Summit Paideia Academy

Summit Paideia Academy

Please fill out all the required information to complete your application.
Parent 1 Name*

First NameLast Name
Parent 1 Phone*
Please enter a valid phone number.
Parent 1 Email*
example@example.com
Parent 2 Name

First NameLast Name
Parent 2 Phone
Please enter a valid phone number.
Parent 2 Email
example@example.com
Emergency Contact (other than parent)

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Church family attends*
Which Denomination
Which campus are you applying for?
Student 1 Full Name*

First NameLast Name
Student Birthdate*

MonthDayYear
Date
Grade Applying For*
Students Allergies (food, environmental, medications)
Students Medications
Any disabilities, special needs or learning struggles we should we aware or sensitive to? (This does not guarantee we can accommodate these needs)
How did you hear about SPA?*
Please tell us who so we can thank them!
Add Sibling?*

Yes, I want to add a siblingNo, this is the only child
Sibling Full Name

First NameLast Name
Sibling Birthdate

MonthDayYear
Date
Sibling Grade Applying For*
Sibling Allergies (food, environmental, medications)
Sibling Medications
Sibling disabilities, special needs or learning struggles we should we aware or sensitive to? (This does not guarantee we can accommodate these needs)

Would you like to enroll a 2nd sibling?*

YesNo
Sibling 2 Full Name

First NameLast Name
Sibling 2 Birthdate

MonthDayYear
Date
Sibling 2 Grade Applying For
Sibling 2 Allergies (food, environmental, medications)
Sibling 2 Medications
Sibling 2 Disabilities, special needs or learning struggles we should be aware of (This does not guarantee we can accommodate these needs)
Would you like to enroll a 3rd sibling?

YesNo
Sibling 3 Full Name

First NameLast Name
Sibling 3 Birthdate

MonthDayYear
Date
Sibling 3 Grade Applying For

Sibling 3 Allergies (food, environmental, medications)
Sibling 3 Medications
Sibling 3 Disabilities, special needs or learning struggles we should be aware of (This does not guarantee we can accommodate these needs)

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