Contact information and academic history…
Guardian and emergency contact information…
Emergency and medical information…
Sign & Submit
Sign and submit the application for admission…
- Student Information
- Family Information
- Emergency & Medical Information
- Sign & Submit
Has student ever repeated grades, been dismissed or suspended at any school?
Does the student live with both parents?
If no to above, please check one of the following.
Sibling Information (Siblings Attending BCA Only)
Does this student have a physical disability or handicap?
May this student be given a non-aspirin pain reliever such as Tylenol or Ibuprofen?
Does your child have an unusual health conditions?
Check any health conditions that apply to your child…
Emergency Treatment & HIPAA Release
In the event that my child experiences a medical emergency and I cannot be immediately reached: 1) The Academy may contact the above-listed physician or dentist, 2) The Academy upon the direction of said physician or dentist or upon their unavailability may transport my child to the emergency room for immediate treatment, and 3) The Academy is authorized hereinto by this release to have access to all “HIPAA” protected information pertaining to the treatment of my child for the pending emergency and may so communicate freely concerning this information with any physician, dentist, nurse or healthcare staff member.
By signing below, I certify that the information provided in this application is true and accurate to the best of my knowledge. Furthermore, I understand that it is my responsibility to immediately notify the administrative office of BCA if any changes to the information represented in this application occur.