Applicant's Information
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Email *
Name of Student *
Birth Date *
MM
/
DD
/
YYYY
Place of Birth *
Address *
Years at Address *
Home Phone Number *
Father's Information
Father's Name *
Father's Cell Phone Number *
Father's Occupation *
Father's Place of Employment
 *
Father's Highest Level of Education *
Is the Father a professing Christian? *
On what do you base your answer about being a Christian?
 *
Mother's Information
Mother's Name *
Mother's Cell Phone Number *
Mother's Occupation *
Mother's Place of Employment
 *
Mother's Highest Level of Education *
Is the Mother a professing Christian? *
On what do you base your answer about being a Christian?
 *
Applicant's School Information
Current Grade *
Last Report Card Presented for Grade *
Has applicant ever been dismissed from school for any reason?
 *
Has applicant failed a grade?
 *
School Last Attended
List all the school student attended (most recent school first) *
Why do you want your child to attend this school?
 *
Do you expect your child to continue in this school after this grade?
 *
Does the student have any mental, emotional, or physical handicap which may affect him/her in school activities or academic progress?
 *
Does the student have any food, medication, or environmental allergies? If yes, please list allergies and reactions.  *
Family Information
Other Children Living with Family
Child / Children Name(s) and Ages *
Do you regularly attend a church?
 *
Please read and prepare to discuss the following covenant:
CCA Covenant
  • “I support the standards of the school and will not tolerate profanity, obscenity in word or action, dishonor to God or the Word of God, or disrespect to the staff of the school. I hereby agree to support regulations published in the school handbook in the applicant’s behalf and authorize the school to employ discipline as it deems wise and expedient for the training of my child. As necessary, I further agree that we will cooperate and discipline our child in the home as needed.”
  • “I agree to uphold and support the high academic standards of the school by encouraging my child in the completion of any homework or assignments.”
  • “I agree that, if our child should become involved in any trouble at school, or we disagree with any policy set by the school, we will not complain to others, but in the love of Christ and with prayer, we will register complaints with the teacher or principal.”
  • “I understand that my child is expected to take part in school activities and sponsored trips away from the educational facility. I hereby absolve the school from liability to me or my child because of injury to my child at properly supervised school activities.”
  • “I hereby assume my Scriptural responsibility for financial support and prayer of the school.”
    “I understand that assessments will be made at the discretion of the school personnel to cover damage to school property caused by my child.”
I have read and agree to support the statement of faith of Canon Christian Academy and its position paper on human sexuality.
 *
Required
Father's and / or Mother's Signature *
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