Register

DHR FORM

Download DHR Form here

Upload DHR Form

Upload the completed DHR Form

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 3 MB, Max. files: 2.

CHILD'S PERSONAL INFORMATION

Child's Name*

First Middle Last Suffix

Child's Home Address*

Street Address Address Line 2 City State ZIP Code

I am registering my child for*

K3/K4
5 yrs and up

Child's Date of Birth*

Child's Place of Birth*

City State / Province / Region Country

Upload Birth Certificate

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 3 MB.

Upload Vaccine Record

Vaccine Record must be from the State of Alabama. Other states not accepted.

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 3 MB.

PARENT/GUARDIAN INFORMATION

PARENT/GUARDIAN 1 (PG-1). The information for PG-1 MUST be the Parent or Legal Guardian that will sign this document. This name and email address will be used for legal purposes. You will also receive a receipt of payment at the email address you provide in this section.

P/G-1 Relationship to the Child*

P/G-1 Name*

Prefix First Middle Last Suffix

P/G-1 Phone*

P/G-1 Email

PARENT/GUARDIAN 2 (P/G-2)

P/G-2 Relationship to the Child*

P/G-2 Name*

Prefix First Middle Last Suffix

P/G-2 Phone*

P/G-2 Email

EMERGENCY CONTACTS

PERSONS TO BE CONTACTED IN AN EMERGENCY IF PARENTS OR GUARDIANS CANNOT BE REACHED

EMERGENCY CONTACT 1 (EC-1)

EC-1 Name*

First Middle Last

EC-1 Relationship to the Child*

EC-1 Address*

Street Address Address Line 2 City State ZIP Code

EC-1 Phone*

EMERGENCY CONTACT 2 (EC-2)

EC-2 Name*

First Middle Last

EC-2 Relationship to the Child*

E.g. grandfather, grandmother, uncle, aunt, etc.

EC-2 Phone*

Name of Child's Doctor*

Prefix First Middle Last

Phone of Child's Doctor*

Address of Child's Doctor*

Street Address Address Line 2 City State ZIP Code

MEDICAL INFORMATION

Does your child have any allergies?*

Yes
No

Check all that apply.*

pollen
peanuts
shellfish
eggs
cows' milk
insect bites
other

List the other allergies your child has*

Does your child have any special need?*

Yes
No

Please describe the special need your child has.*

Will you permit a certified member of our staff to administer first aid to your child if we feel it is required?*

Yes
No

May we call the Paramedics for or transport your child to a medical facility if an emergency should arise?*

Yes
No

Will you agree to be responsible for any cost, which might be incurred as a result of the transportation or treatment of your child if an emergency should arise?*

Yes
No

Will you agree to be responsible for any cost, which might be incurred as a result of the transportation or treatment of your child if an emergency should arise?*

Yes
No

If you cannot be located promptly, will you permit the emergency room staff to begin treatment of your child by whatever means they deem necessary while an attempt is being made to locate you?*

Yes
No

MEDIA WAIVER

Media Waiver*

I grant Covenant Academy permission to use photographs and/or videos of my child, taken during his or her time at Covenant Academy, for any legal use, including — but not limited to — publicity, copyright purposes, illustration, advertising, social media, and web content.

WORLDVIEW

Christian Principles & Character*

I grant Covenant Academy permission to teach and implement the principles and character of Jesus Christ.

REGISTRATION FEE

CA Registration Fee*

$75

CA Registration Fee*

$50

Total

$0.00

Please choose your payment method:*

Credit Card
Check/Cash

Credit Card*

Card Details

Cardholder Name

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

COVENANT ACADEMY

COVENANT ACADEMY

COVENANT ACADEMY

DHR FORM

CHILD'S PERSONAL INFORMATION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACTS

MEDICAL INFORMATION

MEDIA WAIVER

WORLDVIEW

REGISTRATION FEE