Re-Enrollment

Name of Student*
First Middle Last
Name student should go by and learn to spell in the classroom:*
Gender*
Birth Date*
Grade Level Fall 2022*
Program:*
- 3-Day Junior Kindergarten
- 5-Day Junior Kindergarten - 5th Grade (Elementary)
- 6th - 8th Grade (Middle School)
- Friday Enrichment Program (Homeschool)

Second Parent
Parent Name*
First Last
Marital Status of Parent*
Relationship to Student*
Has your home address changed since last school year?*
- Yes
- No
Home Address
Same as previous

Street Address Address Line 2 City State ZIP Code
Has your email address or phone number changed since last school year?*
- Yes
- No
Email Address
Home Phone
Cell Phone
Occupation*
Has your employment information changed since last school year?*
- Yes
- No
Employer
Work Address
Street Address Address Line 2 City State ZIP Code
Work Phone
Work Email
Billing Party*
- Yes
- No

Church Information
Has 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 Phone
Church Address
Street Address Address Line 2 City State ZIP Code
Do both parents have the same home church?*
- Yes
- No

2nd Church Information
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 Phone*
Church Address*
Street Address Address Line 2 City State ZIP Code

Academics
What are your child's special interests, abilities, and academic strengths?*

Spiritual
What is your child's relationship to Jesus Christ?*

Concerns
Do you have any concerns regarding your child's current progress (academic, relational, health, behavior, etc)?*
- Yes
- No
If yes, please explain.

Learning Challenges
Has 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.

Health
Does 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/Weaknesses
Please 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 Agreement
Click 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 Break
We 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
Name
This field is for validation purposes and should be left unchanged.

Providence Classical Academy Re-Enrollment Form

Re-Enrollment

Step 1 of 14

First Parent

Second Parent

Church Information

2nd Church Information

Academics

Spiritual

Concerns

Learning Challenges

Health

Strengths/Weaknesses

Theological Agreement

Section Break

About Us

Information

Academics

Admissions

Contact

Re-Enrollment

Providence Classical Academy Re-Enrollment Form

Re-Enrollment

Step 1 of 14

First Parent

Second Parent

Church Information

2nd Church Information

Academics

Spiritual

Concerns

Learning Challenges

Health

Strengths/Weaknesses

Theological Agreement

Section Break

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About Us

Information

Academics

Admissions

Contact

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