LifeWise Academy Permission Slip

Student Registration for LifeWise Mt Gilead
In addition to their regular classes, parents have the option of enrolling their children in LifeWise Academy.
- LifeWise Academy is a Bible-based character education program that exists to reach public school students with the gospel during school hours.
- Students attend classes during the day on a schedule that fits the public school classroom rotation
- Students will walk with chaperones to and from their LifeWise classes
- For more details, visit our website at lifewise.org/mountgileadoh
Student information
Name*

First NameLast Name
Birth Date *

MonthDayYear
Grade for 23-24 school year*
Parent information
Name*

First NameLast Name
Email Address*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
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.
Yes, I choose to allow my child to attend LifeWise Academy classes.
YesNo
Signature

Clear
Should be Empty:

Student Registration for LifeWise Mt Gilead