Grove City Christian Academy - Enrollment Application

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Below you will find our enrollment application, which you may print out and send to our school office. You may also download a pdf version of the application by clicking on the link below.

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Enrollment Application

Date: ___________

Year:____________

Student’s Full Name: _____________________________________________________

(Last) (First) (Middle)

Date of Birth: ___________ Age:________ Sex: M / F

Grade of Entry:___________ (1 - 8)

Select Preference- All classes are AM unless you are informed otherwise.

5-day Kindergarten AM ___ PM_____

(It is recommended that children be 5 years old by September 1^st before starting Kindergarten)

2-day Preschool/ 3 year olds (T/Th) ___

3-day Pre-Kindergarten (M/W/F) ___

Family Information:

Father

First Name: ______________________________

Last Name: ________________________________

Education: ___ High School ___College ___Postgraduate

Occupation: ______________________________

Employer: ______________________________

Employer’s Phone: (___)_________

Mother

First Name: ______________________________

Last Name: ___________________

Education: ___ High School ___ College ___Postgraduate

Occupation: ______________________________

Employer: ______________________________

Employer’s Phone: (___)_________

Home Address:____________________________

School District: ____________________________

Home Phone: (___)________________________

Cell Phone: (___)_______________

Email Address:___________________________________

Parents are: Married _____ Separated _____ Divorced ____ Widowed ___ Never Married ___

Student lives with: Both Parents _____ Father _____ Mother_____

Guardian______

Guardian (if not father or mother):

First Name: ____________________________

Last Name: ___________________

Relationship: ______________________________________

Education: High School ____ College _____Postgraduate______

Occupation: ___________________________

Employer: _____________________________

Employer’s Phone: (___)_________

Home Address: ___________________________

School District: ________________

Home Phone: (___)_______________________

Other Family Information:

Siblings of Applicant Age Enrolled in GCCA?

__________________________ ____ ________________

**Have you been interviewed at GCCA before?___yes ___no

**Approximate date?_______________

Emergency Contact:

In case of emergency or illness, whom should be contacted? Please list at least two individuals.

Name Phone Relationship to Family

_______________ (___)__________ __________________

Church Information:

What church do you attend? ________________________________________________

Are you a member? _________

Do you attend regularly with your children? ________

Minister’s name: _______________________________

Phone: (___)______________

Please give a brief testimony of your personal faith in Jesus Christ.

Father:_________________________________________________________________

________________________________________________________________________

Mother:__________________________________________________________________

________________________________________________________________________

Student Information: (Please complete this student information page for each child applying to GCCA.)

Schools Attended:

List in order (most recent first) the schools which the student has attended.

Grade School School District

_________ ________________________ _______________________

_________ ________________________ ____________________

_________ ________________________ _______________________

_________ ________________________ ____________________

Has the student ever been retained? ___Yes ___No

If "yes," please state the reason and the grade in which the student was retained.

________________________________________________________________________

How many days of school did your child miss last year?_________________

[If applicable, please submit a copy of your child's last report card with this application.]

Medical Information:

Family Physician: __________________________

Phone: (___)___________________

Is your child generally in good health? ________________________________________

Allergies: _______________________________________________________________

Medication: _____________________________________________________________

Medical Conditions:

Does your child have any handicaps (speech problems, loss of limb, etc.) or physical conditions (asthma, diabetes, epilepsy, etc.)

that the school should know about? ____________________________________________________________

If "yes," please state the condition, any activities the child cannot or should not do, and what should be done in an emergency. _______________________________________________________________________

________________________________________________________________________

Special Interests:

Is there anything you can tell us about your child that would help us know him/her better?__________________________________________________________________

________________________________________________________________________

Why do you want your child to attend Grove City Christian Academy? How do you hope it will benefit him/her?___________________________________________________________

________________________________________________________________________

Marketing Information:

How did you learn about Grove City Christian Academy? (Please check all that apply.)

___ GCCA Family (Name)_______________________________

___ Friend ___ Relative ___ Yellow Page ____Ad ___ Church ___ Other ______________________________________________________________

Signatures:

I will agree to the grade placement Grove City Christian Academy determines is best for my child.

I agree with and will support the discipline policies of Grove City Christian Academy.

I agree to abide by all other Grove City Christian Academy policies as outlined in the Handbook and to be faithful to all of my obligations.

I agree to commit myself to and be supportive of the Christian educational philosophy and mission of Grove City Christian Academy.

Signature of parents or guardians: (Both must sign, if applicable)

_______________________________

______________________________

Please submit this application and a $40 registration fee (non-refundable) per student to:

Grove City Christian Academy

301 N. Madison Avenue

Grove City, PA 16127