Heritage Christian Academy

Parental Information
Name of Mother

First NameMiddle NameLast Name
Mother's Job/Position
Mobile Number
Address of Mother (if not the same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Father

First NameMiddle NameLast Name
Father's Job/Position
Mobile Number
Address of Father (if not the same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permissions
Who, besides parents listed, has permission to pick your child up from school?
Name(s)
Do we have permission to treat minor injuries with general first aid such as ice packs, bandaids, anti-itch cream or antibiotic ointmet?
Yes No
Do we have permission to photograph your child in classroom settings for school social media posts?
Does your child have any allergies?
Yes No
If yes, please list:
Full Name of Parent Applicant

First NameLast Name

Student Information