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Faith Christian Academy Online Registration form
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Register for 2015-2016 School Year
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Have Someone Contact Me
Student Name
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First
Last
Student Home Phone Number
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Student Address
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Line 1
Line 2
City
State
Zip Code
Country
Birthday
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Student Social Security Number
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Entering Grade (Select One)
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Kindergarten K4
Kindergarten K5
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2
3
4
5
6
7
8
9
10
11
12
Last School Attended
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Age on First Day of School (Select One)
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4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Grades (Select One)
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Above Average
Average
Below Average
Has Student Ever Been (Choose Any)
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Suspended
Expelled
Retained
Received Professional Counseling/Testing
Does student have any learning disabilities such as: (Choose Any)
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Dyslexia
Perception
Attention Deficit Disorder
Other
Marital status of parents
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Married
Divorced
Separated
Widowed
Single
Annual Household Income (for determining federal eRate reimbursement. Your names will NOT be published)
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Father's Name
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First
Last
Occupation
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Preferred Phone Number
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Alternate Phone Number
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Work Phone Number
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Email
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Mother's Name
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First
Last
Occupation
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Preferred Phone Number
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Alternate Phone Number
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Work Phone Number
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Email
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If student is not living with parent, please fill out the following:
Guardian Name:
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First
Last
Occupation
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Preferred Phone Number
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Alternate Phone Number
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Work Phone Number
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Email
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Emergency Information (If parents or Guardian cannot be reached):
Name
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First
Last
Relationship
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Preferred Phone Number
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Alternate Phone Number
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Work Phone Number
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Medical Information: Does Student have any allergies/medications/medical conditions? If so, please list.
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Transportation:
These people are allowed to pick up my child.
1).
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2.)
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