Student Enrollment

And

Re-Enrollment Form

Print neatly.  All fields must be completed.  Include payment with enrollment.

 

Todayís Date

Date Classes Begin

Grade in which student is enrolling

 

 

 

Studentís Full Legal Name Ė Last, First, Middle

Studentís Nickname, if applicable

 

 

Studentís Physical Address (no PO Boxes)

Studentís Mailing Address, if different

 

 

Studentís Date of Birth

Place of Birth: City, State, Country

Studentís Sex

Studentís Race*

 

 

 

 

 

Studentís Home Telephone Number

Parentís Email Address

 

 

Motherís Legal Name Ė Last, First, Middle

Fatherís Legal Name Ė Last, First, Middle

 

 

Motherís Address, if different from student

Fatherís Address, if different from student

 

 

Motherís Daytime Telephone Number

Fatherís Daytime Telephone Number

 

 

Church Name, if applicable

Church Address, if applicable

 

 

Name of Last School Attended, if applicable

Address of Last School Attended, if applicable

 

 

Last Grade Completed at Above School

Date of Attendance at Above School

 

 

Circle Desired Reporting Option:

ANNUAL          BI-ANNUAL (twice a year)

Circle Desired Payment Option Ė Payment due at time of registration and should be included unless paid via Paypal. 

 

CHECK     MONEY ORDER     PAYPAL

High School Students Only:

Studentís Social Security Number

Parentís Driverís License Number Ė if paying by check

 

 

*Crossroads Christian School does not discriminate on the basis of race. 

By signing this parents have read and agree to CCS Policy/Parent Responsibility Agreement.

 

 

Parentís Signature                                                          Print Name                                                                         Date