RACS Registration Form - 2024-2025 continued:

Registration Form - 2024-2025

Family and Student Information
Student's Legal Name*

First and Middle NamesLast Name
Child's Date of Birth*

MonthDayYear
Date
Student's Sex
Which of the following best describes you:

Returning Student to Roanoke Adventist Christian SchoolNew student to Roanoke Adventist Christian School in kindergarten or first gradeA transfer student from an out of area schoolA former home schooled child
Primary Contact Person/s Information
Primary Contact Person *

First Name Last Name
Relationship to Child:
*
Are you a US Citizen
E-mail
example@example.com
Phone Number*
Please enter a valid daytime phone number.
Addition Contact Person living at same address *

First NameLast Name
Relationship to Child:
*
Are you a US Citizen
*
E-mail
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?*
Additional person to contact in case of emergency:
First Name   Last Name   Area Code   Phone Number
First Name   Last Name   Area Code   Phone Number
First Name   Last Name     Area Code   Phone Number
Are you a member of the Seventh-day Adventist Church?

Yes, Roanoke SDAYes, North Valley SDAYes, OtherNoOther Christian Denomination
Language other than English spoken at home: Type a label

RACS Registration Form - 2024-2025 continued:
Medical Information
Family Physician

First NameLast Name
Date of Last Physical Form: Date
Is the current physical form completed and current? Yes No
Are there any factors that may interfere with your child's learning such as hearing, vision or speech issues or other medical or emotional conditions of which we should be aware? Please be as specific as possible or schedule an appointment with us to discuss whether our school is equipped to address your child's needs.

Other information:

Note: The following will not be used in assessing the student. However, it will enable us to prepare for the needs of incoming families.
Will you be applying for Financial Aid?

YesNoUnsure
If yes, have you completed the FACTS application?

YesNo
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Should be Empty:

Registration Form - 2024-2025