2023-24 WCCA Registration Form

2023-24 School Registration Form

WILKINSON COUNTY CHRISTIAN ACADEMY, WOODVILLE MS
STUDENT INFORMATION

Those students going to PK3, PK4 or Kindergarten must also provide a copy of birth certificate, social security card and immunization form #121. (*Attach copy of files below or turn copies into office.)
Student Name*

First NameMiddle NameLast Name
Is the Student currently enrolled at WCCA and returning or will student be new to school?

NewReturning
Birth Date*

MonthDayYear
Social Security Number
Grade Entering*
Student's Cell Phone
FAMILY INFORMATION
Parent/Guardian Name

First NameLast Name
Home/Cell Phone
Please enter a valid phone number.
Email Address
Employer
Work Phone
Please enter a valid phone number.
Parent/Guardian Name 2

First NameLast Name
Home/Cell Phone 2
Please enter a valid phone number.
Email Address 2
Employer
Work Phone
Please enter a valid phone number.
Address

Street Address

Mailing Address

CityState / Province

Postal / Zip Code
Upload File

Cancelof
I understand that by submitting this registration form I will also be registered into the school email messaging system.

WCCA uses personal information ONLY for purposes internal to the school community and will never under any circumstances sell, rent or otherwise disseminate your information.
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2023-24 School Registration Form