Adelfiha Christian Academy Registration Form Step 1 - Student Information Student's First Name Student's Middle Name Student's Last Name Nick Name Grade GradeJunior KindergartenSenior KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6 Sex: Sex: Male Female Does the student have any special custody? Does the student have any special custody? Yes No Please specify (e.g. mother only, father only) Date of birth (Month/Day/ Year) Place of Birth Citizenship Does the child have a Legal Guardian? (e.g. Relative or friend) Does the child have a Legal Guardian? (e.g. Relative or friend) Yes No Legal Guardians Name Legal Guardians Phone Number Street Address City Province Postal Code Phone Number Step 2 - Parent Information Mother/Guardian Name Address Occupation Employer/School Employer/School Address Marital Status Home Phone Work/School Phone Cell Phone Email Address Step 3 - Parent Information Father/Guardian Address Occupation Employer/School Employer/School Address Marital Status Home Phone Work/School Phone Cell Phone Email Address Step 4 - Education Background Contact person at last school attended Telephone Number School Attended Address Grade Years Grade Repeated: Grade Repeated: Yes No Grade Advanced: Grade Advanced: Yes No Step 5 - Personal Information Hobbies & Interests Sunday School Attendance Sunday School Attendance Regular Occasional Seldom Accepted Christ Accepted Christ Yes No Father accepted Christ Father accepted Christ Yes No Mother accepted Christ Mother accepted Christ Yes No Personal problems and needs Additional Information Special diet: Special health conditions or allergies: Step 6 - Contact/Pick Up Persons Information 1st Contact/Pick Up Phone Number 2nd Contact/Pick Up Phone Number 3rd Contact/Pick Up Phone Number 4th Contact/Pick Up Phone Number 5th Contact/Pick Up Phone Number Please type your name for Signature Date Step 7 - Billing Information Bill Payer's Full Name (Mr./Ms./Mrs./) Street Address Apt.# City Province Postal Code Day Telephone # Evening Telephone # Email Address Please type name here for signature Date Step 8 - Submit Your Application Privacy Policy |Terms of Use Privacy Policy & Terms of Use Privacy Policy & Terms of Use By clicking the "submit" button, you agree to ACA's Privacy Policy & Terms of Use Submit