CHARACTER EDUCATION FOR THE REAL WORLD

Student Registration for LifeWise Northern Heights & Coesse Elementary
In addition to their regular classes, parents 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.

• Students attend classes during their specials time. They will not always miss the same special all school year. The school will rotate the special that is missed.

• Students will ride a bus or church van to and from the LifeWise building.

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

First NameLast Name
Birth Date *

MonthDayYear
School your child attends
Grade for 23-24 school year*
Classroom Teacher
*If known
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
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Student Registration for LifeWise Northern Heights & Coesse Elementary