SAM Registration Form

Fellowship Baptist Academy Registration Form

Registration does not guarantee acceptance. We are currently at capacity for most grades. To be considered for enrollment please complete the form below or call the church office to discuss.
Student Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Grade
(Grade student is going into)
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School transferring from:
Enrolling another student?
Guardian's details
Mother/Guardian's Name

First NameLast Name
Relationship to student
Email
example@example.com
Mobile Number
Format: (000) 000-0000.
Alternative number
Format: (000) 000-0000.
Father/Guardian's Name

First NameLast Name
Relationship to student
Email
example@example.com
Mobile Number
Format: (000) 000-0000.
Same as aboveOther Address
Emergency Contacts

NameRelationship to ChildPhone Number
NameRelationship to ChildPhone Number
NameRelationship to ChildPhone Number
Allergies/Medical Information:
Doctor's Information

Doctor's NamePhone number
Insurance information (Company, ID number) for each child
Please sign below to signify your intent to enroll your child in Fellowship Baptist Academy and to agree to require your child to follow the rules as outlined in the handbook.

Failure to enroll your child forfeits your place in the waitlist (if applicable). Registration fees will not be reimbursed if the school is not informed by July 1st if you have chosen not to enroll your child.
Mother/Guardian's Signature

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Father/Guardian's Signature

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Date

MonthDayYear
Date
Should be Empty:

Fellowship Baptist Academy Registration Form

Guardian's details

Please sign below to signify your intent to enroll your child in Fellowship Baptist Academy and to agree to require your child to follow the rules as outlined in the handbook.