CHARACTER EDUCATION FOR THE REAL WORLD

Student Registration for LifeWise Crooksville
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 walk with chaperones to and from their LifeWise classes.

• For more details, visit our website at lifewiseacademy.org/crooksvilleoh
Student information
Name*

First NameLast Name
Birth Date *

MonthDayYear
Male ________ Female ________
Grade for 23-24 school year*
Classroom Teacher
*If known
Parent information
Name*

First NameLast Name
Email Address*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
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.
YesNo
*If a shared parenting plan is in place requiring dual consent, both parents are required to submit a separate form with a signature.
Signature
Should be Empty:

Student Registration for LifeWise Crooksville