CCS Application for Admission

Application for Admission

Last updated: July 2025
We are excited that you are applying to Centerville Christian School! We offer classes for students in grades K-10. Please complete the following form. We will review your application after submission and contact you soon thereafter.

Parent/Guardian Profile
Primary Parent/Guardian (The one we should contact first.)

PrefixFirst NameMiddle NameLast Name
Home Address (if different from applicant)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Email
example@example.com
Secondary Parent/Guardian (The one we should contact second.)

PrefixFirst NameLast Name
Home Address (if different from applicant)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Email
example@example.com

Additional Information
If your child has or you suspect any learning disabilities, please explain and include a copy of all testing that has been done.
If your child has ever failed a grade in school, been expelled, or been refused admission to another school please explain.
List any medical conditions, special dietary needs, medications, or allergies your child has.
How did you find out about Centerville Christian School?

Parent/Guardian Consent
I understand that any payments are payable to Centerville Christian School, located at 1010 Lower Shipps Bend Road, Centerville, TN 37033.*

I agree
I certify that the information provided on this application is accurate and complete. *

I agree
I understand that Centerville Christian School only admits students for whom we have the educational resources to meet, and that the school does not discriminate in admissions on the basis of gender, race, color, religion, or national origin.*

I agree
I understand that submission of this application does not constitute admission to Centerville Christian School. *

I agree
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Second Parent/Guardian Signature (if applicable)

Clear
Date

MonthDayYear