WCCA Registration Form

2022 - 2023 School Registration Form

WILKINSON COUNTY CHRISTIAN ACADEMY, WOODVILLE MS
STUDENT INFORMATION

Those students going to PK3, PK4 or Kindergarten must also provide a copy of birth certificate, social security card and immunization form #121. (*Attach copy of files below or turn copies into office.)
Student Name *

First Name Middle Name Last Name
Is the Student currently enrolled at WCCA and returning or will student be new to school?

New Returning
Birth Date *

Month Day Year
Social Security Number
Grade Entering *
Student's Cell Phone
FAMILY INFORMATION
Parent/Guardian Name

First Name Last Name
Home/Cell Phone
Please enter a valid phone number.
Email Address
Employer
Work Phone
Please enter a valid phone number.
Parent/Guardian Name 2

First Name Last Name
Home/Cell Phone 2
Please enter a valid phone number.
Email Address 2
Employer
Work Phone
Please enter a valid phone number.
Address

Street Address

Mailing Address

City State / Province

Postal / Zip Code
Upload File

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I understand that by submitting this registration form I will also be registered into the school email messaging system.

WCCA uses personal information ONLY for purposes internal to the school community and will never under any circumstances sell, rent or otherwise disseminate your information.
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2022 - 2023 School Registration Form

STUDENT INFORMATION

FAMILY INFORMATION