Church School Enrollment - Covenant Christian Academy

School Year *

Public School District Your Home is Zoned: *

Students First Name *

Students Middle Name *

Students Last Name *

Student's Street Address *

Student's City State Zip *

Student's Date of Birth *

Student's Current Grade *

I. Consent for Notification of Church School Enrollment in Covenant Christian Academy.

II. Consent for Notification of Student Withdrawal - I hereby give PRIOR consent to the administration of Covenant Christian Academy to notify the public school superintendent should the above named student cease attendance at said school.

Parent's Electronic Signature *

Today's Date *