C.N. Burrell Sr. Christian Academy , Enrollment Application

C. N. Burrell Sr. Christian Academy of Greater New Galilee Baptist Church

9185 Wilbur Street - Baton Rouge, LA 70807 Telephone- 225-775-6442 - Fax 225-636-992
"Train up a child in the way he should go and when he is old, he will not depart it." Proverbs 22:6
Enrollment Application

Please complete the following information to enroll your child. A $75 non-refundable deposit is required at the time of enrollment.
Date
Enrollment Date
Child's Information

First NameMiddle NameLast NameSuffix
Child's Age
Child's birthday

MonthDayYear
Date
Child's Sex
Child's Height
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Any Known Allergies
Parent/ Legal Guardian Information

Information of person submitting application.
Name of Person Enrolling Child

PrefixFirst NameMiddle NameLast NameSuffix
Relationship to Child

Other
Celluar Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Email
example@example.com
Mother's Name

PrefixFirst NameMiddle NameLast Name
Email
example@example.com
Father's Name

PrefixFirst NameMiddle NameLast NameSuffix
Email
example@example.com
Emergency/Secondary Contacts

Names of persons to contact in case of emergency or if the parents can not be reached.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Information

Please provide accurate and up-to-date information to help us care for your child safely. This information ensures we can respond quickly in case of illness or emergency.
Child's Physician Name
Physician Phone Number

Area CodePhone Number
Preferred Hospital
Child's Dentist Name
Dentist Phone Number

Area CodePhone Number
Does your child have any known allergies or medical conditions?
If yes,please describe.
Medications your child takes reguarly
In the case of a medical emergency, I authorize C.N. Burrell Sr. Christian Academy to obtain necessary emergency care for my child if I cannot be reached.
Signature
Date Signed

MonthDayYear
Date
Parent/ Guardian Agreement

Please review and sign below to confirm your understanding of C.N. Burrell Sr. Christian Academy 's Enrollment Terms and Expectations.
I affirm that all information provided in this application is true and complete to the best of my knowledge. I understand this:
- The $75 registration fee is non-refundable.
- Weekly Tuition payments are due as stated upon enrollment.
- My child's continued enrollment depends on timely payments and adherence to school policies.
I also give permission to C.N. Burrell Sr Christian Academy to seek emergency medical care for my child if I cannot be reached, and I release the school, staff, and Greater New Galilee Baptist Church from liability related to such actions taken in good faith.

I understand and agree to the all the terms stated above.
Parent/ Legal Guardian Printed Name
Signature
Date

MonthDayYear
Date
Submissions Confirmation Message
Thank You For applying!

Your child's enrollment application has been received by C.N. Burrell Sr. Christian Academy. Our staff will review your information and contact you within 2-3 business days to confirm your next steps.

For questions, assistance, or tour please call (225) 775-6442.

"Let the little children come to Me..." -Matthew 19:14
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C. N. Burrell Sr. Christian Academy of Greater New Galilee Baptist Church

Enrollment Application

Parent/ Legal Guardian Information

Emergency/Secondary Contacts

Medical Information

Parent/ Guardian Agreement

Submissions Confirmation Message