Online Registration

Faith Christian Academy Online Registration form

* Indicates required field

Register for 2015-2016 School Year *

Yes, Definitely Very Likely Have Someone Contact Me

Student Name *

First

Last

Student Home Phone Number *

Student Address *

Line 1

Line 2

City

State

Zip Code

Country

Birthday *

Student Social Security Number *

Entering Grade (Select One) *

Last School Attended *

Age on First Day of School (Select One) *

Grades (Select One) *

Has Student Ever Been (Choose Any) *

Suspended Expelled Retained Received Professional Counseling/Testing

Does student have any learning disabilities such as: (Choose Any) *

Dyslexia Perception Attention Deficit Disorder Other

Marital status of parents *

Annual Household Income (for determining federal eRate reimbursement. Your names will NOT be published) *

Father's Name *

First

Last

Occupation *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Phone Number *

Alternate Phone Number *

Work Phone Number *

Email *

Mother's Name *

First

Last

Occupation *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Phone Number *

Alternate Phone Number *

Work Phone Number *

Email *

If student is not living with parent, please fill out the following:

Guardian Name: *

First

Last

Occupation *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Phone Number *

Alternate Phone Number *

Work Phone Number *

Email *

Emergency Information (If parents or Guardian cannot be reached):

Name *

First

Last

Relationship *

Preferred Phone Number *

Alternate Phone Number *

Work Phone Number *

Medical Information: Does Student have any allergies/medications/medical conditions? If so, please list. *

Transportation: These people are allowed to pick up my child.

1). *

2.) *

Submit