Enrollment Application - Legacy Christian Academy

Application Type * (1 required)

New Family Application Sibling Application

Student Last Name *

Student First Name *

Date of Birth mm/dd/yyyy *

Gender * (1 required)

Male Female

Grade Entering *

Is student currently enrolled in another school or preschool? * (1 required)

Yes No

If yes, what school is the student currently attending?

Student's Address *

Address 1
Address 2

City

State

Zip

Mother's Information

Last Name *

First Name *

Relationship to Student: * (1 required)

Mother Step Mother Guardian Other

Marital Status * (1 required)

Married Single Divorced Separated Widowed

Does Mother live with student? * (1 required)

Yes No

Additional Parent/Guardian/Custody Information

File Upload Label

(allowed file types: doc, jpeg, jpg, pdf, png, txt)

Please list names/ages of siblings living in the home:

Cell Phone *

Home Phone

Work Phone *

Email Address *

Address if different than student's

Address 1
Address 2

City

State

Zip

Employer

Which church does your family attend? *

Father's Information

Last Name *

First Name *

Relationship to Student * (1 required)

Father Step Father Guardian Other

Marital Status * (1 required)

Married Single Divorced Separated Widower

Does Father live with student? * (1 required)

Yes No

Additional Parent/Guardian/Custody Information

File Upload Label

(allowed file types: doc, jpeg, jpg, pdf, png, txt)

Please list names/ages of sibling living in the home:

Cell Phone *

Home Phone

Work Phone *

Email Address *

Address if different than student's

Address 1
Address 2

City

State

Zip

Employer

Which church does your family attend? *

Emergency Contact Information

Emergency Contact #1 (When parents cannot be reached) *

Phone Number *

Relationship to child *

Emergency Contact #2 (When parents cannot be reached) *

Phone Number *

Relationship to child *

Authorized Pick Up (will need to present ID when picking up student)

Authorization for Emergency Medical Care *

Child's Health History and Current Health Problems

I realize that there may be children in school for whom an immunization exemption has been filed. * (1 required)

Check Box

My child is in good health and is able to participate in school related activities * (1 required)

Yes No

My child is able to participate but has special health/medical requirement listed below * (1 required)

Yes No

Allergies, Special Medical Conditions, Chronic Health Conditions

In preparation for the Family interview, please answer the following questions:

Briefly share your Christian testimony - how you came to know Christ (Mother & Father separately). *

As a parent describe what you feel your role is in the learning process. *

How did you learn about Legacy? *

Please submit the following as needed to complete your application

1. Family photo or a recent photo of the applicant

2. Attendance & discipline record if transferring

3. Report card if transferring

4. Ask your teacher or preschool/Sunday school teacher to complete the Teacher Recommendation Form

Attachments *

(allowed file types: doc, docx, gif, html, jpeg, jpg, mp4, mpeg, pdf, png, ppt, pptx, txt, zip)

I certify that the information provided is true and authorize prior schools to provide Legacy with records and opinions regarding the applicant.

Name *

Enter Your Email Address: *