CHARACTER EDUCATION FOR THE REAL WORLD

Student Registration for LifeWise Columbus City
In addition to their regular classes, parents/guardians have the option to enroll their children in LifeWise Academy.
- LifeWise Academy is a non-denominational, Bible-based Released Time Religious Instruction (RTRI) program with an emphasis on character education.
- Classes are held during the school day on a schedule that fits the public school classroom rotation.
- Students will either walk or be transported by vehicle with chaperones to and from the off school property LifeWise program
- Find more details at: lifewiseacademy.org/columbuscityoh
Student Information
School for 2022-23 School Year*
'Other' school is your child attending in 2022-23
Name of School
Thank you for sharing your interest. To help start a program at your school, please consider registering as a Champion.
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Grade Level for 2022-23 School Year*
Classroom Teacher's Name (if known)
Parent/Guardian Information
Parent Name*

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

Street Address Line 1

Street Address Line 2 (i.e. apartment number or letter)

CityState / Province

Postal / Zip Code
Indicate any 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 RTRI program and for this permission slip to remain valid as long as my child is enrolled in Columbus City Schools.*

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

YesNo
This is not a Columbus City Schools sponsored program and student participation is voluntary upon written permission of the parent/guardian.
*Note: If a shared parenting plan is in place requiring dual consent, both parents/guardians are required to submit and sign separate forms.
Parent/Guardian Signature

Clear
Should be Empty:

Student Registration for LifeWise Columbus City

Student Information

Parent/Guardian Information