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School Year _______________ Today's Date ________________

Name __________________________________________________________________

(Last) (First) (Middle)

Address _____________________________________________________

City and Zip _________________________________________________

Home Telephone ( ) _____________________

Birth date __________________ Age _______________ Sex _______________

Grade to Enter ____________________ Soc. Sec. #______________________

School Last Attended ______________________________________________

Father's Name _________________________________________________________

Place of Employment ___________________________________________________

Work # ___________________________Cellular Phone # ______________________

Mother's Name _________________________________________________________

Place of Employment ____________________________________________________

Work #___________________________ Cellular Phone # ______________________

_____Married ____Divorced ___Separated ___Widow(er)

Emergency Contact _______________________ Phone # ______________________

School age children in family that are not applying:

Name ________________________ Age _______________________

Name ________________________ Age _______________________

Reason they are not coming _______________________________________

Church Attended ___________________________________________

Has applicant ever been baptized?___________________________

Has your child ever been expelled, dismissed, suspended, or refused admission to another school?______________________________

If yes, explain ____________________________________________________________

Has your child ever had any disciplinary difficulties? _____________________________

If yes, explain ____________________________________________________________

Please indicate academic level of pupil's previous work:

Excellent _______ Good _________ Average _________ Poor __________

Has your child ever failed any subject or grade in school? _____________

If yes, explain ____________________________________________________________

How did you hear about this school?__________________________________________

Reasons for selecting this school?____________________________________________

I recognize that Colquitt Christian Academy has a qualified trained staff and have confidence in their ability to perform the educational function due my child at their discretion.

I agree to insist that my child submit to the academic and disciplinary regulations, and all other requirements instituted by the administration and carried out by the faculty of Colquitt Christian Academy.

I realize that from time to time children take issue with actions that they do not agree with and they are prone to criticize statements out of context. Should such occur, I will not support criticism. I will correct my child, support the school personnel, and call in for full details at any time I have a question concerning an incident.

I further realize that building strong relations with my child's teacher to aid in the training of my child is as much my responsibility as it is the school's. I will cooperate with the teachers in discipline, in laying a spiritual foundation, follow through with any work, assignments, or slips to be signed, see that the children reach school on time, and attend all parent functions.

I realize that attending Colquitt Christian Academy is a privilege. It is my intention to abide by the decisions and support the discipline of the administration.

Parent's Signature ________________________________

Student Signature _________________________________

Date ______________________________

I give permission for my child, ____________________, to take part in all school activities, and school sponsored trips away from school premises.

___________________________________ ___________________________

Parent's Signature Date

I give permission for all names listed below to pick up my child from school either during or after school if necessary. I understand that only the people listed below will be allowed to pick up my child.

Name _____________________________ Phone # ________________________

Name _____________________________ Phone # ________________________

Name _____________________________ Phone # ________________________

Name _____________________________ Phone # ________________________

Name _____________________________ Phone # ________________________