Enrollment Application 2026/2027

Enrollment Application 2026/2027
(Last, First, Middle) Student's Name:
Date of Birth:

MonthDayYear
Date
Address:
City:
State:
Zip Code:
Student's Home Phone:
Format: (000) 000-0000.
Student's Cell Phone:
Format: (000) 000-0000.
Parent's/Guardian's Names:
Mom Phone Number:
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Dad Phone Number:
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Email:
example@example.com
Church Currently Attending:
City:
Pastor's Name:
Last Grade Completed:
Last School Attended:
If your child needs to take medication at school, please send it in the original bottle clearly labeled with your child's name and dosage information.
Medications Currently Taking:
Allergies:

EMERGENCY CONTACT/PICK UP LIST

In the occurrence of an emergency where the Parent/Guardian cannot be notified, please contact:
Name, Phone, Relationship
The following people may pick up my child. (I understand LCA may ask for ID to ensure student safety). No student will be allowed to leave campus with anyone other than those listed below unless written permission is given by the student's parents.
Name
Phone Number:
Format: (000) 000-0000.
Relationship
Name
Phone Number:
Format: (000) 000-0000.
Relationship
Name
Phone Number:
Format: (000) 000-0000.
Relationship
Liability Release Form
I, the undersigned authority, give my permission for (student name) to attend Liberty Christian Academy at Cornerstone Church for the school year of 2026/2027. I agree to hold harmless Cornerstone Church, Inc., Liberty Christian Academy, and any employees, directors, or agents of said organizations from any liability or claims of personal injury.
Parent/Guardian Signature
Date

MonthDayYear
Date
Parent/Guardian Signature
Date

MonthDayYear
Date

Discipline Policy
Students of LCA will maintain a school atmosphere of excellence and Godly character. Students are expected to work quietly and attentively for the duration of their lessons. Students will sit and remain in their designated areas for each class period. Students will be respectful with teachers at all times. Students will be honest at all times. Outright disrespect will not be tolerated. A conference with parents will be scheduled immediately. If the behavior occurs a second time, LCA holds the right to suspend, or possibly expel the student.
Grades K4-6 will have a homework folder with a calendar that must be signed daily by the parent. This calendar gives a report of behavior for the day, important notes, and homework information.
Dress Code: No Tattoos or Piercings are allowed. Students shall not acquire tattoos or piercings during their attendance at LCA. The only acceptable body piercing is for girls, in their ears. Guys may not wear earrings. Shirts must cover the entire stomach and back. Girls & guys must wear a belt at all times if belt loops are visible. Flip-flops or open back shoes are not permitted at any time. No holes or frays in jeans that show visible skin will be permitted for guys or girls. Students will abide by the supplemental uniform code provided. (see attached)
Hygiene: Shower and wear deodorant and brush teeth daily. Guys' hair will be kept above the shirt collar and completely out of the eyes. No facial hair is permitted. Girls' hair will be kept neat and out of eyes. All hair must be kept a natural hair color.
LCA reserves the right to determine what is appropriate attire for our school. We will ensure that you are given ample notice for any changes that will occur with our Dress Code Policy before they are enforced.
Cell Phones are not allowed during school hours and must be turned in at the beginning of the day. If cell phones become a persistent problem, the student will not be allowed to bring it at all.
There will be absolutely no smoking, vaping, drinking, or drug use on or off our school property. If a student is caught doing these things, they will be suspended and possibly expelled.
I have read and agree to ALL of these rules:
Student's Signature:
Parent Signature:

Tuition Contract
The 2026/2027 school year’s tuition for my student/students is $__________. I understand that this may be paid in one of the following three methods. Please initial one.
I understand that should I choose option #3, payment will be run on the day chosen unless contact is made with Pastor Michael.
Parent Guardian's Signature:
(Date)

Student Questionnaire
Dear Students and Parents,
Liberty Christian Academy (LCA) is dedicated to providing a safe atmosphere for leaming where Christian values are promoted. We meet four days per week at our school building, but we still rely on the parents' involvement at home. Our school is not a reform institution, and we will not accept students who have been expelled from another school, or have extreme behavior problems. Students, please read, complete, and return this form along with the other enrollment forms.
Do you desire to attend Liberty Christian Academy?
Why?
What is the reason for leaving your previous school?
Are you a born-again Christian?
Do you see yourself as self-motivated?
Are you faithful to attend your youth group or church service?
Do you agree to abide by all LCA rules?
Do you agree to do the work assigned?
Do you have problems with authority?
Do you agree to respect all authority figures of LCA?
Any comments/concerns?
Student Signature:
Parent/Guardian Signature:
Date

MonthDayYear
Date
Should be Empty:

Enrollment Application 2026/2027

Liability Release Form

Discipline Policy

Tuition Contract

Student Questionnaire