Admissions

Student Information

First Name

Last Name

Gender

Date of Birth

Current Grade

Ethnicity

Address

Country

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Former/Current School Information

Additional Student Information

Address of Former School

Country

Address Line 1

Address Line 2

City

State

Zip Code

Was your child receiving special education based on an IEP?

if yes, what type of disability has your child been diagnosed?

Primary Doctor Physician's Name

Address of Primary Physician

Country

Address Line 1

Address Line 2

City

State

Zip Code

Phone of Primary Physician

Is student's immunization record up to date?

Parent Information

Mother's Full Name

Mother's Primary Contact Number

Mother's Email

Father's Full Name

Father's Primary Contact Number

Father's Email

Higher Education Completed

Employment Information of Mother

Name of Company or Organization

Phone Number of Company or Organization

Address of Company or Organization

Country

Address Line 1

Address Line 2

City

State

Zip Code

Employment Information of Father

Name of Company or Organization

Phone Number of Company or Organization

Address of Company or Organization

Country

Address Line 1

Address Line 2

City

State

Zip Code

Photo/Video Release Permission

I give my consent for Free to Worship Academy to use pictures/videos of my child

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Student Information

Additional Student Information

Parent Information

Employment Information of Mother

Employment Information of Father

Photo/Video Release Permission

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