Reenrollment

Faith Christian Academy

Registration 2009

Student Information

First Name:
Middle Name:
Last Name:
Goes By:
Gender:	M F
Birthdate:
Children:	Child of
Date of Application:
Applying for Grade:
Has child been asked to repeat any grade?
Application for School Year:
US Citizen?
Address:
City:
Zip Code:
Home Phone:

Family Information

Parent/Guardian 1
Title (Mr., Mrs., Etc.)
First Name:
Last Name:
Relation to Student:
Employer:
Occupation:
Work Phone (ext):
Home Phone:
Email Address:
Fax #:
Cell Phone:

Parent/Guardian 2
Title (Mr., Mrs., Etc.)
First Name:
Last Name:
Relation to Student:
Employer:
Occupation:
Work Phone (ext):
Home Phone:
Email Address:
Fax #:
Cell Phone:

Person(s) responsible for Tuition:
Daytime Contact Number:
Name:
Emergency care person:
Number:
Address:
Child's Physician:
Number:
Why do you wish for child(ren) to attend Faith Christian Academy?

State any/all medical, physical, or emotional problems that your student has that the school needs to be aware of:

May child take Tylenol?	Yes No
May child take Ibuprofen?	Yes No
Should the child require medication during the day, all prescription medications must be in the original prescription container with the dosage listed on the outside. Should the dosage change, the container will need to reflect that as well.

Church Affiliation:

Name of Church you attend:
Pastor's Name:
Please print out the Pastor Reference Form linked below. Give it to your pastor along with a copy of the Doctrinal Statement Agreement Form (at the bottom) and have him fill it out and give it to the school office.
Pastoral Reference Form
Church Phone number:
Denomination:
Are you a member?	Yes No
How often do you attend?
Please give a brief testimony of your salvation experience:

Please list any Extracurricular Activities or community involvement in which your child participates. Include any awards, honors, etc. that he or she has received.

School attended last year:
Grade:
Address:
Phone:

Please read the following two linked documents. They may be saved or printed for further reference.
FCA Doctrinal Statement FCA Statement of Cooperation
*I, my spouse, and my student have read and agreed to the FCA Doctrinal Statement.
*I and my spouse have read and agreed to the FCA Statement of Cooperation.

school@faithbaptistministries.org

Faith Christian Academy

4301 N. Shary Rd. Palmhurst, Texas 78573-8346