Withdrawal - Covenant Christian Academy

Date *

Family Email *

Parents Names *

Address *

City State Zip *

Family Phone Number *

Parent Signature *

Reason Leaving: Moving Out of State, Enrolling in Public School, Enrolling in Private School, Enrolling in Homeschool Cover *

List names of student(s) withdrawing and their grade; plus submit a report card and attendance form for each student.

Child 1 Name *

Child 2 Name

Child 3 Name

Child 4 Name

Child 1 Current Grade *

Child 2 Current Grade

Child 3 Current Grade

Child 4 Current Grade

Child 1 Report Card *

Emailed/Hand Carried to CCA

Child 2 Report Card

Emailed/Hand Carried to CCA

Child 3 Report Card

Emailed/Hand Carried to CCA

Child 4 Report Card

Emailed/Hand Carried to CCA

Child 1 Attendance *

Emailed/Hand Carried to CCA

Child 2 Attendance

Emailed/Hand Carried to CCA

Child 3 Attendance

Emailed/Hand Carried to CCA

Child 4 Attendance

Emailed/Hand Carried to CCA

Request for records to be sent to:

Child 1 School Name

Child 1 School Address

If Child 2 needs records sent to a different place, request for records to be sent to:

Child 2 School Name

Child 2 School Address

If more than 2 children and records need sent a 3rd place, please fill out a second form with that information after submitting this one.