Re-Enrollment Priority enrollment is given to all families who are currently enrolled at Providence. Please register by Friday, April 8th to reserve your seat for the 2022-2023 school year. Providence Classical Academy Re-Enrollment Form Re-Enrollment Step 1 of 14 7% Name of Student* First Middle Last Name student should go by and learn to spell in the classroom:* Gender*MaleFemaleBirth Date* Grade Level Fall 2022*Jr. KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeProgram:* 3-Day Junior Kindergarten 5-Day Junior Kindergarten - 5th Grade (Elementary) 6th - 8th Grade (Middle School) Friday Enrichment Program (Homeschool) First ParentParent Name* First Last Marital Status of Parent*MarriedDivorcedSeparatedNever MarriedStudent lives with:*Both ParentsMotherFatherOther GuardianRelationship to Student* Has your home address changed since last school year?* Yes No Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Has your email address or phone number changed since last school year?* Yes No Email Address Home PhoneCell PhoneHas your employment information changed since last school year?* Yes No Occupation Employer Work Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work PhoneWork Email Billing Party* Yes No Is there another parent/guardian?* Yes No Second ParentParent Name* First Last Marital Status of Parent*MarriedDivorcedSeparatedNever MarriedRelationship to Student* Has your home address changed since last school year?* Yes No Home Address Same as previous Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Has your email address or phone number changed since last school year?* Yes No Email Address Home PhoneCell PhoneOccupation* Has your employment information changed since last school year?* Yes No Employer Work Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work PhoneWork Email Billing Party* Yes No Church InformationHas your church information changed since last school year?* Yes No Home Church Are you a member of this church? Yes No How long have you been a member? Pastor's Name First Last Pastor's Email Pastor's PhoneChurch Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do both parents have the same home church?* Yes No 2nd Church InformationHome Church* Are you a member of this church?* Yes No How long have you been a member?* Pastor's Name* First Last Pastor's Email* Pastor's Phone*Church Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code AcademicsWhat are your child's special interests, abilities, and academic strengths?* SpiritualWhat is your child's relationship to Jesus Christ?* ConcernsDo you have any concerns regarding your child's current progress (academic, relational, health, behavior, etc)?* Yes No If yes, please explain. Learning ChallengesHas your child ever been tested or has anyone recommended that your student be tested for learning disabilities?* Yes No If yes, please explain.Has your child ever repeated a grade or received any special tutoring?* Yes No If yes, please explain. HealthDoes your child (or has your child) taken prescribed medication for physical and/or behavioral/emotional issues such as ADHD, depression, asthma, allergies, migraines, etc? Please list and explain.* Strengths/WeaknessesPlease list the strengths and weaknesses that you see in your child's moral character.* Would you be interested in volunteering in your child's classroom?* Yes No Maybe Are you interested in before or after school day-care for your child?* Yes No Please list any other information which you feel would be helpful to the Board of Directors. Theological AgreementClick on the link below to read the Apostle's Creed and Statement of Faith: View Apostle's Creed and Statement of Faith Mother: Do you agree entirely with the Apostle's Creed and Statement of Faith?* Yes No Father: Do you agree entirely with the Apostle's Creed and Statement of Faith?* Yes No Section BreakWe certify that this application is correct. We understand that the parents and the child will be interviewed by the School Board prior to enrollment. We have read and agree with the mission and purpose statement of the school and have a basic understanding of the classical teaching method. We agree to cooperate with all the written policies of Providence Classical Academy. This is most important in the area of discipline, schoolwork standards, dress code policies as well as active communication with the respective teacher(s) and administration. We understand that Providence Classical Academy is a startup and cannot guarantee that my child’s class will be offered in Fall of 2022 unless certain enrollment numbers are met. We agree to be completely involved in the education of our children. We also understand that we must attend all scheduled Parent Meetings.Do you agree with the terms listed above?* Yes No NameThis field is for validation purposes and should be left unchanged.