STUDENT INFORMATION
NAME OF STUDENT
*
First Name
Last Name
DATE OF BIRTH
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
GENDER
*
Male
Female
Student Shirt Size
Please Select
YXS
YS
YM
YL
YXL
XS
S
M
L
XL
XXL
Student Shorts Size
Please Select
YXS
YS
YM
YL
YXL
XS
S
M
L
XL
XXL
STUDENT ADDRESS
*
Street Address
Street Address Line 2
City
State
Zip Code
ACADEMIC INFORMATION
PREVIOUS SCHOOL / HOMESCHOOL
*
GRADE LEVEL FOR THE 2026-27 SCHOOL YEAR
*
Please Select
PRESCHOOL
KINDERGARTEN
1ST GRADE
2ND GRADE
3RD GRADE
4TH GRADE
5TH GRADE
6TH GRADE
7TH GRADE
8TH GRADE
9TH GRADE
10TH GRADE
11TH GRADE
12TH GRADE
DOES YOUR CHILD HAVE A 504 OR AN IEP?
*
YES
NO
I'M NOT SURE WHAT THAT IS
HOW WILL YOU PAY TUITION AND FEES FOR YOUR STUDENT?
Please Select
WV HOPE SCHOLARSHIP
PRIVATE PAYMENTS
OTHER
WHAT ARE AREAS OF STRENGTH FOR YOUR CHILD?
WHAT ARE AREAS OF DIFFICULTY FOR YOUR CHILD?
WHAT INFORMATION CAN YOU GIVE US TO BETTER CONNECT WITH AND GUIDE YOUR CHILD?
WHICH ENRICHMENT AREAS WOULD YOUR CHILD BE INTERESTED IN?
MUSIC
ART
TECHNOLOGY
HOME ECONOMICS
GARDENING
SHOP
WOULD YOUR CHILD BE INTERESTED IN ANY OF THE FOLLOWING SPORTS?
ARCHERY
GIRLS VOLLEYBALL
GIRLS BASKETBALL
BOYS BASKETBALL
WHAT ARE YOUR HOPES FOR YOUR CHILD THIS SCHOOL YEAR?
FAMILY INFORMATION
PARENT/GUARDIAN (1)
*
First Name
Last Name
RELATION TO STUDENT (1)
*
Please Select
FATHER
MOTHER
GRANDFATHER
GRANDMOTHER
FOSTER PARENT
OTHER
PHONE NUMBER (1)
*
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL (1)
*
example@example.com
OCCUPATION (1)
IS THE PARENT/GUARDIAN (1) ADDRESS THE SAME AS STUDENT ADDRESS?
*
YES
NO
PARENT/GUARDIAN (1) ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
IS THERE A 2ND PARENT/GUARDIAN THAT YOU WISH TO HAVE ON FILE?
YES
NO
PARENT/GUARDIAN (2)
First Name
Last Name
RELATION TO STUDENT (2)
Please Select
FATHER
MOTHER
GRANDFATHER
GRANDMOTHER
FOSTER PARENT
OTHER
PHONE NUMBER (2)
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL (2)
example@example.com
OCCUPATION (2)
IS THE PARENT/GUARDIAN (2) ADDRESS THE SAME AS STUDENT ADDRESS?
YES
NO
PARENT/GUARDIAN (2) ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
STUDENT LIVES WITH...
*
BOTH PARENTS (TOGETHER)
ONE PARENT (FATHER)
ONE PARENT (MOTHER)
BOTH PARENTS (SHARED CUSTODY)
APPOINTED LEGAL GUARDIAN
OTHER
ARE THERE ANY OTHER FAMILY MEMBERS THAT ALSO ATTEND TCA?
*
YES
NO
POSSIBLY
LIST THEM BELOW
PICKUP INFORMATION
IS THERE ANYONE WHO IS PERMITTED TO PICK YOUR CHILD UP FROM THE SCHOOL OTHER THAN A PARENT/GUARDIAN?
YES
NO
LIST THE PEOPLE WHO ARE PERMITTED BELOW
IS THERE ANYONE WHO IS NOT PERMITTED TO PICK YOUR CHILD UP FROM THE SCHOOL?
YES
NO
LIST THE PEOPLE WHO ARE NOT PERMITTED BELOW
WILL YOUR CHILD NEED AFTERCARE? (3:15PM - 5:45PM)
*
Daily
Certain Days
Occasionally
Unsure
NO
HOW LONG MIGHT YOU NEED AFTERCARE SERVICES?
Please Select
4:00PM
4:30PM
5:00PM
5:30PM
5:45PM
LEAVE BLANK IF N/A
MEDICAL INFORMATION
WHO IS YOUR CHILD'S EMERGENCY CONTACT?
*
PARENT/GUARDIAN (1)
PARENT/GUARDIAN (2)
BOTH PARENT/GUARDIAN (1) AND (2)
OTHER
EMERGENCY CONTACT
*
HAS YOUR CHILD EVER BEEN DIAGNOSED WITH ANY OF THE FOLLOWING:
*
MI (Mentally Impaired)
ADD (Attention Deficit Disorder)
ADHD (Attention Deficit Hyperactivity Disorder)
LD (Learning Disabled)
AU (Autism)
BD (Behavior Disorder)
NONE
DOES YOUR CHILD HAVE ANY UNLISTED MEDICAL CONDITIONS?
*
YES
NO
PLEASE LIST MEDICAL CONDITIONS BELOW
DOES YOUR CHILD HAVE ANY ALLERGIES?
*
YES
NO
PLEASE LIST ALLERGIES BELOW
IS YOUR CHILD TAKING ANY MEDICATIONS?
*
YES
NO
PLEASE LIST MEDICATIONS BELOW
MEDICATION (DOSAGE) REASON FOR MEDICATION
QUICK SURVEY
HOW DID YOU HEAR ABOUT TABERNACLE CHRISTIAN ACADEMY?
EXAMPLE: FACEBOOK/FRIEND OR FAMILY(NAME)/NEWFIRE BASKETBALL ETC.
WHAT ARE YOUR REASONS FOR SEEKING A CHRISTIAN EDUCATION?
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