Application Form for Student Demographics & Program Selection

Student's Name*

Student's Last name*

Your email

Gender*

What Program are you applying for?*

Workbook Program

Online program

What grade are you applying for?*

K- 5th

6th-8th

9th-12th

Specify Grade *

Indicate last grade completed *

Current Address*

City State and Zip-Code*

Date and Year of Birth*

Parent/Legal guardian's information*

Parent/Legal Guardian's Phone Number*

Parent/Legal Guardian's Email*

Immunization information

For religious reasons this child should not be immunized.

For personal conviction reasons this child should not be immunized.

Digital Signature of Parent /Legal Guardian*

If referred by an employee, please include their name , to get a waiver of $110 enrollment fee/Otherwise type NA

Any other important information/ Otherwise type NA

Please complete form with up to date information, * are very important. If you have any questions, please send an email to addmissions@godslovechristianacademy.com or call/text 470-981-8575

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