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Being God's People...
Becoming God's People...
Building Up God's People...
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2018-2019 Registration Form
The maximum number of form submissions has been reached. This form is currently not available.
The student(s) your are registering live with
Select One
None
Father
Stepfather
Other
First Name
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Middle Name
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Last Name
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Select One
None
Mother
Stepmother
Other
First Name
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Middle Name
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Maiden Name
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Last Name
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Street Address
REQUIRED
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City
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State
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Zip
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Please enter a zip code.
Email
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Please enter an email address.
Home Phone Number
REQUIRED
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Please enter a phone number.
Father's Work Phone Number
Please enter a phone number.
Father's Cell Phone Number
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Mother's Work Phone Number
Please enter a phone number.
Mother's Cell Phone Number
Please enter a phone number.
Father's Religion
REQUIRED
Please fill out this field.
Please enter valid data.
Mother's Religion
REQUIRED
Please fill out this field.
Please enter valid data.
If students are not living with both mother and father, please complete this section.
Father - check all that apply
Deceased
Separated
Divorced
Remarried
Please list date of each event
Mother - check all that apply
Deceased
Separated
Divorced
Remarried
Please list date of each event
Child 1
First Name
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Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
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Please enter valid data.
Birth Date
REQUIRED
Please fill out this field.
Please enter valid data.
Gender
REQUIRED
Male
Female
Please fill out this field.
Grade for the 2018-2019 School Year
REQUIRED
(Select One)
Preschool - must be born BEFORE 9/1/14
Kindergarten - must be born BEFORE 9/1/13
1
2
3
4
5
6
7
8
Please fill out this field.
Name of school
Please enter valid data.
Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.?
REQUIRED
Yes
No
Please fill out this field.
If yes, explain below (please list any special services your child is receiving from their school or through private counseling).
Please do not use just initials in describing any difficulties
. List any medications they may be taking for these difficulties.
Please be assured this information will be kept confidential.
Class Time
None
Wednesdays 4:00-5:40 PM - Preschool-Grade 6
Saturdays 9:00-10:40 AM - Preschool-Grade 6
Sundays 7:20-9:00 PM - Grades 7&8 Only
Child 2
First Name
Please enter valid data.
Last Name
Please enter valid data.
Birth Date
Please enter valid data.
Gender
Male
Female
Grade for the 2018-2019 School Year
None
Preschool - must be born BEFORE 9/1/14
Kindergarten - must be born BEFORE 9/1/13
1
2
3
4
5
6
7
8
Name of school
Please enter valid data.
Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.?
Yes
No
If yes, explain below (please list any special services your child is receiving from their school or through private counseling).
Please do not use just initials in describing any difficulties
. List any medications they may be taking for these difficulties.
Please be assured this information will be kept confidential.
Class Time
None
Wednesdays 4:00-5:40 PM - Preschool-Grade 6
Saturdays 9:00-10:40 AM - Preschool-Grade 6
Sundays 7:20-9:00 PM - Grades 7&8 Only
Child 3
First Name
Please enter valid data.
Last Name
Please enter valid data.
Birth Date
Please enter valid data.
Gender
Male
Female
Grade for the 2018-2019 School Year
None
Preschool - must be born BEFORE 9/1/14
Kindergarten - must be born BEFORE 9/1/13
1
2
3
4
5
6
7
8
Name of school
Please enter valid data.
Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.?
Yes
No
If yes, explain below (please list any special services your child is receiving from their school or through private counseling).
Please do not use just initials in describing any difficulties
. List any medications they may be taking for these difficulties.
Please be assured this information will be kept confidential.
Class Time
None
Wednesdays 4:00-5:40 PM - Preschool-Grade 6
Saturdays 9:00-10:40 AM - Preschool-Grade 6
Sundays 7:20-9:00 PM - Grades 7&8 Only
Child 4
First Name
Please enter valid data.
Last Name
Please enter valid data.
Birth Date
Please enter valid data.
Gender
Male
Female
Grade for the 2018-2019 School Year
None
Preschool - must be born BEFORE 9/1/14
Kindergarten - must be born BEFORE 9/1/13
1
2
3
4
5
6
7
8
Name of school
Please enter valid data.
Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.?
Yes
No
If yes, explain below (please list any special services your child is receiving from their school or through private counseling).
Please do not use just initials in describing any difficulties
. List any medications they may be taking for these difficulties.
Please be assured this information will be kept confidential.
Class Time
None
Wednesdays 4:00-5:40 PM - Preschool-Grade 6
Saturdays 9:00-10:40 AM - Preschool-Grade 6
Sundays 7:20-9:00 PM - Grades 7&8 Only
Child 5
First Name
Please enter valid data.
Last Name
Please enter valid data.
Birth Date
Please enter valid data.
Gender
Male
Female
Grade for the 2018-2019 School Year
None
Preschool - must be born BEFORE 9/1/14
Kindergarten - must be born BEFORE 9/1/13
1
2
3
4
5
6
7
8
Name of school
Please enter valid data.
Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.?
Yes
No
If yes, explain below (please list any special services your child is receiving from their school or through private counseling).
Please do not use just initials in describing any difficulties
. List any medications they may be taking for these difficulties.
Please be assured this information will be kept confidential.
Class Time
None
Wednesdays 4:00-5:40 PM - Preschool-Grade 6
Saturdays 9:00-10:40 AM - Preschool-Grade 6
Sundays 7:20-9:00 PM - Grades 7&8 Only
Submit