HERITAGE CHRISTIAN ACADEMY REGISTRATION FORM
A. Registration Form
Name:
Address:
City/ State:
ZIP:
Telephone:
Format: (000) 000-0000.
Age:
Birthdate:
-
Month
-
Day
Year
Date
School Last Attended:
B. Family Information
Father's Name:
Employment:
Business Number:
Mother's Name:
Employment:
Business Number:
Emergency Contacts Name:
Number:
C. Religious Information
Church Attending:
Address:
Pastor:
Father: Christian: Y/N
Mother: Christian: Y/N
Has applicant ever made a profession of faith in Christ?: Y/N
760-955-7353 heritagecavv@gmail.com 12626 1 Ave Victorville
School Form
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Medical Information
Family Physician:
Address:
City/ State:
ZIP:
Telephone:
Format: (000) 000-0000.
Age:
Birthdate:
-
Month
-
Day
Year
Date
School Last Attended:
Scholastic Information
Has child ever been expelled, dismissed, suspended, or refused admission to another school?
If yes, explain:
Please indicate academic level of student's previous work:
Academic Level
Excellent:
Good
Average:
Poor:
General Information
How did you hear about this school?
Reason for selecting this school:
760-955-7353 heritagecavv@gmail.com 12626 1 Ave Victorville
School Form
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