Registration Form

School Year*

2021-2022

Registration For:*

2-Day Classes
3-Day Classes
5-Day Classes

Date*

Child's Name*

First Middle Last

Address*

Street Address City State ZIP Code

Home Telephone*

Email*

Place of Birth*

Date of Birth*

Baptized*

Yes
No

Church

Family Information

Father/Guardian*

First Last

Address*

Street Address City State ZIP Code

Cell Phone*

Father's Place of Birth*

Father's Occupation*

Church Membership at:*

Mother/Guardian*

First Last

Address*

Street Address City State ZIP Code

Mother's Place of Birth*

Cell Phone*

Mother's Occupation*

Church Membership at:*

Other Children in the Family:*

Please provide the following information for the other children in the family: •Name •Date of Birth •School Now Attending •Church where Baptized

Child lives with:*

Parents
Father
Mother
Other

Please Explain

I understand that there is a nonrefundable $50 registration fee due at the time of registration. Payment can be dropped off in the office or mailed to school.*

Yes
No

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Family Information

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