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CCJA Application for VPK Enrollment
Choose one of the following options:(*)




Please choose one option. If you are not applying for VPK, use our standard enrollment application.
*See Fours / Pre-K page for details on pricing.

VPK Attendance Requirements:
1. Your child must arrive in the VPK classroom between 8:45am-9:00am.
2. Your child must participate in VPK activities until 12:00pm daily.
3. Children who arrive late or leave early will be counted as absent on the VPK attendance form.
4. You must call the office (928-1069) if your child is going to be late or absent.
5. If your child is absent 3 consecutive days for any reason a written letter from the parent is required.
6. If a child is absent for 5 consecutive instructional days without an excused absence he/she will be dismissed from the VPK program.
7. Upon notification to out office, absences and tardiness may be excused under “extraordinary circumstances” if appropriate documentation is provided. These include:
   a. Hospitalization of the child, his parents or guardian (doctor’s note required).
   b. Illness of the student, his parents or guardian that required the ill person to remain home (doctor’s note required).
   c. Death of a member of the student’s parents, or guardian, or immediate family.
   d. Court ordered visitation (court documentation).
   e. Parents or guardians military deployment (military documentation).
8. A child may not miss more than 26 days per year for illness.
9. A child may not miss more than 35 days per year regardless of circumstances.
10. Parents must sign their child in and out on a daily basis.
11. Parents must complete and sign an attendance verification form EACH month (as required by state). These forms will be distributed on the last instructional day of each month and must be signed and returned to the office the same day.

Children who do not meet the attendance requirements will lose VPK funding. The child may be allowed to remain in class but will be required to pay full tuition.




I understand and accept the terms of the VPK attendance policy(*)

Your acceptance is required to apply for VPK at any school.


STUDENT INFORMATION


Enrollment Date


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First Name(*)

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Middle Name(*)

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Last Name(*)

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Nickname

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Gender(*)

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Date of Birth(*)
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Age(*)

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SSN

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We understand if you do not wish to submit a SSN online, but we will need it by your child's first day of school.
Attended another child care center?(*)

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If yes, last childcare center attended?

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PARENT / GUARDIAN #1


Title

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First Name(*)

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Email Address(*)

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Relation to Student(*)

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Billing Party?(*)

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Primary Phone(*)

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(*)

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Secondary Phone

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Employer / Occupation(*)

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Driver's License #

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State Issued

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SSN

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We understand if you do not wish to submit a SSN online, but we will need it by your child's first day of school.

PARENT / GUARDIAN #2


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First Name

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Last Name

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Home Address

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Email Address

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Relation to Student

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Billing Party?

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Secondary Phone

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Employer / Occupation

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Driver's License #

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State Issued

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SSN

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We understand if you do not wish to submit a SSN online, but we will need it by your child's first day of school.

In the event of an emergency, we MUST have the names and information on 2 other contact persons!

EMERGENCY CONTACT #1


(*)

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Name(*)

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Relation to Student(*)

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Home Address

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Email Address

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Primary Phone(*)

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(*)

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Secondary Phone

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Can this person pick up your child?(*)

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EMERGENCY CONTACT #2


(*)

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Name(*)

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Relation to Student(*)

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Home Address

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Email Address

Check the email address again. Make sure there is an @ but NO www.

Primary Phone(*)

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(*)

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Secondary Phone

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Can this person pick up your child?(*)

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DO NOT RELEASE CHILD TO
(Who May Not Pick Up This Child?)




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Name

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Home Address

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Primary Phone

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Employer / Occupation

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Physical Description

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MEDICAL INFORMATION & RELEASE



We are required by Florida State Regulations to maintain the following information on file for each student. In the event that you are new to the area and have not yet found a pediatrician, please record the information for your local acute care center until you have selected a pediatrician. Your child will not enter the preschool without this information completed in full.


Child's Physician or Clinic(*)

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Phone Number of Dr/Clinic(*)

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Hospital Preferred(*)

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Date of Last Physical Exam(*)


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Known special physical conditions(*)

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Known medical allergies(*)

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Known food allergies(*)

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Parent or Guardian Signature(*)

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Calvary Christian Jr. Academy reserved the right to refuse any application or dismiss any child, at any time, for any necessary reason. I certify that all enclosed information is true and correct to the best of my knowledge. I also consent to the guideline set forth by Calvary Christian Jr. Academy.






Tuition: Fours

Florida VPK
FREE for Florida VPK hours (9am - 12noon)
You MUST have a Certificate of Eligibility from the ELC - apply as soon as possible
See Florida VPK for more information

Optional / VPK Before & After Care
Before Only (6:30am-8:45am) - $35*
After Only (12pm-6pm) - $65*
Before & After (6:30am - 6pm) - $95 per week*

All Day Pre-K (6:30am - 6pm)
If your child does not have a Certificate of Eligibility
$140 per week*

Contact Us

Our Location

3266 Southside Blvd
Jacksonville, FL 32216

Hours of Operation

6:30am to 6:00pm
Monday thru Friday

Contact Us

office@ccjra.com
Tel. 904.928.1069

Connect With Us

Classroom Availability

Thanks for contacting us about your child's care! Please fill out the form below and our staff will be in contact with your shortly.