STUDENT ENROLLMENT FORM

STUDENT ENROLLMENT FORM

Ashe County, NC
Student's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Applying for Grade
Academic Year
Mother's Name

First NameLast Name
Mother's Cell Phone
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Work Phone
Please enter a valid phone number.
Mother's Email
example@example.com
Father's Name

First NameLast Name
Father's Cell Phone
Please enter a valid phone number.
Father's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Work Phone
Please enter a valid phone number.
Father's Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Cell Phone
Please enter a valid phone number.
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Work Phone
Please enter a valid phone number.
How did you hear about Freedom Christian Academy? (New Applicants Only)
Medical Concerns/Allergies/etc:
Academic Concerns:
Social Concerns:
Other Concerns:
If Enrolling For The First Time, Please Answer The Following Questions:
1. Last School or Preschool Attended.
2. Reason for Leaving Previous School.
3. Has Your Child Ever Been Suspended or Expelled? If Yes, Please Explain.
4. Has Your Child Ever Repeated a Grade? If Yes, Which Grade? And Please Explain.
5. Does Your Child Have Attendance/Tardy Issues? If Yes, Please Explain.
6. Does Your Child Have Any Discipline Issues? If Yes, Please Explain.
7. What Concerns Do You Have About Your Child's Academic, Social, Spiritual, Behavioral, or Physical Health?
8. What Are Your Child's Academic Interests, Abilities, and Strengths?
Parent/Guardian Signature:

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Date:

MonthDayYear
Date
** NOTE **

With submission of this form, please mail $150 Enrollment Fee to:

Freedom Christian Academy

PO Box 38

Jefferson, NC 28640
Should be Empty:

STUDENT ENROLLMENT FORM

If Enrolling For The First Time, Please Answer The Following Questions: