WSA Registration Form
This form is required as the first step to registering at Wellspring Academy.
Student First (Given) Name (eg. Emmanuel) *
Please use Upper Case ONLY for first letter of name.
Your answer
Student Last (Family) Name (eg. Murenzi) *
Please use Upper Case ONLY for first letter of name.
Your answer
Father's First (Given) Name (eg. Emmanuel) *
Please use Upper Case ONLY for first letter of name.
Your answer
Father's Last (Family) Name (eg. Murenzi) *
Please use Upper Case ONLY for first letter of name.
Your answer
Mother's First (Given) Name (eg. Beatrice) *
Please use Upper Case ONLY for first letter only
Your answer
Mother's Last (Family) Name (eg. Mugabekazi) *
Please use Upper Case ONLY for first letter only
Your answer
Father's e-mail address *
This email will be used to complete the registration process.
Your answer
Mother's e-mail address *
This email will be used to complete the registration process.
Your answer
Father's Phone Number *
We will use this number for contact regarding the student's application status and future communication.
Your answer
Mother's Phone Number *
We will use this number for contact regarding the student's application status and future communication.
Your answer
Who is the primary contact? *
Grade Choice *
Select the grade required for the above named student for 2018-2019 academic year starting in September 2018.
Date of Birth *
MM
/
DD
/
YYYY
Returning Family? *
Please indicate If you are a returning family to Wellspring Academy (eg. if your children have attended Wellspring Academy).
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This form was created inside of The Wellspring Foundation for Education.