CHARACTER EDUCATION FOR THE REAL WORLD

Student Registration for LifeWise Whitehall, OH
In addition to their regular school classes, ALL Whitehall 2nd - 5th Grade students 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 LifeWise classes during the school day, opting out of their regular Library time.

LifeWise students are bussed, with chaperones, to and from their LifeWise location once per week.

For more details, visit our website at lifewiseacademy.org/whitehalloh or email Virginia Davis, Whitehall Director, at whitehalloh@lifewiseacademy.org
Student information
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade for 22-23 school year *
Select School
Classroom Teacher *
If unknown at this time, type UNKNOWN
Parent information
Parent Name *

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

Street Address

Street Address Line 2

City State / 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. *

Yes No
*If a shared parenting plan is in place requiring dual consent, both parents are required to submit a separate form with a signature.
Signature

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Student Registration for LifeWise Whitehall, OH

Student information

Parent information