Enrollment Packet

Confirm Student & Family

Student Full Name *

Grade *

Parent / Guardian 1 Name *

Email Address *

Health & Medical Information

Georgia law requires a completed Certificate of Immunization (DPH Form 3231) or a notarized Affidavit of Religious Objection to Immunization (DPH Form 2208) before a child may attend any school in Georgia, public or private (O.C.G.A. § 20-2-771).

Which will you provide? *

Georgia Certificate of Immunization (Form 3231) Notarized Affidavit of Religious Objection (Form 2208)

Vision, Hearing, Dental & Nutrition Screening (Form 3300) on file? *

Yes, will provide Not yet completed

Allergies (or None)

Medications Taken Regularly (or None)

Chronic Conditions We Should Know About (asthma, seizures, diabetes, etc. — or None)

Primary Physician Name

Physician Phone

Health Insurance Carrier

Policy Number

I authorize Eterna Christian Academy staff to seek emergency medical treatment for my child if I cannot be immediately reached. *

Emergency Contacts & Authorized Pickup

List at least two people, other than the parents/guardians above, who may be contacted in an emergency or may pick up your child.

Contact 1 — Name *

Relationship to Student *

Phone *

Authorized for Pickup? *

Yes Emergency contact only

Contact 2 — Name *

Relationship to Student *

Phone *

Authorized for Pickup? *

Yes Emergency contact only

Records & Conduct

I authorize Eterna Christian Academy to request academic and disciplinary records from my child's current or most recent school. *

I have received and reviewed the Eterna Christian Academy Student Handbook / Code of Conduct and agree to its terms as a condition of enrollment. *

I consent to occasional photos or video of my child being used in Eterna Christian Academy's newsletters, website, or social media. (optional)

Founding Family Covenant

Eterna Christian Academy is built on covenant — not contract. By enrolling, your family and Eterna enter into a shared commitment to the formation, education, and flourishing of your child and this community.

Download the Founding Family Covenant

I have read the Founding Family Covenant, understand the expectations described in it, and agree to abide by its terms if my child is enrolled at Eterna Christian Academy. *

Enrollment Agreement & Deposit

The enrollment deposit reserves a student's seat after enrollment has been approved by Eterna Christian Academy. It is applied toward the first month's tuition and is non-refundable, except that Eterna Christian Academy will refund the deposit in full if your child is not accepted.

Total Annual Tuition

Payment Schedule *

How do you plan to submit your enrollment deposit? *

Check (payable to City Impact CDC) Online — secure payment link, sent after acceptance

Digital Signature

By typing my full legal name below, I acknowledge that I have read and agree to the Founding Family Covenant, the Student Handbook / Code of Conduct, and the enrollment terms described above, and I am entering into this commitment in good faith as an electronic signature on behalf of my family.

Parent / Guardian 1 — Full Legal Name *

Parent / Guardian 2 — Full Legal Name (if applicable)

Enrollment
Packet

Enrollment Details

Welcome to the Eterna Family!

Founding Family Covenant

EnrollmentPacket

Enrollment Details

Welcome to the Eterna Family!