FHCA Off-Campus Application

FAITH HERITAGE CHRISTIAN ACADEMY

Off-Campus Application for Admission (please complete ALL parts)
FaithHeritage Christian Academy (FHCA) admits students of any race, color, national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. FHCA does not discriminate on the basis of race, color, national and ethnic origin in the administration of its educational policies, admission policies, scholarship and loan programs, athletic and other school administered programs.

Please note: this Application is for ONE student. If you have multiple children who will be enrolling, we need you to complete this form on each child separately. This is crucial as different children can have different needs, special information, etc and we must be able to track such information in separate records.

Important: All Kindergarten students must submit a copy of their birth certificate and immunization when applying for enrollment.

Thank you for understanding.
Student Information
Please classify this Application as either "New" or "Renewal" *

New Renewal
Applying for Grade:
School Year:
Student's Full Name: *
Gender: *

Female Male

Home Address : *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone : *
Birthdate: *

Month Day Year
Age: *
Parent/Guardian E-mail: *
Previous School Attended:
County / School District: *
School Address:
Reason For Leaving:
Parental & Family Information
Father's Name: *
Father's Occupation/Title: *

Father's Address (If different from above):

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Work or Cell Phone: *
Father's E-mail:
Mother's Name: *
Mother's Occupation/Title: *

Mother's Address (If different from above):

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Work or Cell Phone: *
Mother's E-mail:
Does Divorced/Separated Spouse receive mail/email?

Yes No Doesn't Apply
Grandparents Name and Mailing Address (Father):
Grandparents Name and Mailing Address (Mother):
Church Family Presently Attends
Pastor's Name
Does your family attend church on a regular basis?

Yes No
Person Authorized to Care for Child In Emergency

(If a parent cannot be contacted)
Emergency Contact Name:
Contact Phone:
Relationship:
Name of Family Physician:
Physician Office Phone:
General Information
What are the special needs (if any) or accommodations for your child?
What are the special talents of your child?
Has this student ever repeated a grade? If yes, please discuss here:
Has this student ever had disciplinary difficulties in school? If yes, please discuss here:
Has this student ever been recommended for special education, been diagnosed with a learning disability, had any childhood illnesses which might impair his/her ability to learn or been recommended for drug or alcohol treatment? If yes, please discuss here:
Is there anything else you'd like us to know about this student? If yes, please discuss here:
Has this student ever been enrolled at FHCA before - on or off-campus?

Yes No
What are your objectives for your child as a student at FaithHeritage Christian Academy?
Disclaimers & Signatures
I agree to the following: *

To abide by the requirements stated in the Instructions for Off-Campus Enrollment To attend the Parent/Teacher Orientation at FHCA campus at the beginning of enrollment. To submit quarterly grades and attendance reports in a timely manner To bring this students (grade 2 and up) to FHCA annual achievement testing.
PLEASE NOTE: The facts given in this application are true and complete to the best of my knowledge. I/We understand that discovery of the fabrication of any statement/s or significant omissions of fact during any phase of the enrollment process
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature: *
FaithHeritage Christian Academy (FHCA) admits students of any race, color, national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. FHCA does not discriminate on the basis of race, color, national and ethnic origin in the administration of its educational policies, admission policies, scholarship and loan programs, athletic and other school administered programs.
Should be Empty:

FAITH HERITAGE CHRISTIAN ACADEMY

Student Information

Parental & Family Information

Person Authorized to Care for Child In Emergency

General Information

Disclaimers & Signatures