Student Enrollment Application Student Registration Form To register for the school year please complete all fields. Student Name* First NameMiddle NameLast Name Date of Birth* -Month -DayYear Student Social Security Number* Name of Previous School Entering Grade* Student Ethnicity Male/Female?* MaleFemale Student lives with Name Relationship to Student Person Responsible for Tuition Please enter full name and phone number. Student Address* Street Address Apartment/Unit (if applicable) City Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Back Next Parent/Guardian Information Guardian/Mother's Name First NameLast Name Mobile/Main* Work Address if different from student Email example@example.com Guardian/Father's Name First NameLast Name Mobile/Main Work Address if different from student Email example@example.com List two adults who are authorized to pick up your child(ren). Please enter their name, number, and relationship to student. PHOTO/VIDEO WAIVER By signing on the line below, I grant The Way Christian Academy (TWCA) permission to photograph/record my child for school and marketing related puorposes only. Date of Signature* -Month -DayYearDate Signature* SUBMITSUBMIT Should be Empty:
