CHARACTER EDUCATION FOR THE REAL WORLD

Student Registration for LifeWise West Central
In addition to their regular classes, parents have the option of enrolling their children in LifeWise Academy.

• LifeWise Academy is a non-denominational, Bible-Based Released Time Religious Instruction Program with emphasis on Character Education.
• Students attend classes during the day on a schedule that fits the public school classroom rotation.
• Students will be transported by bus with chaperones to and from their LifeWise classes.
• For more details, visit our website at lifewiseacademy.org/westcentralin
Student information
Name*

First NameLast Name
Birth Date *

MonthDayYear
Grade for 22-23 school year*
Classroom Teacher
*If known
Parent information
Name*

First NameLast Name
Email Address*
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any student health concerns or food allergies we should be aware of:
Should a health or allergy-related concern arise during the program, LifeWise personnel will contact the school directly after taking appropriate action.
I consent to my student participating in the LifeWise Academy Released Time Bible Education Program. This permission slip will remain in effect as long as my child is enrolled with the local public school.*

Yes, I choose to allow my child to attend LifeWise Academy classes.
I consent to the photography or video of my student while in LifeWise, for promotional purposes.*

YesNo
Signature

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Student Registration for LifeWise West Central

Student information

Parent information