ABUNDANT LIFE CHRISTIAN LEARNING CENTER

Abundant Life Christian Learning Center APPLICATION FOR ADMISSION

for SCHOOL YEAR 2024- 2025
1. Student Registration Info
New or Returning Student?*

Returning StudentNew Student
Name of School Attended 2023-2024 (Last Year)*
Please enter Student's Information exactly as it appears on official documents.
Student Name *

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Gender*
Grade Entering 2024-2025*
Tuition Scholarship*
Scholarship Award Letters must be sent to School Office
Would you be interested in Transportation services to and/or from school?*
We are exploring providing transportation services for a minimal fee
2. Family Info
Student Lives With (Check all that apply)*

MotherFatherStepparentGrandparentGuardian/Other
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mother/ Guardian Name*

First NameLast Name
Email*
example@example.com
Occupation:*
Home Phone*

Area CodePhone Number
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Father/ Guardian Name*

First NameLast Name
Email
example@example.com
Occupation:
Main Phone Number*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Emergency Contact (If Parent/Guardian cannot be reached)*
Relationship to Student*
Emergency Phone*

Area CodePhone Number
Student's Siblings/Relatives attending or have attended Abundant Life Christian Learning Center, Inc. (select button to update)
Name of Church you attend:*
3. Student's Education & Medical History
Has Student Ever Been Retained?*

NoYes
Grade Retained
Has Student ever been tested or received special help for reading or learning difficulties?*

NoYes (you will be contacted for more details)
Has Student Ever Been Enrolled in a Special Education Program?*

NoYes
Does Student regularly require medication?*

NoYes
Medication Taken (select update to save entry)
Notes:
Add Student 2? (Check box if you want to register a second child)

Add Student 2
Student 2 Registration Info

Enter Registration information on Student 2
Student2: New or Returning Student?*

Returning StudentNew Student
Stu2: Name of School Attended 2023-2024 (Last Year*
Student Name *

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Gender*
Grade Entering 2024-2025*
Tuition Scholarship*
Scholarship Awards Letter must be sent to School Office.
Student 2 Family Info
Student 2 lives with Student 1*

YesNo
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Student 2 same Mother as Student 1*

YesNo
Mother/ Guardian Name*

First NameLast Name
Email*
example@example.com
Occupation:*
Home Phone*

Area CodePhone Number
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Student# 2 same Father as Student 1*

YesNo
Father/ Guardian Name*

First NameLast Name
Email
example@example.com
Occupation:
Phone Number*

Area CodePhone Number
Phone Number

Area CodePhone Number
Cell Phone

Area CodePhone Number
Student#2 Education & Medical History

Enter info for Student 2 only
Has Student#2 Ever Been Retained?*

NoYes
Grade Student#2 Retained
Has Student#2 ever been tested or received Special help for reading or learning difficulties?*

NoYes (you will be contacted for more details)
Has Student#2 Ever Been Enrolled in Special Education Program?*

NoYes
Does Student#2 regularly require medication?*

NoYes
Medication Taken (select save to update)
Notes:
Summary of Registration Fees
Registration Fee
Per Student
Entrance Exam
Per New Student Only
Note:

Early Bird Registration Fee: $75.00 until June 21, 2024!

Contact the School Office to arrange payment of enrollment fees including registration and entrance testing fee (when applicable).

Payment of registration fees and a current school account required to secure enrollment space for the 2024-25 school year.
Terms and Conditions
Today's Date

MonthDayYear
Date
By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), verify that all statements and representations contained in this document are complete. You understand that New Jerusalem Christian Academy reserves the right to contact applicant's previous school(s) to obtain any documentation and/or information which may be relevant in determining admission decision. All new enrollments are required to pay a non-refundable $25 entrance exam fee. Parents/Guardians of new enrollment applicants will be contacted to schedule entrance exam testing date and procedures.
Name of Parent Submitting Application

First NameLast Name
All statements and representations contained in this document are complete.*

I Agree
Should be Empty:

Abundant Life Christian Learning Center APPLICATION FOR ADMISSION

1. Student Registration Info

2. Family Info

3. Student's Education & Medical History

Student 2 Registration Info

Student 2 Family Info

Student#2 Education & Medical History

Summary of Registration Fees

Terms and Conditions