New Faith Christian Academy Academic Recommendation

Enrollment Application New Faith Christian Academy
Student Information:
Student’s Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender:

MaleFemale
SSN
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Name of Last School Attended
Grade to Enter:
Student Email (if applicable):
example@example.com
Marital Status:

MarriedDivorcedSeparatedSingleWidowed . .
Father/Guardian Full Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home phone
Please enter a valid phone number.
Cell phone
Please enter a valid phone number.
Email
example@example.com
Employer
Work Phone:
Please enter a valid phone number.
Mother/Guardian Full Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home phone
Please enter a valid phone number.
Cell phone
Please enter a valid phone number.
Email
example@example.com
Call me. I have some personal comments that may help you make your decision
Signature

Clear
Date

MonthDayYear
Date

Church Information:
Name of current church:
Phone
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pastor’s Name
How often does your family attend church?
List any church activities in which you and/or your family are involved. Pleaseattach additional sheets as necessary
Students entering the 1st – 12th grade need to complete the following information. Students entering kindergarten should go to the next page.
Write in your own words what you know about Jesus
Write in your own words why you want to attend New Faith Christian Academy

Siblings (List all other children living with the family)

	Name	Age	Grade	School Attending
1
2
3
4
5

Payment Plan. Please check the type of payment schedule you would prefer to follow

AnnuallySemi-AnnuallyMonthly
Financial Aid. Will your family be applying for financial aid?

YesNo
To whom this may concern:
I hereby give my consent to any emergency physician at any emergency hospital to administer necessary treatment to my child Type a label in the event of an emergency at which time I cannot be reached. I give consent to transport by ambulance or helicopter should the situation warrants such action.
Parent or Guardian Signature:

Clear
Date

MonthDayYear
Date
Name of Child’s Doctor
Phone Number
Please enter a valid phone number.
Insurance Company covering child:
Phone Number
Please enter a valid phone number.
Policy #:
Preferred Hospital:
Emergency Phone Numbers (Please number a according to preferred calling order):
Home
Mother at Work:
Father at work:
Other:
Cell - Mother:
Please enter a valid phone number.
Cell - Father:
Please enter a valid phone number.
Please list any allergies, communicable diseases or special medical conditions we need to be aware of. Include any medications regularly taken by your child.
On theType a labelDay ofType a label 20 . before me came .to me known to be the described in and who executed the foregoing instrument and acknowledged that they executed the same. Type a label (Notary Public)
Authorization for Release of Education Records
Student’s Name:
Grade
In accordance with Federal regulations regarding the privacy rights of parents and students under the Family Educational and Privacy Act of 1974, the undersigned hereby consent to the release to New Faith Christian Academy of all educational records about the above-named individual who is applying to New Faith Christian Academy, including recommendations and such other information as may be requested.