New Family Enrollment

Covenant Christian Academy Family Enrollment

Family Last Name

Family Last Name *

Dad's Information

Father's Name *

Father's Cell Phone *

Father's Email *

Father's DOB *

Father's Employer *

Father's Education/Degree *

Father's Work Number *

Mom's Information

Mother's Name *

Mother's Cell Phone *

Mother's Email *

Mother's DOB *

Mother's Employer *

Mother's Education/Degree *

Mother's Work Number *

Family Address *

Family City State Zip *

Children's Names

Cld 1 Name *

Cld 2 Name

Cld 3 Name

Cld 4 Name

DOB

Cld 1 DOB *

Cld 2 DOB

Cld 3 DOB

Cld 4 DOB

M/F

Cld 1 M/F *

Cld 2 M/F

Cld 3 M/F

Cld 4 M/F

Rising Grade

Cld 1 Rising Grade *

Cld 2 Rising Grade

Cld 3 Rising Grade

Cld 4 Rising Grade

Current School

Cld 1 Current School *

Cld 2 Current School

Cld 3 Current School

Cld 4 Current School

Allergies/Learning Differences

Cld 1 All/Ln Diff *

Cld 2 All/Ln Diff

Cld 3 All/Ln Diff

Cld 4 All/Ln Diff

Pastor's Name

Pastor's Name *

Our family is actively involved in our church. The name of our church is

Church Name *

Denomination

Denomination *

Years Attended

Years Attended *

If more than 4 children to enroll, please fill out a second form after submitting this one.