Registration - Risen Christ Christian Academy

Application for Enrollment

Student Information
Address to which all mail is to be sent
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
Social Security Number*
Parent's Email*
Student's Email

If applicable
Father/Guardian
Name
First Last
Phone
Occupation/Title
Company
Church Membership
Mother/Guardian
Name
First Last
Phone
Occupation/Title
Company
Church Membership
With whom does the student live?*
Allow photos in all school publications?
- Yes
- No
Allow photos in all public publications?
- Yes
- No
Sibling Information
Please include Name, Gender, and Birthday.
How did you hear about Risen Christ Christian Academy?
Who can we thank for referring you to our school?
Persons permitted to pickup student
Other than parents/guardians listed above. Please include name and their relation.
Childcare & Education Information
What grade is your child registering for?
Has your child been in childcare before?
- Yes
- No
School attended last
How long?
School Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
School Phone
Principal
Reason for leaving
Has your child ever been involved in a remedial class?
Subject
Has your child ever been involved with a tutor?
Subject
Has your child ever been involved in an advanced class?
Subject
Has your child ever experienced any discipline/conduct problems in relation to school suspensions, school expulsions, grade retention, promotions, etc.? If yes, please explain.
Does your child have any special visual, hearing, motor, or other type physiological or psychological difficulty of which we should be aware to most effectively educate your child?
Does your child have any specific allergies?
Is your child on any special medication? If yes, please list.
Is there any specific difficulty your child is experiencing at school?
For International Students
Local Address
Street Address Address Line 2 City State ZIP Code
Country of Birth
Passport Number
Guardian Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Guardian Phone
The above information is true and factual to the best of my/our knowledge. I/we understand that misrepresentation of the student’s past record may be considered grounds for dismissal. I/we give permission for administrative officials of Risen Christ Christian Academy to contact previous schools to verify the above and to discuss the student’s academic, disciplinary and attendance record. I/we hereby obligate myself/ourselves to meet the charges for tuition and fees when due. In consideration for the enrollment of my/our son/daughter to Risen Christ Christian Academy, I/we agree to pay the published tuition for his/her enrollment as a condition precedent to the school’s release of my /our son’s/daughter’s grades each semester. I/we further understand that my/our failure to meet the tuition obligation may mean termination of my/our child’s enrollment at Risen Christ Christian Academy. By signing this application I (we) agree to the financial obligations and understand that all families are required to participate in some of the selected family fund raising activities. By submitting this application I agree to the stated financial policies.