Character Academy Application Form

Character Academy Application Form

Application for the Greater Calvary Character Academy PreK - 4th
Child's Name*

First NameLast Name
Child's Birth Date:*

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState

Zip Code
Child's School Name*
School Name
Child's Teacher's Name*

PrefixFirst NameLast Name
Child's Grade*
Grade
Mother's/Guardian's Name*

First NameLast Name
Mother's/Guardian's Cell Phone Number:*
Mother's/Guardian's E-mail*
example@example.com
Father's/Guardian's Name*

First NameLast Name
Father's/Guardian's Cell Phone Number:*
Father's/Guardian's E-mail*
example@example.com
Family's Church*
Church
Is a parent in the military?*
Military Parent
Are there any security/custody issues with this child?*
If you answered "YES" to the question above, please help us to know the security/custody issues for the safety of your child.
Security/Custody Issues
Does the child have any special needs (ADD, Asperger’s, Dyslexia, etc.)*
If you answered "YES" to the question above, please list the special needs of the child. (ADD, Asperger’s, Dyslexia, etc.)
Special Needs
Does your child have any allergies? (peanuts, chocolate, etc.)*
If you answered "YES" to the question above, please list your child's allergies.
Allergies
Emergency Contact #1*

First NameLast Name
Phone Number*
Emergency Contact #2*

First NameLast Name
Phone Number*
In addition to those listed above (Guardian, Parents, & Emergency Contacts), please list the individuals who are also allowed to pick up your child from school.*
Allowed to pick up child.
Please list any individual who is NOT allowed to pick up your child from school.
NOT Allowed to pick up child.
My child will get home after club by:*

Parent/Guardian will pick up after club.My child will walk home after club.My child will attend the Boys and Girls Club after club.
Name*

First NameLast Name
Should be Empty: