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New Family Application
Application Fee: $150 (per family/non-refundable)
Mother/Guardian Name
*
First Name
Last Name
Check the boxes that apply
*
The student(s) lives with me
I will be the person responsible to pay the tuition and fees of the school
I would like to receive the correspondence for my student
Address
*
Address
Street Address Line 2
City
State / Province
Zip Code
Home Phone
Cell Phone
*
Work Phone
Primary Email
*
example@example.com
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Next
Employer
Position
Education
High School
College
Years of High School Completed
Years of College Completed
Please check one:
*
Married
Widow
Separated
Divorced
Single
Church (if applicable)
Have you personally received Jesus Christ as your Savior and Lord?
*
Yes
No
Not Yet, but I would like to learn more
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Father/Guardian Information
Father/Guardian Name
First Name
Last Name
Check the boxes that apply
The student(s) lives with me
I will be the person responsible to pay the tuition and fees of the school
I would like to receive the correspondence for my student
Address
Address
Street Address Line 2
City
State / Province
Zip Code
Home Phone
Cell Phone
Work Phone
Email
example@example.com
Back
Next
Employer
Position
Education
High School
College
Years of High School Completed
Years of College Completed
Please check one:
Married
Widow
Separated
Divorced
Single
Church (if applicable)
Have you personally received Jesus Christ as your Savior and Lord?
Yes
No
Not Yet, but I would like to learn more
Back
Next
Billing and Household Information
Billing Name if different from above
First Name
Last Name
Billing Address if different from above
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email
example@example.com
Number of people living in the household:
*
Who lives in the household of the student? (Include the student, and please put their relationship to the child):
*
Electronic Signature Authorization
*
My signature below verifies that all the information above is correct to the best of my knowledge. By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable.
Parent/Guardian Signature
*
Date
*
/
Month
/
Day
Year
Date
Pay Your Registration Fee Now - and skip a trip to the main office! (Optional)
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Family Registration Fee 2023-2024
One per family/non-refundable
$
150.00
Quantity
1
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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