VPK Application

Fill out the form below to begin the application process.

*Application does not guarantee enrollment.

Mission Statement

SCA partners with families to provide an outstanding Biblically-integrated education that equips students to: succeed professionally, know God personally, serve God passionately, and edify others persistently.

Vision Statement

SCA will dynamically impact the world for the glory of God by producing academically-equipped, spiritually-shaped, and Holy Spirit empowered individuals for strengthening the Body of Christ, The Church.

Student Full Name *

First

Middle

Last

Address *

Students physical Address/City/State/Zip

Mailing Address

(Optional) Student mailing address if different, Address/City/State/Zip

2024-25 Grade *

Student Health Information

Physician name and phone number

Student Health Insurance Information

Student Health insurance Company and Group/policy #

If other please specify

Medical Conditions

Name any medical conditions, past or present, which would restrict physical or academic activities at School.

Behavioral Conditions

Name any behavioral conditions, past or present, which would restrict physical or academic activities at School. (for example- emotional disorders, ADHD, ADD, etc)

Prescription Medications

Is the student taking any prescription medications? If yes, please specify

Allergies to Medications

Does the student have allergies to medications? If yes, please specify

Other Allergies

Does the student have other allergies? If yes, please specify

Special Services

Does the student receive special services such as speech, language, or physical therapy? If yes, please specify

Other Health Information

Please explain any other important health information that was not listed above.

Parent/Guardian Full Name #1 *

First

Middle

Last

Parent/Guardian Address *

Parent/Guardian Mailing Address/City/State/Zip

Contact *

Best Contact #

Contact 2

Next Best Contact #

Email *

(will be used for communication and billing)

Place of Employment

Company Name / Phone #

Parent/Guardian Full Name #2

First

Middle

Last

Parent/Guardian Address

Parent/Guardian Mailing Address/City/State/Zip

Contact

Best Contact #

Contact 2

Next Best Contact #

(will be used for communication and billing)

Place of Employment

Company Name / Phone #

If Student does not live with both parents, please select the applicable reason

Parent Deceased
Parents Divorced
Other

If other please explain

If parents are separated or divorced, who has legal custody?

Is there a court order on file? If so please provide documentation and specify

Non-Custodial Parent Full Name #1

First

Middle

Last

Non-Custodial Parent Address

Parent/Guardian Mailing Address/City/State/Zip

Contact

Best Contact #

Contact 2

Next Best Contact #

Non-Custodial Parent Full Name #2

First

Middle

Last

Non-Custodial Parent Address

Parent/Guardian Mailing Address/City/State/Zip

Contact

Best Contact #

Contact 2

Next Best Contact #

Emergency Contact #1 Name

First

Last

Emergency Contact #1

Relationship to Student

Emergency Contact #1

Phone Number

Emergency Contact #2 Name

First

Last

Emergency Contact #2

Relationship to Student

Emergency Contact #2

Phone Number

Emergency Contact #3 Name

First

Last

Emergency Contact #3

Relationship to Student

Emergency Contact #3

Phone Number

Transportation #1