Student's Full Name *

First Name

Last Name

Student's Date of Birth *

MM

DD

YYYY

Student's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's Gender *

Male

Female

Father or Guardian's Name *

First Name

Last Name

Father or Guardian's Phone Number *

(###)

###

####

Mother or Guardian's Name *

First Name

Last Name

Mother or Guardian's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother or Guardian's Phone Number *

(###)

###

####

Has your student ever been evaluated with a formal educational or psychological battery of testing? (Please provide copies of all test reports/results with this application) *

Yes

No

Does your student have an individualized educational plan (IEP)? *

Yes

No

Do you suspect or have you identified that your student may have a. Learning disability? *

Yes

No

Other (please explain below)

Does your student have any allergies or physical limitations? *

Yes

No

Is your student seeing any medical professionals on a regular basis? *

Yes

No

Is your family involved in a local church? *

Yes

No

Did you read CHA’s Statement of Faith? *

Yes

No

I acknowledge that I have read and understand the school's statement of faith. I understand that CHA will be providing a Christ-centered education for my student and that the Bible, gospel story, and biblical principles as laid out in the Statement of Faith will be taught, referenced, and discussed daily. I also understand that these Biblical principles will impact the curriculum choice and ways of teaching. I agree to discuss any questions, concerns, or disagreements directly with CHA leadership concerning these issues prior to enrollment and throughout my student’s years at CHA. *

Yes

No

I have read and understand the student code of conduct. I agree to abide by these standards and understand that failing to meet these requirements will result in parent teacher conferences, warnings, and, in necessary circumstances, removal of your student from CHA. *

Yes

No