ACC New Student Application

1
Child #1 Name* This field is required.
First Name
Middle Name
Last Name
2
Is this child a new student at The Academy?If your student is returning, please exit out and complete the Returning Student Application.
YesNo
3
Child 1 - Gender* This field is required.
Male
Female
4
Child 1 - Date of Birth* This field is required.
Date
Month
Day
Year
5
Child 1 - Applying for Which Grade?* This field is required.
3 Year Old Preschool
4 Year Old Preschool
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
6
Student Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Student Cell Phone Numberif applicable
Area Code
Phone Number
8
Alternate Student Phone Numberif applicable
Area Code
Phone Number
9
Parent/Guardian #1 Name
First Name
Last Name
10
Parent/Guardian #1 AddressOnly if Different from Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
11
Parent/Guardian #1 Phone Number
Area Code
Phone Number
12
Parent/Guardian #1 Alternate Phone Number
Area Code
Phone Number
13
Parent/Guardian #1 EmailWe use email as a primary method of communication. Please provide an address that you check regularly and to which you are responsive.
example@example.com
14
Parent/Guardian #1 Marital Status
Married
Widowed
Separated
Divorced
Remarried
15
Parent/Guardian #1 Employer
16
Parent/Guardian #1 Occupation
17
Parent/Guardian #1 Work Phone
Area Code
Phone Number
18
Does Parent #1 live with student?* This field is required.
Yes
No
19
Will Parent #1 be receiving Academy mail/billing?* This field is required.
Yes
No
20
Church Attendance - Parent/Guardian #1
Regular
Seldom
Never
21
Parent/Guardian #2 Name
First Name
Middle Name
Last Name
22
Parent/Guardian #2 AddressOnly if Different from Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
23
Parent/Guardian #2 Phone Number
Area Code
Phone Number
24
Parent/Guardian #2 Alternate Phone Number
Area Code
Phone Number
25
Parent/Guardian #2 Marital Status
Married
Widowed
Separated
Divorced
Remarried
26
Parent/Guardian #2 EmailWe use email as a primary method of communication. Please provide an address that you check regularly and to which you are responsive
example@example.com
27
Parent/Guardian #2 Employer
28
Parent/Guardian #2 Occupation
29
Parent/Guardian #2 Work Phone
Area Code
Phone Number
30
Does Parent #2 live with student?* This field is required.
Yes
No
31
Will Parent #2 be receiving Academy mail/billing?* This field is required.
Yes
No
32
Church Attendance - Parent/Guardian #2
Regular
Seldom
Never
33
Will other children in the family be attending The Academy?* This field is required.
Yes
No
34
Child 2 Name
First Name
Last Name
35
Child 2 Date of Birth
Date
Month
Day
Year
36
Child 2 Applying for Which Grade?
3 Year Old Preschool
4 Year Old Preschool
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
37
Child 3 Name
First Name
Last Name
38
Child 3 Date of Birth
Date
Month
Day
Year
39
Child 3 - Applying for Which Grade?
3 Year Old Preschool
4 Year Old Preschool
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
40
Child 4 Name
First Name
Last Name
41
Child 4 Date of Birth
Date
Month
Day
Year
42
Child 4 - Applying for Which Grade?
3 Year Old Preschool
4 Year Old Preschool
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
43
Family Physician Name
First Name
Last Name
44
Family Physician Phone Number
Area Code
Phone Number
45
Emergency Contact 1* This field is required.
First Name
Last Name
46
Student's relationship to Emergency Contact 1?* This field is required.
47
Emergency Contact 1 Phone Number* This field is required.
Area Code
Phone Number
48
Emergency Contact 2* This field is required.
First Name
Last Name
49
Student's relationship to Emergency Contact 2?* This field is required.
50
Emergency Contact 2 Phone Number
Area Code
Phone Number
51
Who Recommended ACC to you?
