LifeWise Academy Permission Slip

Student Registration for LifeWise South Adams
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.
- LifeWise Academy is administered and operated by LifeWise, Inc. an Ohio not-for-profit corporation organized and tax exempt under Section 501(c)(3) of the Internal Revenue Code (“LifeWise Academy”).
- Students attend classes during the day on a schedule that fits the public school classroom rotation
- Students will travel with chaperones to and from their LifeWise classes
- For more details, visit our website at lifewise.org/southadamsin
Student information
Name*

First NameLast Name
Birth Date *

MonthDayYear
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.
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:
YesNo
Signature

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Should be Empty:

Student Registration for LifeWise South Adams