Daniel Initiative Application JotForm

The Daniel Initiative

Application
Child's Information:
Full Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Grade for 2024-2025 School Year*
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Has your child made Jesus Lord of his/her life?*

YesNo, not yet
If yes, what year did they make Jesus Lord of their life?
Has your child been baptized?*

YesNo, not yet
If yes, what year were they baptized?
School History
Name of school child last attended*
Are you able to provide a copy of your child's previous year's report card?*

YesNo
Are you able to provide a copy of your students' transcripts?*

YesNo
What grade level is your child currently performing at in the following:
Math Grade Level*
Reading Grade Level*
Writing Grade Level*
Briefly describe your student's previous year of schooling:*
Does your child thrive in a traditional school setting?*

YesNo
Please explain the answer above:*
How does your child best learn?*
Does your child have any learning disabilities/difficulties?*

YesNo
If yes, please explain:
Does your child have any behavioral challenges?*

YesNo
If yes, please explain:
Does your child have any allergies or take any medications?*

YesNo
If yes, please list and explain:
Will you be registering any additional children?*

YesNo
If so, how many?
Second Child's Information:
Second Child's Full Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Grade for 2024-2025 School Year*
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Has your child made Jesus Lord of his/her life?*

YesNo, not yet
If yes, what year did they make Jesus Lord of their life?
Has your child been baptized?*

YesNo, not yet
If yes, what year were they baptized?
Second Child's School History
Name of school 2nd child last attended*
Are you able to provide a copy of your child's previous year's report card?*

YesNo
Are you able to provide a copy of your students' transcripts?*

YesNo
What grade level is your child currently performing at in the following:
Math Grade Level*
Reading Grade Level*
Writing Grade Level*
Briefly describe your student's previous year of schooling:*
Does your child thrive in a traditional school setting?*

YesNo
Please explain the answer above:*
How does your child best learn?*
Does your child have any learning disabilities/difficulties?*

YesNo
If yes, please explain:
Does your child have any behavioral challenges?*

YesNo
If yes, please explain:
Does your child have any allergies or take any medications?*

YesNo
If yes, please list and explain:
Third Child's Information:
Third Child's Full Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Grade for 2024-2025 School Year*
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Has your child made Jesus Lord of his/her life?*

YesNo, not yet
If yes, what year did they make Jesus Lord of their life?
Has your child been baptized?*

YesNo, not yet
If yes, what year were they baptized?
Third Child's School History
Name of school 3rd child last attended*
Are you able to provide a copy of your child's previous year's report card?*

YesNo
Are you able to provide a copy of your students' transcripts?*

YesNo
What grade level is your child currently performing at in the following:
Math Grade Level*
Reading Grade Level*
Writing Grade Level*
Briefly describe your student's previous year of schooling:*
Does your child thrive in a traditional school setting?*

YesNo
Please explain the answer above:*
How does your child best learn?*
Does your child have any learning disabilities/difficulties?*

YesNo
If yes, please explain:
Does your child have any behavioral challenges?*

YesNo
If yes, please explain:
Does your child have any allergies or take any medications?*

YesNo
If yes, please list and explain:
Fourth Child's Information:
Fourth Child's Full Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Grade for 2024-2025 School Year*
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Has your child made Jesus Lord of his/her life?*

YesNo, not yet
If yes, what year did they make Jesus Lord of their life?
Has your child been baptized?*

YesNo, not yet
If yes, what year were they baptized?
Fourth Child's School History
Name of school 4th child last attended*
Are you able to provide a copy of your child's previous year's report card?*

YesNo
Are you able to provide a copy of your students' transcripts?*

YesNo
What grade level is your child currently performing at in the following:
Math Grade Level*
Reading Grade Level*
Writing Grade Level*
Briefly describe your student's previous year of schooling:*
Does your child thrive in a traditional school setting?*

YesNo
Please explain the answer above:*
How does your child best learn?*
Does your child have any learning disabilities/difficulties?*

YesNo
If yes, please explain:
Does your child have any behavioral challenges?*

YesNo
If yes, please explain:
Does your child have any allergies or take any medications?*

YesNo
If yes, please list and explain:
Fifth Child's Information:
Fifth Child's Full Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Grade for 2024-2025 School Year*
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Has your child made Jesus Lord of his/her life?*

YesNo, not yet
If yes, what year did they make Jesus Lord of their life?
Has your child been baptized?*

YesNo, not yet
If yes, what year were they baptized?
Fifth Child's School History
Name of school 5th child last attended*
Are you able to provide a copy of your child's previous year's report card?*

YesNo
Are you able to provide a copy of your students' transcripts?*

YesNo
What grade level is your child currently performing at in the following:
Math Grade Level*
Reading Grade Level*
Writing Grade Level*
Briefly describe your student's previous year of schooling:*
Does your child thrive in a traditional school setting?*

YesNo
Please explain the answer above:*
How does your child best learn?*
Does your child have any learning disabilities/difficulties?*

YesNo
If yes, please explain:
Does your child have any behavioral challenges?*

YesNo
If yes, please explain:
Does your child have any allergies or take any medications?*

YesNo
If yes, please list and explain:

Parent/Guardian Information
Are you a parent or a guardian?*

ParentGuardian
Father/Guardian Name

First NameLast Name
Father/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father/Guardian Cell
Please enter a valid phone number.
Father/Guardian Email
example@example.com
Mother/Guardian Name

First NameLast Name
Mother/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother/Guardian Cell
Please enter a valid phone number.
Mother/Guardian Email
example@example.com
***If there are any pending parent/guardian custody decisions, please request our pending form to be completed and submit a copy of the most recent court documents for the safety and well-being of your child and our volunteers.

You can upload court documents in the space above.
Cancelof

Emergency Contact Information
Name*

First NameLast Name
Relationship to Child*
Phone Number*
Please enter a valid phone number.
Does this person have your permission to pick up your child from activities?*

YesNo
Please add a second emergency contact below:
Name*

First NameLast Name
Relationship to Child*
Phone*
Does this person have your permission to pick up your child from activities?*

YesNo

Church Information

These are your parent/guardian answers
Church Name*
Church Address*

Address

Street Address Line 2

CityState / Province

Zip Code
Senior Pastor*
Recommending Pastor*
How often do you attend?*

WeeklyMonthlyBi-MonthlyOccasionally
What classes have you taken in your church? (Father/Guardian answer)
What classes have you taken in your church? (Mother/Guardian answer)
What area(s) are you involved in your church? (Father/Guardian answer)
What area(s) are you involved in your church? (Mother/Guardian answer)
Tell us about your salvation experience? (Father/Guardian answer)
Tell us about your salvation experience? (Mother/Guardian answer)

More Information & Agreement
How did you hear about The Daniel Initiative?*
Why do you think The Daniel Initiative would be a good fit for your child or children?*
Please read the Parent/Guardian Partnership Requirements for the Daniel Initiative below:

Fill out school affidavit with School Board in August 2024
Oversee child’s completion of assignments/projects
Meet with leader quarterly to review child’s progress
Complete two personal growth workshops per year (finances, marriage, parenting…)
Attend 3 parent/guardian gatherings per year
Commit to fulfill one of many volunteer roles
Parents/Guardian's Signature*

Clear
Parents/Guardian's Signature

Clear
Should be Empty:

Child's Information:

School History

Second Child's Information:

Second Child's School History

Third Child's Information:

Third Child's School History

Fourth Child's Information:

Fourth Child's School History

Fifth Child's Information:

Fifth Child's School History

Parent/Guardian Information

Emergency Contact Information

Church Information

More Information & Agreement