Child

What are your child's strengths?

What are your child's challenges?

What are your child's interests/hobbies?

How best would you describe your child?

Does your child have an IEP, 504, or neuro-psychological report?*

If yes, a copy of the IEP (or 504) and all related evaluations must be uploaded with this application.

Yes No

Attach File

Max file size: 10 MB

Which program are you applying for?

Prekindergarten

Half Day 9:00 am - 12:00 Noon, Full Day 9:00 am - 3:00 pm

5 Half Days 5 Full Days

How did you hear about Holy Child Academyrequired