Jubilee Academy Application Form
I certify that I have read the student handbook and watched the 2025-2026 information video.
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Yes
No
Student's Full Name
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First Name
Last Name
Sex
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Male
Female
Student's Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Lives with:
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Please Select
Both Parents
Mother
Father
If parent's are separated or divorced, is the non-custodial parent to receive a copy of the grade report?
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Please Select
Yes
No
Are there any restrictions on the non-custodial parent that we need to be aware of? If so, please explain:
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Has your child been in a school setting before?
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Please Select
Yes
No
What is the name and email of your student's current teacher?
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Previous Grade Completed:
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Please Select
Preschool
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4h Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
Last School Attended:
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Reason for leaving:
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Was the student allowed to re-enroll in previous school?
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Please Select
Yes
No
If no, please explain:
If transferring from Public School, are there any discipline or behavioral problems we should know about? Or were any type of evaluations or therapies encouraged/recommended by teachers/school staff?
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Please Select
Yes
No
If yes, please explain:
Did the student receive any special education or 504 services?
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Please Select
Yes
No
Has the student been tested for any of the following ADD/ADHD, SLD, emotional disturbance, vision, hearing, speech and language? If so, please explain:
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Has the student ever repeated or skipped a grade? If so, please explain:
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Father's Full Legal Name:
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First Name
Last Name
Father's Email
*
example@example.com
Father's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Home Address (if different from the student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Occupation
*
Father's Place of Employment
*
Father would like to volunteer?
*
Please Select
Yes
No
Mother's Full Legal Name
*
First Name
Last Name
Mother's Email
*
example@example.com
Mother's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mother's Address (If different from Student)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Occupation
*
Mother's Place of Employment
*
Mother would like to volunteer?
*
Please Select
Yes
No
Does your family have a church affiliation?
*
Please Select
Yes
No
If so, where do you attend?
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Name of party responsible for tuition payments and relationship to student:
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Who will be responsible for dropping off and picking up? Please include names, phone numbers, relationship to the student and driver's license numbers for each person allowed to pick up and drop off.
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Emergency Contacts
Please list 2 people other than parents:
Emergency Contact #1 Full Name
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First Name
Last Name
Emergency Contact #1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact #1 Relationship to Student
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Emergency Contact #2 Full Name
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First Name
Last Name
Emergency Contact #2 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact #2 Relationship to student
*
I would like my child to attend
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Please Select
4 days a week
Tuesday/Thursday Farm Days Only
Monday/Wednesday Church Days Only
My Products
*
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Application Fee
$25.00
$
25.00
Quantity
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Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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