School Registration 2020-2021 Step 1 of 7 14% I am registering for...*2020-2021 Spanish Preschool 2 days a week (8:30am-12pm) *not available for Pre-K/4K*2020-2021 Spanish Preschool 3 days a week (8:30am-12pm)2020-2021 Spanish Preschool 5 days a week (8:30am-12pm)2020-2021 Spanish Kindergarten 5 days a week, Half Day (8:15am-12:45pm)2020-2021 Spanish/English 1st grade (8:15am-3:15pm)2020-2021 Spanish/English 2nd grade (8:15am-3:15pm)2020-2021 Spanish/English 3rd and 4th grade (8:15am-3:15pm)2020-2021 Mandarin Kindergarten and First Grade(4 days a week)2020-2021 Afterschool program for students 5yo+ (12:30-5pm, *10 student minimum required)What is your child's FULL NAME?* First Last What do you prefer we call your child?Example: Kate for Katherine, Ben for BenjaminWhat is your child's birthdate?* Date Format: MM slash DD slash YYYY Gender*MaleFemalePlease select your child ethnicity/race*American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderTwo or more racesWhite or CaucasianPrefer not to answerChurch Affiliation*You do not need to join a church in order to enroll at CBA. We are very open with parents with what we share with the children from the Bible, which is discussed during the school tour. Families who are active members of Friendship Baptist Church receive a 10% discount on tuition (not included with other scholarships or for lunch bunch or other programs).Current relationship between child's mother and father*MarriedSeparatedDivorcedNever MarriedDeceased Guardian Information (1st Contact)Parent/Guardian Name (1st person to be contacted)* First Last Is this the mother, father or someone else?*MotherFatherSomeone ElseIf someone else, who is this?Uncle, Aunt, Grandparent, etc.?Primary phone number*Alternate phone number*Email address (used for CBA-related information and class lists)* Occupation* Guardian Information (2nd Contact)Parent/Guardian Name (2nd person to be contacted)* First Last Is this the mother, father or someone else?*MotherFatherSomeone ElseIf someone else, who is this?Uncle, Aunt, Grandparent, etc.?Primary phone number*Alternate phone number*Email address (used for CBA-related information and class lists)* Occupation* Household InformationNames and birth dates of other children in the family*Parents/Guardian Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Any special circumstances of which our school should be aware?*Single parent, adoption, grandparents living in home, etc.Please note any serious illnesses, injuries, surgery, allergies, conditions, etc.*If your child does not have any allergies, please note "NO ALLERGIES."Is your child a returning Charleston Bilingual Academy student?*YesNo Physician's Name* First Last Physician's Phone Number*Physician's Practice Name*For example, Doctor's Care, Palmetto Primary Care Physician's, etc.Child's insurance carrier and number*All students are required to have insurance Emergency InformationPlease list the names of the two persons in the local area who will accept responsibility for the care of your child if you cannot be reached.First Emergency Contact Name* First Last First Emergency Contact Phone Number*First Emergency Contact Relationship to Child*Second Emergency Contact Name* First Last Second Emergency Contact Phone Number*Second Emergency Contact Relationship to Child*I hereby authorize Charleston Bilingual Academy to secure emergency medical treatment for my child if the parents, guardians, or family physician cannot be reached. Yes No I hereby authorize Charleston Bilingual Academy to secure emergency medical treatment for my child if the parents, guardians, or family physician cannot be reached. Yes No AuthorizationPictures*YesNoThroughout the year, we take the children's pictures. We would like to use some of these pictures on our school website, newsletter, social media pages, and school apps. It is also possible that local news stations will feature our classrooms. Please indicate your permission to put your child's picture in these venues.Pick up Policy*Only Mom or Dad, or the people listed below as having parental permission, will be allowed to pick up your child. Any other arrangements, either temporary or permanent, must be given in writing. In case of a last minute emergency, a parent must call the Charleston Bilingual Academy office, and the message will be relayed to your child's teacher. A picture ID is required for anyone other than a parent.**Enter the name, relationship to the child, and phone numberHow did you find out about our school?*Briefly, why are you interested in enrolling your child at CBA?How long do you anticipate your child attending CBA?at least 1-2 yearsthroughout preschoolthroughout elementarythroughout middle schoolSuperpower*What is your superpower? This school exists, in part, because of parental involvement. What are your strengths and how could you see yourself using them to help the school?Where do you live in Charleston (closest)?Park CircleNorth Charleston (Ashley Phosphate area)North Charleston (Ladson area)SummervilleGoose CreekDowntownMount PleasantDaniel Island / Clements FerryWest AshleyJames IslandJohns IslandOtherWe use this information to help families network.Since you picked other, please tell us where you live.Do you have any military affiliation?* Veteran Active Reserves Civilian that works with the military No Is there any Networking information you would like to share with other families in our Parent Directory (carpooling, occupation, interests, etc.)Signature*Your signature legally confirms that all of the information you have given is accurate. You also hereby authorize Charleston Bilingual Academy to secure emergency medical treatment for your child if you, parents, guardians, or family physician cannot be reached.