CHARACTER EDUCATION FOR THE REAL WORLD

Student Registration for LifeWise Sto-Rox
Parents of Sto-Rox K-8th grade students 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.

• For more details, visit our website at lifewiseacademy.org/sto-roxpa
Student information
Name*

First NameLast Name
Grade for 23-24 School Year*
Birth Date *

MonthDayYear
Classroom Teacher
*If known
Parent 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
Please list any student health concerns or food allergies we should be aware of:
Should a health or allergy-related concern arise during the program, LifeWise personnel will contact the school directly after taking appropriate action.
I consent to my student participating in the LifeWise Academy released time religious instruction program. This permission slip will remain in effect as long as my child is enrolled with the local public school.*

Yes, I choose to allow my child to attend LifeWise Academy classes.
I consent to the photography or video of my student while in LifeWise, for promotional purposes.*

YesNo
Signature

Clear
Should be Empty:

Student Registration for LifeWise Sto-Rox