sTUDENT ADMISSIONS APPLICATION

The Christian Village Academy

www.mycva.net
sTUDENT ADMISSIONS APPLICATION
Parent/ Guardian Name

First NameLast Name
Parent/ Guardian E-Mail
example@example.com
Parent/ Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/ Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Grade Level
for Incoming A.Y. '12-'13
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Previous School Name
Emergency Contact

First NameLast Name
Relationship
ex. Father, Mother, etc.
Phone Number Of Person To Contact In Case Of Emergency
Please enter a valid phone number.Format: (000) 000-0000.
Hybrid Private School3-Day Homeschool Program1- Day Homeschool ProgramIndividual Class Registration2-Day Homeschool Program

REGISTRATION FEE

New Student Registration Fee

$25.00 Quantity

Total

$0.00

Credit Card

Cash App Pay