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THE ACADEMY OF EXCELLENCE

NEW STUDENT APPLICATION FORM

To help you prepare for the enrollment process you will need: ● AOE Application: Updated phone numbers and addresses for emergency contacts and pickup permissions. ● Scholarship Award Letter ● (www.AAAScholarships.org), (www.StepUpForStudents.org)

Need help? Call during Office hours and an AOE rep. will be happy to answer any questions.

Phone

904-779-0177 ext. 3

Email

admin@theaoejax.com

Social Media

Discounts & Late Fees Enroll by April 1st and receive a $25 loyalty discount

Refer a friend and receive a $25 discount. (The new student must list the referring family on the application) Enroll after June 1st - late fee of $100 (for returning students only) Early Withdrawal before end of school year fee of: $500 Enrollment Fees due at the time of application for ALL NEW Students: $300

Get Started

Student Name

Start Date

Parent Name

Phone Number

Parent Email

Files to be brought in on student interview day

Scholarship Award Letter

Previous Schools Information

Form DH3040 School Entry Form

Form 680 Certification of Immunization

Birth Certificate

Pledge of Cooperation

Parental Consent for Release of Student Photograph and Information

Student Name

Current Grade Level

Parent Name

Parent Phone

Parent Email

Please list all former schools' students have attended

Student Information

Date of Birth

Sex *

Male

Female

Date of Enrollment

Full Name

Child's Physical Address

Last School Attended

Current Grade

Child Lives With

Mother's Name

Mother's Address

Mother's Phone

Mother's Employer

Mother's Employer Address

Mother's Work Phone

Mother's Email

Father's Name

Father's Address

Father's Phone

Father's Employer

Father's Employer Address

Father's Work Phone

Father's Email

Custody *

Mother

Father

Both

Other

I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

Doctor

Doctor Address

Doctor Phone

Dentist

Dentist Address

Dentist Phone

Hospital Preference

Please list allergies, special medical or dietary needs, or other areas of concern:

Emergency Care Plan instructions (if applicable):

Child(ren) will be released only to the custodial parent, legal guardian or the persons listed below for daily pickup. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason, the custodial parent or legal guardian cannot be reached:

Emergency Contact Name

Emergency Contact Address

Emergency Contact Cell

Emergency Contact Work

Emergency Contact Name

Emergency Contact Address

Emergency Contact Cell

Emergency Contact Work

Emergency Contact Name

Emergency Contact Address

Emergency Contact Cell

Emergency Contact Work

Your signature below indicates that you have completed the above items and that the information on this enrollment form is complete and accurate. I hereby grant permission for the staff of this facility to have access to my child's records.

Your Signature

Signature Date