CHARACTER EDUCATION FOR THE REAL WORLD

Student Registration For LifeWise New Albany

2022-2023
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 assume responsibility for any missed schoolwork.
• Students will be transportated to and from their LifeWise classes by program staff or volunteers.
• For more details, visit our website at lifewiseacademy.org/newalbanyoh.
Student information
Name*

First NameLast Name
Birth Date *

MonthDayYear
Gender
Grade for 2022-2023 school year*
Classroom Teacher
*If known
Parent/Guardian 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
Does your child have any health or allergy concerns? If yes, please explain:
Should a health or allergy-related concern arise during the program, LifeWise personnel will contact the school directly after taking appropriate action.
Is there anything we should know about your child, such as special social or learning circumstances?
I consent to my student participating in the LifeWise Academy Released Time Bible Education Program. Program participation includes the walking or transporting of students to and from LifeWise classes. Students will be chaperoned at all times by staff and volunteers who have undergone background screening and training.*

Yes, I choose to allow my child to attend LifeWise Academy classes during 2022-2023.
I consent to the sharing of attendance and other information between Lifewise Academy and New Albany Plain Local Schools.*

YesNo
I consent to the photography or video of my student while in LifeWise, for promotional purposes.*

YesNo
I consent to share my contact information with other LifeWise parents.*

YesNo
This program is not sponsored by the New Albany Plain-Local School District. Student participation is voluntary upon written permission of the parent.
If a shared parenting plan is in place requiring dual consent, both parents are required to submit a separate form with signature.
Signature

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Student Registration For LifeWise New Albany

Student information

Parent/Guardian information