School Registration

School Registration
Tabernacle Ministries Academy
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Appointment
Signature
Additional documents for registration

Bring this registration form and the following documentation to the school office.

• Original Certified Birth Certificate
• Original Social Security Card
• Current Immunization Form
• Current Proofs of Residence (ex. power, water or gas bill)
• Other
Student Information
Name

First NameLast Name
M.I.
Gender
Ethnicity
Email Address
Entry Year
Grade
Semester
Have you previously applied to or attended this school?
If yes, what year?
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Primary Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
Emergency Contact 2
Name

First NameLast Name
Phone Number

Area CodePhone Number
Physician and Medical Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Previous School 1
School Name
City
State
Date Started

MonthDayYear
Date Ended

MonthDayYear
Previous School 2
School Name
City
State
Date Started

MonthDayYear
Date Ended

MonthDayYear
Previous School 3
School Name
City
State
Date Started

MonthDayYear
Date Ended

MonthDayYear
Notes
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.

Weekly Fees are due on each Monday of the week.
Take Photo
I give my child permission to attend field trips at Tabernacle Ministries Academy.
tabernacleministriesacademy@gmail.com
thetabernacle123@gmail.com
Should be Empty: