2020-2021 Registration Application K-3rd Graders FULL DAY ONLY

PLEASE NOTE - this is FULL DAY option only. Individual classes are placed on registration for your convenience but this program is all inclusive.
Email address *
Student's Last Name *
Your answer
Student's first name *
Your answer
Grade in Fall of 2020-21* *
Gender *
Your answer
Student email
Your answer
Mother's name (first and last) *
Your answer
Mother's primary phone number *
Your answer
Father's name (first and last)
Your answer
Father's primary phone number
Your answer
Alternate phone number for parents
Your answer
Email(s) to receive Ecclesia and/or Protégé communications *
Your answer
Emergency Contact (Name, relationship, phone) *
Your answer
What is your school of record *
Do you intend to pay for classes with charter fees (Please also specify, later in the form, when choosing each class whether you will be using charter funds to pay) *
For what classes do you plan to pay with charter funds? (check all that apply) *
Required
I have read an understood the Registration Terms of Agreement *
Required
Signed: *
Your answer
Is there anything else you would like us to know?
Your answer
Include your mailing address below *
Your answer
A copy of your responses will be emailed to the address you provided.
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