52
Last School Attended?If applicable
53
Address of Last School AttendedIf applicable
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
54
Phone Number of Last School AttendedIf applicable
Area Code
Phone Number
55
What are your academic goals for your child/children?* This field is required.(Please designate goals with names of each child if registering more than one)
56
How do you anticipate your child or children will benefit from being at The Academy of Coastal Carolina?* This field is required.(Please designate with names of each child if registering more than one)
57
What do you anticipate your child's or children's academic challenges will be?* This field is required.(Please designate with names of each child if registering more than one)
58
Describe your child/children's strengths?* This field is required.(Please designate with names of each child if registering more than one)
59
What do you anticipate your child/children's social challenges will be?* This field is required.(Please designate with names of each child if registering more than one)
60
List all previous schools your child/children have attended. Please give dates of attendance.(Please designate with names of each child if registering more than one)
61
Has your child ever repeated a grade?* This field is required.
Yes
No
62
If yes, please explain.(Please designate with names of each child if registering more than one)
63
Has your child had disciplinary problems at school?* This field is required.
Yes
No
64
If yes, please explain.(Please designate with names of each child if registering more than one)
65
The following important medical information will help The Academy serve your child. Has your child had any of the following:
Premature birth
Asthma
Other medical conditions
66
Please list any medical or food allergies(Please designate with names of each child if registering more than one)
67
Does your child have normal vision?* This field is required.
Yes
No
68
Date and location of last eye exam(Please designate with names of each child if registering more than one)
69
Does your child have normal hearing?* This field is required.
Yes
No
70
Has your child been diagnosed with ADD or ADHD? (If so, you will need to provide the office a copy of the diagnosis sheet)* This field is required.
Yes
No
71
Is your child taking medication for ADD/ADHD? If so, please list the type of medication taken.(Please designate with names of each child if registering more than one)
72
Are your child's immunization up to date? (You will need to provide a copy of your child's immunization record to the school office)* This field is required.
Yes
No
73
Has your child been hospitalized in the past 12 months?* This field is required.
Yes
No
74
If yes, please explain.(Please designate with names of each child if registering more than one)
75
Has your child been diagnosed with depression or other mental health conditions?* This field is required.
Yes
No
76
If yes, please explain.(Please designate with names of each child if registering more than one)
77
If someone other than the mother or father will be financially responsible for your child/children's tuition, please list their name.
First Name
Last Name
78
I agree with the policies and procedures outlined in the Parent/Student handbook.* This field is required.
Yes
No
79
I am aware of and will comply with the policies outlines in the current Tuition & Fee Schedule.* This field is required.
Yes
No
80
I will support the administration and teachers through respect, frequent communication, and volunteer efforts at school functions.* This field is required.
Yes
No
81
I will support the academic success of my child by insuring that he or she remains current in class requirements, including but not limited to: class attendance with minimal absences, class participation, daily homework assignments, test & quiz preparation, and class projects.* This field is required.
Yes
No
82
I am aware of and will comply with the student dress code.* This field is required.
Yes
No
83
I consent for the Academy to use my child or children's likeness and image for school publications, including, but not limited to: Facebook, Instagram, brochures, ads, digital media, website, press releases and newsletters.* This field is required.
Yes
No
84
I consent for my the school to include my name, address, phone, and email in the school directory.* This field is required.
Yes
No
85
I understand and agree to timely payment of all fees, tuition payments and late penalties as stated in the Student/Parent Handbook.* This field is required.
Yes
No
86
I understand and agree to timely payment of all fees, tuition payments and late penalties as stated in the Student/Parent Handbook.* This field is required.
Yes
No
87
Thank you for completing the New Student Application for The Academy of Coastal Carolina! Once your application has been accepted, we will contact you to place a $250 deposit to hold the spots for your student(s).

You may submit the deposit via cash or check (payable to ACC) to Sarah Mayberry in the school office. If you wish to pay the deposit via credit card, please call Mrs. Mayberry at the school (910-754-9637).
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