School Registration

School Registration
Little Heritage Christian School

All students must be registered for virtual learning through the school district. Only 40 spaces are available.

The school hours are from 8:00 a.m. to 3:00 p.m. Early drop-off is 6:00 a.m. and late pick-up is 5:30 p.m. Daily meals will be provided, but students may bring lunch if preferred.

Please complete online form and a staff member will contact you. Upon completion of the registration process, each parent must complete a COVID-19 Waiver.

Thank you for your interest in Little Heritage.
Student Information
Name

First Name Last Name
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
M.I.
Birth Date

Month Day Year
Gender
Entry Year
Grade
Semester
If yes, what year?
Will you utilize a DHS Voucher?

Yes No
Current Residence Information
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number

Area Code Phone Number
Cell Phone Number

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

Street Address

Street Address Line 2

City State / Province

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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Are you interested in extracurricular activities?
Email Address
Emergency Contact 1
Name

First Name Last Name
Phone Number

Area Code Phone Number
Emergency Contact 2
Name

First Name Last Name
Phone Number

Area Code Phone Number
Physician and Medical Information
Name

First Name Last Name
Phone Number

Area Code Phone 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

Month Day Year
Date Ended

Month Day Year
Previous School 2
School Name
City
State
Date Started

Month Day Year
Date Ended

Month Day Year
Previous School 3
School Name
City
State
Date Started

Month Day Year
Date Ended

Month Day Year
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.
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