Greater Life Academy Pre-K & Kindergarten Registration
Please complete this form in its entirety to register for enrollment of the Greater Life Academy Pre-K and Kindergarten Program.
Student Name
*
First Name
Middle Name
Last Name
Preferred Name
Birthdate
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Entering Grade
*
Preschool
Kindergarten
Do you require Early Drop Off or Late Pick Up?
*
No
Early Drop Off
Late Pick Up
Both
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Ethnicity
African American
Asian
Bi-Racial
Caucasian
Hispanic / Latino
Native American
Languages Spoken at Home
Chinese
English
French
German
Hebrew
Japanese
Russian
Spanish
Vietnamese
Does the student have any other siblings?
Yes
No
If Yes, please list them below:
Name
Age
Grade and Current School
1
2
3
4
5
Please Upload a current picture of student:
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Household Information
Parent/Guardian #1
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Relationship to Student
*
Phone Number
*
-
Area Code
Phone Number
Can this phone receive texts?
Yes, I prefer texts
Yes, but I prefer calls
Yes, but I prefer email
No
Work Phone
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Parent/Guardian #2
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to Student
Phone Number
-
Area Code
Phone Number
Can this phone receive texts?
Yes, I prefer texts
Yes, but I prefer calls
Yes, but I prefer email
No
Work Phone
-
Area Code
Phone Number
Email
example@example.com
Address if different than above
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
If Parents are Separated or Divorced, which parent/guardian has legal responsibility for school related decisions.
Emergency Contact
*
First Name
Last Name
Relationship to child
*
Phone Number
*
-
Area Code
Phone Number
Medical Information
Does the applicant have any food or environmental based allergies?
*
Yes
No
If yes, please list each allergy and the action plan in case of an allergic reaction
Has the applicant ever been diagnosed by a qualified professional to have a medical or emotional condition that requires continuous medication?
*
Yes
No
If yes, please explain (include the medication name, dosage, time given and the name of monitoring doctor).
Do you authorize us to administer any of these medications?
Yes
No
Health Care Provider
*
Child's Doctor Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Other Information
Please list all authorized persons able to pick up your child and their relationship to your child.
*
Please list any additional information you would like for our teachers and staff to know about your child.
Are you a member of Greater Life Church?
*
Yes
No
My Products
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Application Fee
This application fee is nonrefundable.
$
50.00
Credit Card
My signature below affirms that all of the information contained in this application is correct, complete, and honestly presented. I understand that withholding or misrepresenting information in this application may jeopardize my child's admission.
*
Clear
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
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