CHARACTER EDUCATION FOR THE REAL WORLD

Student Registration for LifeWise Allen East
In addition to their regular classes, parents have the option of enrolling their children in LifeWise Academy.

- LifeWise Academy is a non-denominational, Bible-based released time religious instruction program with emphasis on character education.
- Students attend classes during the day on a schedule that fits the public school classroom rotation.
- Students will travel with chaperones to and from their LifeWise classes

For more details, visit our website at lifewise.org/alleneastoh

Note: This permission slip will remain in effect as long as the child is enrolled with the local public school.
Student information
Name*

First NameLast Name
Birth Date *

MonthDayYear
Grade for 2024-2025 school year*
Classroom Teacher
*If known
Parent information
Name*

First NameLast Name
Email Address*
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any student health concerns or food allergies we should be aware of:
Should a health or allergy-related concern arise during the program, LifeWise personnel will contact the school directly after taking appropriate action.
Yes, I consent to the disclosure of personally identifiable information (as defined in FERPA) including medical information to LifeWise personnel in the event of a medical emergency or for reasons determined by the school district as appropriate. *
Yes, I choose to allow my child to attend LifeWise Academy classes. I have read and fully understand the terms of the Release and Waiver found at lifewise.org/release and I waive the right to sue LifeWise Academy.
I consent to the photography or video of my student while in LifeWise, for promotional purposes.*

YesNo
Signature
Should be Empty:

Student Registration for LifeWise Allen East

Student information

Parent information