ABUNDANT LIFE CHRISTIAN LEARNING CENTER

Abundant Life Christian Learning Center APPLICATION FOR ADMISSION

for SCHOOL YEAR 2025- 2026
1. Student Registration Info
New or Returning Student?
Name of School Attended 2024-2025 (This 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 2025-2026
Tuition Scholarship
Step Up For Student (SUFS) Scholarship Award ID#
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)
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?
Grade Retained
Has Student ever been tested or received special help for reading or learning difficulties?
Has Student Ever Been Enrolled in a Special Education Program?
Does Student regularly require medication?
Medication Taken (select update to save entry)
Notes:
Add Student 2? (Check box if you want to register a second child)
Student 2 Registration Info

Enter Registration information on Student 2
Student2: New or Returning Student?
Stu2: Name of School Attended 2025-2026 (Last Year
Student Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Gender
Grade Entering 2025-2026
Tuition Scholarship
Scholarship Awards Letter must be sent to School Office.
Student 2 Family Info
Student 2 lives with Student 1
Address

Street Address

Street Address Line 2

CityState

Zip Code
Student 2 same Mother as Student 1
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
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?
Grade Student#2 Retained
Has Student#2 ever been tested or received Special help for reading or learning difficulties?
Has Student#2 Ever Been Enrolled in Special Education Program?
Does Student#2 regularly require medication?
Medication Taken (select save to update)
Notes:
Summary of Registration Fees
Registration Fee
Per Student
Entrance Exam
Per New Student Only
Note:

Registration Fee: $125.00

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

To secure enrollment space for the 2025-26 school year, registration fees must be paid and a current school account must be opened.
Terms and Conditions
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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.
Email
example@example.com
Email
example@example.com
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