Student 1 *

First Name

Last Name

Student 1 Birthday Date *

MM

DD

YYYY

Student 2

First Name

Last Name

Student 2 Birthday Date

MM

DD

YYYY

Student 3

First Name

Last Name

Student 3 Birthday Date

MM

DD

YYYY

Student 4

First Name

Last Name

Student 4 Birthday Date

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father's Name *

First Name

Last Name

Father's Phone Number

(###)

###

####

Mother's Name *

First Name

Last Name

Mother's Phone Number *

(###)

###

####

Do you agree to have your child taught in accordance with CCCA's Statement of Faith? *

I Agree

I Disagree

We have read and understand the Statement of Faith representing that we believe in and agree to the applicant(s) being educated based on the Statement of Faith *

I Agree

We have read and understand the Christian Living Statement *

I Agree

We have read and fully support the Family Handbook *

I Agree

We have carefully considered participation and partnership of our child(ten) in CCCA *

I Agree

We understand that admission is solely at the discretions of those who operate CCCA and such admission may be terminated at any time *

I Agree

Due to limited resources and for the good of all enrolled students, we cannot guarantee individualized accommodations for students with learning difficulties of disabilities, significant physical disabilities, severe medical diagnoses, and/or potentially life-threatening allergies/dietary restrictions. *

— Academic Testing — Board Interview — Request for Personal References

I understand