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Application for Enrollment

I affirm that the information below is complete, true, and accurate to the best of my abilities.

STUDENT INFORMATION:

Children of School Age Not Applying to Genesis Christian Academy

MEDICAL INFORMATION:

If YES, please list.

If not, or if the child is entering Kindergarten or the 7th Grade this form is required by law and can be obtained from the child's doctor.

RELIGIOUS INFORMATION:

Church Affiliation

Pastor's Name

Pastor's Phone

If YES, when?

SCHOLASTIC INFORMATION:

If YES, explain:

If YES, explain:

If YES, explain:

If YES, explain:

If YES, explain:

If YES, explain:

If YES, explain:

If Child has some sort of learning problem, what has been done in the classroom to help with the problem? Please explain:

GENERAL INFORMATION:

How did you hear about Genesis Christian Academy?

Reason for selecting Genesis Christian Academy

Reason for withdrawing from previous school

If the applicant has had discipline or drug related problems in previous schools and the behavior shows no evidence of being corrected, the applicant cannot be accepted for enrollment. Evidence of drug usage while enrolled at Genesis Christian Academy will be grounds for immediate dismissal.

The application must be filled out completely before it can be processed. An interview with the parent(s) and the child will be required before final acceptance.

I have read all the information materials, and I agree to insist that my child submit to it's program academic and disciplinary regulations, and all other requirements instituted by the administration and carried out by the principal and faculty. Also, all information on this application is complete and accurate.

Florida ELECTRONIC SIGNATURES (ss. 668.001-668.006)

Signature of Father or Guardian

Signature of Mother or Guardian

Upon SUBMIT
DO NOT hit your back button and please WAIT for the success message!

Thank you for applying to Genesis Christian Academy! We will contact you as soon as possible.

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