Student's Full Legal Name *

Student's Nickname

Grade *

Date of Birth *

Birthplace (City & State, or other Country) *

Has the student been baptized? *

If so, when and where was the baptism?

Place of church membership

Address *

Who does the child live with? *

Name of Father (or guardian) *

Father's e-mail address

Father's birthplace

Father's citizenship

Father's religious affiliation

Father's occupation

Father's work phone

Father's cell phone

Name of Mother (or guardian) *

Mother's e-mail address

Mother's birthplace

Mother's citizenship

Mother's religious affiliation

Mother's occupation

Mother's work phone

Mother's cell phone

Names and ages of siblings in the home

Person to notify in case of an emergency, if unable to reach parents (name, phone number, relation to child) *

Another person to notify in case of an emergency, if unable to reach parents (name, phone number, relation to child)

Please list those who have permission to pick your child up from school

Name of last school attended

Why have you chosen College Park Christian Academy? *

I understand that completing this form does not guarantee enrollment. Registration requires both the registration form and registration fee of $275. This is a first step to the enrollment process. The office will contact you to provide any additional forms or to request documents that may be needed prior to the start of the school year. *