Application for Admission

APPLICATION FOR ADMISSION

I. FAMILY INFORMATION:

Father's Name*

Answer Required

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Marital Status*

Answer Required

Married

Separated

Divorced

Single

Home phone no.

Number Required

Mobile phone:

Number Required

Occupation

Answer Required

Email address*

Answer Required

Personally accepted Jesus Christ as Savior?*

Answer Required

Yes

Mother's Name*

Answer Required

Occupation

Answer Required

Mobile phone

Answer Required

Work Phone

Number Required

E-mail address*

Answer Required

Marital Status*

Answer Required

Married

Divorced

Separated

Single

Personally accepted Jesus Christ as Savior?*

Answer Required

Yes

II. Student Information

Student Full Name*

Answer Required

Entering Grade*

Answer Required

Sex*

Answer Required

Date of Birth*

Answer Required

School last attended*

Answer Required

Has this student ever been dismissed, suspended, or expelled from any school?*

Answer Required

Student Full Name

Answer Required

Entering grade

Answer Required

Sex

Answer Required

Date of birth

Answer Required

School last attended

Answer Required

Has this student ever been dismissed, suspended, or expelled from any school?

Answer Required

Student Full Name

Answer Required

Entering Grade

Answer Required

Sex

Answer Required

Date of birth

Answer Required

School last attended

Answer Required

Has this student ever been dismissed, suspended, or expelled from any school?

Answer Required

Please state why you desire to enroll your child(ren) in Canaan Christian Academy:*

Answer Required

Please describe any unusual factors that are present in the life of the student(s). (i.e. prolonged illness, serious injury, absence of father or mother)*

Answer Required

III. Church Information

Name of Home Church *

Answer Required

Name of Pastor*

Answer Required

Phone number or e-mail*

Answer Required

Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Does your family attend the church regularly?*

Answer Required

Which of the following are members of this church?*

Answer Required

Father

Mother

Student applicant

None

Canaan Christian Academy admits students of any race, color, national, and ethnic origin to all the rights, privileges, program, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational policies, admissions, policies, scholarship programs, and athletic and other school-administered programs.

Please note: Applications cannot be processed until the $50 application fee per student has been paid in full and all references are in.

IV. PAYMENT OPTIONS

Application fee by credit card

Answer Required

$50.00 - 1 student

$100.00 - 2 students

$150.00 - 3 students

$200.00 - 4 students

I would prefer to pay my application fee by the following:

Answer Required

Cash

Check

OFFICE USE ONLY:

Please fix the highlighted areas below before submitting.

Application for Admission

I. FAMILY INFORMATION:

II. Student Information

III. Church Information

Please note: Applications cannot be processed until the $50 application fee per student has been paid in full and all references are in.

IV. PAYMENT OPTIONS