Tidewater Adventist Academy Intent to Enroll 2021-2022

Intent to Enroll

2021-2022
To whom it may concern, I am committed to enrolling my child(ren) in Tidewater Adventist Academy for the 2021-2022 academic school year. To demonstrate my commitment, I am including a $100 deposit (per student) with this form. I understand that this deposit will be applied toward Registration & Enrollment Fees which will be charged in July 2021 and is non-refundable.
Parent/Guardian Signature

Clear
Phone
E mail
example@example.com
Student 1:

First Name Last Name
Student Birthday

Month Day Year
Date
What School is your student currently attending? What is their current grade?
Student 2:

First Name Last Name
Student Birthday

Month Day Year
Date
What School is your student currently attending? What is their current grade?
Student 3:

First Name Last Name
Student Birthday

Month Day Year
Date
What School is your student currently attending? What is their current grade?
Student 4:

First Name Last Name
Student Birthday

Month Day Year
Date
What School is your student currently attending? What is their current grade?
Name of Mother/Guardian

First Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Name of Father/Guardian

First Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are you interested in taking on a leadership role within our Parent/Teacher partnership groups?

Yes No
Do you have skills/experience that you would be willing to share that might benefit our school?

Yes No
If you answered YES, please describe.
I am including a $100 deposit (per student) with this form.
prev next ( X )
Student Deposit for Registration I understand that a deposit of $100.00 will be applied toward Registration & Enrollment Fees for the 2021-2022 school year. A convenience fee of $3.00 has been added to this total.
$ 103.00 Quantity

Total

$ 0.00

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty: