Restoration Christian Academy  Registration Form 
Application must be filled out completely before it can be processed. Application,  An interview with the parents and student will be required before final acceptance.
Email *
*
Address City, State, Zip 
 *
Age  *
Sex *
Required
Birthdate  *
MM
/
DD
/
YYYY
School Last Attended (Please include the Address and ) *
What is the last grade the child completed? *
Fathers Name 
Employment 
Position
Cell Phone 
Email Address 
Emergency number other than the one listed 
 *
Mothers Name 
Employment
Position 
Cell Phone 
Email Address
Emergency number other than the one listed 

 *
Church Attending 
Address 
Pastor 

 *
Is the child's Father a Christian  *
Is the child's Mother a Christian 
 *
Has the Child ever made a profession of Faith in Christ? *
Family Physician 
Phone Number

 *
Does the Child have any physical disabilities or allergies? *
If you answered yes to previous question please explain. *
Has student ever been expelled, dismissed, suspended, or refused admission to another school? *
If you answered yes to previous question please explain.
 *
Has student ever had disciplinary difficulty at school?
 *
If you answered yes to previous question please explain.
 *
Does student have a juvenile or arrest record?
 *
If you answered yes to previous question please explain.
 *
Has student ever used tobacco or nonprescription drugs of any kind?
 *
If you answered yes to previous question please explain.
 *
Please indicate academic level of student’s previous work:
 *
Has student ever failed an academic subject in school? *
If you answered yes to previous question please explain.
 *
How did you hear about this school?
 *
Reason for selection of this school:
 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms